Thursday, December 30, 2010


Consumer toolkit, online complaint filing, agent lookup: New tools for the New Year

We're rolling out new consumer tools for the new year, including an easy way to look up past violations and complaints against insurers and agents.
The insurance commissioner’s website now includes a “consumer toolkit” that offers:

• Easy-to understand information on different types of insurance.

• Online filing – and tracking – of complaints against an insurance company.

• Online filing of complaints against an insurance agent or broker.

• And a new system to look up contact information, licensing history, past violations and consumer complaints against agents or companies.

The agency also continues to expand its website and its social media presence, including a new page on Facebook.

Wednesday, December 29, 2010


Automobile Policy Exclusions

The Superior Court of Justice has re-emphasized the requirement that an insurer must take appropriate steps to bring exclusions to the insured’s attention where the effect of an exclusion will have the harsh result of denying coverage under an automobile policy.

In GMAC Lease Co. Corp v. Lombard Insurance (2007), 87 O.R. (3d) 813, at paragraph 9, the Court of Appeal held that an insurer must provide the insured with a copy of every endorsement, per section 232(3) of the Insurance Act. The fact that an insurer can provide a certificate of insurance instead of the policy does not take away the duty imposed by section 232(3).

The obligation then is to provide the policy or certificate in an improved form as well as a copy of every endorsement. Since the insurer had failed to comply with section 232(3) of the Insurance Act by failing to deliver a copy of the OPCF 28A endorsement, excluded driver, the insurer cannot rely on the exclusion.

Justice Chapnick more recently in Chen Estate v. Chung, [2010] O.J. No. 5086 (SCJ), reiterated the Ontario Court of Appeal’s decision in GMAC Lease Co. Corp. v. Lombard Insurance.

Tuesday, December 28, 2010


Job opening: Financial examiner

We're looking for a person to fill a financial examiner 3 position in our company supervision division, which is located in Seattle. Applications must be received by 5 p.m. on Friday.

The successful applicant will plan, conduct, and lead in-the-field financial examinations of insurance companies and other entities that our agency regulates. Duties include:
Examines and analyzes annual financial statements, actuarial opinions, management discussions and analyses, audited financial statements, holding company statements, quarterly financial statements, financial ratios, and other sources of information to discern financial condition, difficulties, trends, statutory compliance, accuracy, and completeness.


For more details, please see the job announcement.

Monday, December 27, 2010


Stranded traveler? Here are some things to check

The weather on the East Coast has clearly scrambled plans for a lot of travelers this holiday; here are some tips that might help as you sort out your plans for getting home.

If you're wondering what your rights are, do an online search for the name of your airline and the words "contract of carriage." (Here, for example, is a summary of United's.) This is your contract with the carrier. If you feel they're violating it, you can file a complaint here. The bad news: Travel experts say that airlines generally aren't obligated to provide meals or a hotel if the problem is weather-related.

Also, if you used a credit card to buy the ticket, check with your credit card company. Cards come with a variety of perks, and you may have trip coverage without knowing it. Mastercard, for example, offers many cardholders reimbursement for lost or delayed baggage and trip cancellation insurance, as long as the tickets were paid for with an eligible MasterCard card.

For general information on travel insurance, see our page on this topic, which spells out the types of coverage and what they mean, in plain language. We're not trying to sell you anything; we're the state agency that regulates insurance in Washington state.

Lastly, here's the list of toll-free numbers for airlines.

Good luck.

Tool to compare insurance companies by the number of complaints

One of the most-used features of our website is our "Complaint Comparison Tool," a free and simple online tool that lets you compare the number of complaints filed by consumers against different insurance companies.

The information's broken down by year and by type of insurance (health, life, homeowners, auto, etc.). It also compares the number of complaints to an insurer's market share, which makes for easy apples-to-apples comparisons with other companies.

Take a look. We've posted 5 years' worth of data, and should be posting more soon.

Wednesday, December 22, 2010


Job opening: Chief market analyst

Our office is looking for a chief market analyst to fill an opening at our Tumwater office.

The person will manage staff performing market analysis, and help ensure that companies are acting within the scope of their license and are complying with laws and regulations.

Here's the job listing, which has much more detail about qualifications, salary, etc.

The critical part: Applications are due by 5 p.m. on Dec. 31, 2010.

Also, here's a handy online tool from careers.wa.gov that can e-mail you information about any job openings at state agencies, universities, etc.

