The American Agency, Overland Park, Kansas, was formed in 1980 solely to provide insurance coverages for this particular industry. The agency created a package program for ambulance services, and it has remained a leader in providing coverages for ambulance providers in all states except Alaska, Hawaii, Massachusetts, New Jersey, New York and the District of Columbia

"Proper underwriting discipline, quality loss control and risk management have enabled us to weather many a storm in this line of business and stay the course, while competitors have come and gone," says Howard Handler, president of The American Agency. He and his partner, Kent Clements, executive vice president, consider ambulance services their "flagship" program. Clements joined the agency in 1998 after eight years of working with its carrier in the capacity of home office program manager. Moreover, Handler and Clements believe this line of business has remained profitable for them because of their emphasis on loss control. To support American's activity in this area, W.H. "Bill" Leonard recently joined the agency as senior vice president/risk management and client services. Among them, Handler, Clements and Leonard have amassed roughly 90 years of experience in the ambulance service business.

The American Agency also provides coverage for paratransit operations and hospital fleets. However, writing ambulance services is what the agency has become known for in the insurance business. "The key to writing this line of business is to understand the exposures to loss, to communicate those exposures to the client and then educate the client as to how to mitigate those losses," says Handler. "If you do these things and maintain pricing integrity, the business will be profitable. Let's face it: If you don't provide an underwriting return for the carrier, you are destined to have a short-term relationship with that carrier and, eventually, a failed program. The American Agency is proud of its 14-plus-year relationship with its A rated carrier, Empire Fire and Marine Insurance Company, a member of the Zurich Financial Services Group."

A key loss exposure in the ambulance services business, Handler says, is the driver. "Many drivers assume that, just because they put on the lights and sirens, everyone will get out of the way. That isn't so. Many times a driver of an automobile hears the siren, but doesn't know at first where the siren is coming from and therefore doesn't know which way to pull over. Automobiles today come equipped with better soundproofing, radios and air conditioners, not to mention drivers' personal cell phones. These distractions may cause the driver to not hear the siren. We educate our clients' drivers to stop for lights before entering an intersection and to make sure that they clear each lane of traffic safely, one lane at a time, before proceeding on to the next. Ambulances are large, cumbersome vehicles, and they can sustain a lot of damage as well as do a lot of damage."

Providing patient care creates a unique set of exposures, says Handler. "Here we get into the area of malpractice, a very tough line. When a patient being transported is injured, even if it's not the fault of the driver or the EMS person, sometimes the family will perceive that things were not done properly and file a lawsuit. Moreover, ambulance personnel have to deal with dicey situations, such as entering premises where there is a family dispute in progress. We tell our clients that crew members should be informed that, under these circumstances, they should wait until the police arrive before entering."

Educating clients about potential exposures is where Bill Leonard comes into the picture. "Bill is one of the most seasoned loss control persons in the business," says Handler. "Bill works with our clients individually and conducts seminars on proper protocols so that EMS people will act with due regard. That's how we keep our business profitable."