Statutory Third Party

Ahmed v. Maharaj, [2010] O.J. No. 4922 (S.C.J.)

Here's a decision that might be useful to counsel for a Statutory Third Party. There were two issues in this motion:

1. Whether the Statutory Third Party is entitled to pursue a crossclaim against one of the co-defendants; and
2. Whether the Statutory Third Party could be compelled to answer questions on examination for discovery about why it denied coverage.

Justice Stewart held as follows:

1. The Statutory Third Party is entitled to bring a crossclaim, since the Insurance Act does not expressly limit it to the right to file a Statement of Defence;
2. The Statutory Third Party is not required to answer questions about why coverage was denied. Generally issues of coverage and issues of liability are to be kept separate. A plaintiff who wishes to challenge a denial of coverage may do so following judgment pursuant to s. 258(1) of the Insurance Act but until that happens, issues of coverage are generally not relevant.

Tuesday, December 21, 2010


We're expanding our social media presence

As a small agency with a broad consumer-protection mission, one of our hardest jobs is simply getting the word out to consumers that we can help them. Increasingly, we're turning to social media tools to help spread the word.

In the summer of 2009, we launched this blog, which is getting thousands of visitors a month. Shortly thereafter, we set up a Twitter feed, which we believe is now the second-largest among state insurance departments nationwide. From what we can tell, the blog tends to attract consumers Googling around for information. Our Twitter followers tend to be industry folks: agents, brokers and insurers.

Now we've launched an agency Facebook page. We're hardly the first Washington state agency to do so (Here's the list, put together by the good people at access.wa.gov), but surprisingly few insurance departments are using this tool. We'll see how it goes.

Monday, December 20, 2010


Where to look if you can't afford health coverage

We've put together a list of resources, suggestions and alternatives for folks who cannot find affordable health coverage. Our "can't afford health care coverage" page includes links and information about:
  • community clinics and local free clinics,
  • state-offered health coverage,
  • free cancer screenings
  • hospital charity care
  • dental exams and treatment
  • and specific programs for certain diseases or disabilities.

Friday, December 17, 2010


High wind warning for eastern Puget Sound

The National Weather Service is forecasting gusts of up to 60 miles per hour tonight and Saturday in the east Puget Sound lowlands, which includes Bellevue, Gold Bar, Enumclaw, North Bend and Buckley. The good news is that those are the gusts; the wind will generally be 20-30 miles per hour in the area.

Wet soil and high winds often mean tree damage, so here's our ever-popular winter storm guide, with common questions about insurance and storm damage.

Insurance survey ranks Olympia as the safest mid-sized U.S. city in America; a dozen other Washington cities also score well

Farmers Insurance Group has released its seventh annual list of the safest cities in America.

Scoring highest among mid-sized cities: Olympia, Wash. Also doing well: Seattle/Bellevue/Everett, Bellingham, Yakima, the Tri-Cities, Spokane, Bremerton-Silverdale, Wenatchee, and Mount Vernon-Anacortes. (Some areas are grouped into single statistical areas.)

How do they decide? Here's what their press release says:
The rankings, compiled by database experts at www.bestplaces.net, took into consideration crime statistics, extreme weather, risk of natural disasters, housing depreciation, foreclosures, air quality, terrorist threats, environmental hazards, life expectancy and job loss numbers in 379 U.S. municipalities.

Case closed: Man who claimed $33k tie collection had been stolen pays the money back, pleads guilty

A Lynnwood man who claimed that thieves had repeatedly made off with his collection of more than 200 silk neckties has paid back more than $33,000 and pleaded guilty to two counts of making a false insurance claim.

Under a diversion agreement, the felony charges will be dropped from his record if he complies with the agreement.

Carlton H. Wopperer, 50,  was charged with two counts of insurance fraud in Snohomish County Superior Court in July. Last week, he paid restitution of $33,370.67 and signed the diversion agreement.


Three times in 9 years, Wopperer claimed, thieves had stolen his collection of 212 silk neckties from his vehicle. But an investigation by the state insurance commissioner's office revealed that Wopperer had returned many of those ties within minutes of buying them.

On Jan. 5, 2009, Wopperer told the Mill Creek Police Department that his vehicle had been broken into while parked at a greeting card store. He said that four plastic containers containing 212 of his silk neckties had been stolen. He said that he’d taken the ties to a quilt shop to see about having them sewn onto a quilt for display.

Wopperer purchased replacement ties from Nordstrom, Butch Blum, Barneys New York and Mario’s of Seattle, submitting the receipts to his insurer. His insurer, PEMCO Insurance, paid him $33,370 under the terms of a provision allowing for replacement cost of stolen items.

Six months later, on June 9, 2009, Wopperer reported a very similar crime. He told the Everett Police Department that his vehicle had been broken into while he was moving. The 212 replacement ties that he’d purchased following the January theft had been stolen, he said. He subsequently filed an insurance claim for approximately $35,000.

But a PEMCO adjuster, checking with the retailers, learned that most of the ties purchased in January had been returned almost immediately. PEMCO denied Wopperer’s claim and reported the case to Insurance Commissioner Mike Kreidler’s Special Investigations Unit. State investigators interviewed store employees, documented the paper trail and referred the case to the Snohomish County Prosecutor’s Office.

(The investigation also revealed that there had been a third claim. Nine years earlier, on June 19, 2000, Wopperer told the Lynnwood Police Department that his collection of 212 silk ties had been stolen from his vehicle while parked at a mall. His insurer at the time paid his $16,900 claim.)

Wednesday, December 15, 2010


Individual plan open enrollment for kids ends Dec. 15

If you want to buy an individual health plan for your child this year, or add your child to your individual plan, or if you’re an emancipated minor looking for an individual health plan, the 2010 open enrollment ends today. Kids still can get coverage through the Washington Health Insurance Pool and, if they qualify, from the Pre-existing Condition Insurance Plan.

We'll announce enrollment options for 2011 in the next few weeks.

New consumer protections under the Affordable Care Act prevent all health plans from discriminating against children because of a pre-existing condition. However, special enrollment periods are allowed. Washington state’s 2010 individual plan open-enrollment period was Nov. 1-Dec.15. During this time, children under age 19 could enroll in an individual health plan without having to take a health screen.

Insurance Commissioner Mike Kreidler created the special open enrollment period through a rule. After today, children under age 19 can get coverage through the Washington State Health Insurance Pool (WSHIP), or if they qualify, through the new Pre-existing Condition Insurance Plan (PCIP-WA). To enroll in PCIP-WA, you must have been uninsured for at least six months and have a pre-existing medical condition. There are some exceptions where parents can apply for coverage anytime in the individual market, such as the birth or adoption of a child or if a child or the parent:

■is no longer eligible for a state program.
■loses coverage due to a divorce.
■loses employer-sponsored coverage.
■moves and their plan is not available in where they live.

If you have questions about how to find health insurance or if you need help understanding your rights, call us at 1-800-562-6900 or read our health insurance page.

Settlement of Accident Benefits is Not an Admission Threshold Met in Tort

Anand v. Belanger, 2010 ONSC 2345 (CanLii)

The plaintiff was injured when she was struck by a stolen vehicle. State Farm was the plaintiff’s accident benefits provider, and was named as a tort defendant pursuant to the uninsured motorist provisions of the policy.

State Farm paid IRBs until the 104 week mark, when it terminated benefits on the basis that Ms. Anand did not suffer a complete inability to engage in any employment for which she was reasonably suited by education, training or experience. At a mediation, the parties settled past and future IRBs for $100,000. Ms. Anand signed a release that included a provision that the settlement was not an admission of liability.

At the tort trial, the plaintiff sought to preclude State Farm from alleging the plaintiff did not meet threshold on the basis that it had paid for past and future IRBs, which constituted an implicit admission.

Justice Stinson held that payment of IRBs does not amount to an admission in the tort action. The plaintiff signed a release specifically agreeing that the settlement was not an admission of liability. In addition, in its capacity as the accident benefits carrier, State Farm had contractual duties and a duty of utmost good faith in dealing with its insured, Ms. Anand. As a tort defendant, State Farm owed no such duties. Accordingly, State Farm was free to argue the plaintiff did not meet threshold.

Justice Stinson's decision is sensible, especially given the differing characteristics of accident benefits and tort. It also underscores the importance of including a paragraph in releases that settlement is not an admission of liability.

Monday, December 13, 2010


Defence "Life Care" Assessment

This entry was prepared by Alexandra Lacko, articling student.




In the case of Vanderidder v. Aviva Canada Inc., 2010 ONSC 6222, the moving party sought an order compelling the plaintiff, Vanessa Vanderidder to participate in a life care plan assessment by a certified life care planner.

The action arose out of an accident in which the plaintiff sustained an injury when a rock fragment fell from a truck, deflected from the road surface, went through her open car window and struck her in the head. The plaintiff alleged that she sustained serious injuries which caused permanent and serious disfigurement and serious impairments of important physical, mental and psychological functions. She also alleged that she continued to suffer and required treatment, and would continue to suffer from the effects of her injuries for an indefinite period of time. The plaintiff claimed damages for future health care costs as a result of the effects of the injuries on the activity of the plaintiff.

In support of Vanessa Vanderidder’s claim for future health care costs, counsel for the plaintiff served a future care cost report authored by Keith C. Hayes, Ph.D. The report was analysed by an actuary and placed a present value on the plaintiff’s future health care needs at $719,901.00.

As a result of the substantial monetary claim of the plaintiff, the moving party wished to have Vanessa participate in a life care assessment/future care cost assessment by an individual who had a Bachelor of Science in Occupational Therapy and was defined as a “practitioner” pursuant to s. 52 of the Evidence Act, R.S.O. 1990, c. E.23. The basis for the moving party’s motion for the life care assessment/future care cost assessment was prejudice.

The position of the responding party, Vanessa Vanderidder, was that the moving party had not deduced any evidence that the requested assessment was necessary to aid a health practitioner as a diagnostic tool.

Plaintiff’s counsel asked Justice Granger to recuse himself from hearing the motion on the grounds that in Kozhani v. Gelbart, [2010] O.J. No. 1348, Justice Granger ordered the plaintiff to submit to a life care assessment/future care cost assessment by an occupational therapist without a health practitioner requiring the assessment as a diagnostic tool. Plaintiff’s counsel suggested that based on Justice Granger’s earlier decision, there was a reasonable apprehension of bias and that Granger J. should recuse himself from hearing the motion. Justice Granger went through the test for bias and found that plaintiff counsel’s apprehension was an apprehension of lack of success rather than an apprehension of bias and Justice Granger did not recuse himself.

In coming to his decision on the assessment, Justice Granger underwent an analysis of the case law in the area of non-medical expert assessment. Justice Granger stated that:

It would seem to me that if Vanessa Vanderidder elects to place before the court evidence concerning her future care needs as determined by a non-health practitioner, she can hardly be heard to claim that it would be unfair to order her to submit to such an assessment by a person of the choosing of the defence.

The Court concluded that “fairness can only be achieved by ordering Vanessa Vanderidder to participate in a life care assessment by a person other than a “health practitioner” notwithstanding that there is a lack of evidence before me from a health practitioner that such an assessment is needed by a health practitioner as a “diagnostic aid.”

The plaintiff was therefore ordered to participate in a life care plan assessment by the certified life care planner and occupational therapist. The Court’s goal was to achieve fairness in the trial process in order to create a “level playing field” for trial.

Wednesday, December 8, 2010


An Interesting Twist on Beasley v. Barrand

The fallout from the Beasley v. Barrand decision continues. You may recall that in Beasley, the Court refused to permit expert evidence at trial from accident benefits assessors.

In Jeffrey v. Baker, [2010] O.J. No. 4415 (S.C.J.), the defendant sought to compel the plaintiff to attend at an orthopaedic IME. She had already attended at two IMEs with a physiatrist and psychiatrist, and the defendant had lost a motion in 2009 to compel two additional examinations.

Justice Quigley allowed the motion and ordered the plaintiff to attend the orthopaedic assessment. One of the reasons for allowing the IME was that prior to enactment of the new rule 53 the defendant would have been at liberty to call accident benefits assessors to give expert evidence at trial, but given the rule change this is no longer permitted, as made clear in Beasley. The Court was satisfied there was a real risk the defendant would be left without evidence to refute the plaintiff’s claims if the orthopaedic IME was not permitted.

Wednesday, December 1, 2010


Tort Defendant May Call SABS Assessors as Fact Witnesses

You may recall that we recently blogged on the case of Beasley v. Barrand, in which Justice Moore held that accident benefits assessors could not be called as experts to testify for the tort defendant at trial. The link is here:

http://ontarioinsurancelaw.blogspot.com/2010/10/tort-defendant-not-permitted-to-call.html

In Anand v. State Farm (unreported decision, April 23, 2010), Justice Stinson followed Justice Moore’s decision, but held that the accident benefits assessors could be called as fact witnesses. They were not permitted to testify about their conclusions or opinions, but could testify about their observations of the plaintiff.