Agent pleads guilty, taken into custody

Agent pleads guilty, taken into custody

Former Washington insurance agent Jasmine Jamrus-Kassim pleaded guilty this morning to 10 counts of theft for stealing more than $1 million in retirement funds from elderly insurance clients.

Jamrus-Kassim, who had been free on bond, was immediately taken into custody.

From 2007 to late 2009, several of Jamrus-Kassim's clients cashed out large portions of their retirement accounts, apparently thinking they were re-investing the money. In reality, the money went to Jamrus-Kassim, who spent tens of thousands of dollars on a psychic hotline, clothes, jewelry and a trip to Mexico.

An investigation by the Washington insurance commissioner's Special Investigations Unit led to her arrest in March.

And Bankers Life and Casualty, one of the companies that Jamrus-Kassim worked for, agreed last month to repay the money that Jamrus-Kassim stole

Sentencing in King County Superior Court is slated for Nov. 18.
Children's open enrollment ends Monday, Oct. 31

Children's open enrollment ends Monday, Oct. 31

If you need an individual health plan for your child or want to add them to your insurance, you have until Monday, Oct. 31. After that, unless you meet certain requirements, you'll have to wait until March 15-April 30, 2012.

There are some exceptions that allow children to be enrolled anytime during the year. Parents must apply for their child within 31 days of the following events if either they or their child:
  • No longer qualify for a state program.
  • Lose coverage due to a divorce.
  • Lose employer-sponsored coverage (including COBRA).
  • Move and their plan is not available where they live.
  • Also, parents or guardians can apply year-round for individual coverage within 60 days of birth, adoption, or placement of a child for adoption.
New Minor Injury Guideline

New Minor Injury Guideline

The new Statutory Accident Benefits Schedule (SABS) came into effect September 1, 2010. Among the key amendments, there has been a reduction of medical and rehabilitation benefits from $100,000.00 to $50,000.00. In some cases, this will be further reduced to $3,500.00 under the new Minor Injury Guideline (MIG).

The MIG applies to accidents that occurred on or after September 1, 2010, and replaces the Pre Authorized Framework for Grade I and II whiplash associated disorders. Section 268.3 of the Insurance Act requires that the MIG be considered in any determination involving the interpretation of the SABS.

An insured person’s impairment comes within this Guideline if the impairment is predominantly a minor injury. “Minor injury” is defined in the new SABS as a “sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associate sequelae”. Each of these conditions are further defined to specify the severity of each to move it out of the “minor injury” category. For example, “whiplash associated disorder” is defined as “a whiplash injury that does not exhibit objective, demonstrative, definable and clinically relevant neurological signs, and does not exhibit a fracture in or dislocation of the spine”.

The objectives of the MIG are to speed access to rehabilitation for persons who sustain minor injuries in auto accidents, improve utilization of health care resources, provide certainty around cost and payment for insurers and regulated health professionals, and be more inclusive in providing immediate access to treatment without insurer approval for those persons with minor injuries.

Many accident victims may now find their benefits reduced to $3,500.00 and if they do not have a tort claim, they may have little alternative for additional medical coverage. The Financial Services Commission of Ontario expects the MIG to capture 30%-40% of accident claims.

Section 18(2) provides for an exclusion from MIG if the insured person’s health practitioner determines and provides compelling evidence that the insured person has a pre-existing medical condition that will prevent the insured person from achieving maximal recovery from the minor injury if subject to the $3,500.00 limit. This exception raises the question of what the courts will consider to be “compelling evidence”.

- Kristen Dearlove, Student-at-Law
Does insurance cover space junk crashing to earth?

Does insurance cover space junk crashing to earth?

If pieces of a satellite crash on your home or car -- or on you -- does insurance cover that?

Yes, according to the Insurance Information Institute:

"Damages caused by falling objects are generally covered under standard auto, business, homeowners, and life insurance policies..."

the industry group says. It also noted, however, that the odds of being struck by space debris are extremely low.
Municipality attempts to exert rights to shoreline road after discovering a 150 year old By-law

Municipality attempts to exert rights to shoreline road after discovering a 150 year old By-law

Meaford (Municipality) v. Grist [2011] O.J. No. 4188

This is an interesting case regarding an 1854 By-law that had been found in 2004, which purported to create a municipal/public road along the shore of Georgian Bay.

Some of the named defendants brought two summary judgment motions claiming that there are no genuine issues requiring a trial. The action is disputed by the defendants because the road would take away approximately 66 feet of their shorelines lands.

The road had not been registered on title until 2007 after the Municipality discovered the By-law.

The Municipality’s argument, among other things included the doctrine of dedication and acceptance.

Justice Daley set out the test for the common law doctrine of dedication and acceptance/ long user:

Dedication depends on the intention of the donor and also acceptance of
the road by public authority.

There are three conditions:

1. An owner of the land on which the road is situated had formed the
intention to dedicate the land to the public road or highway;

2. The intention was carried out by the road being thrown open to the
public; and

3. The road was accepted by the public.

Dedication can occur by usurpation and long enjoyment.

Where members of the public continually use the road over a long period
of time, dedication may be inferred.

Justice Daley stated that the plaintiff bears the onus “upon a preponderance of probability to demonstrate that the conditions necessary for the establishment of dedication and acceptance were all present”. He then refers to the Reed v. Town of Lincoln [1973] decision where the “cogency of the evidence required to satisfy the burden … may vary … according to the nature of the issue with respect to which the burden must be met.”

Using this ruling, he bolsters the onus requiring the municipality to “satisfy the onus by a clear and substantial preponderance of evidence that the property owners have lost the title to a portion of their property which now constitutes a public road”.

Meaford argued that the public highway existed prior to the by-law. It was held that there was no genuine issue for trial; the plaintiff had not offered any physical/documentary evidence. Even if there had been a road, the time from the initial Crown grant in 1840 to the date of the by-law in 1854, is not enough time to find a “long user”.

It was further held that there was no dedication and acceptance in modern day, for many reasons, including:

1. The municipality graded the road approximately twice a year –
otherwise had no involvement in the upkeep.

2. The municipality entered into a maintenance agreement with the
cottage owners association.

3. In 1986, part of the road had washed away and the municipality had
not restored the road. In fact, the owner of the property had a
different portion of his property, severed, re-zoned and built a
private driveway (no dispute that this “inland” driveway was a
private road).

4. The “inland” driveway was maintained pursuant to the maintenance
agreement.

5. The defendants were bona fide purchasers for value and the cottages
built on the lots comply with zoning by-laws in regards to set back
from the water’s edge and not from the disputed road.

6. There was no evidence of municipal funds or labour to build, maintain
or restore the road.

7. The municipality, in this action, was only trying to lay claim to a
very small potion of the road that the By-law purported to create.

Justice Daley held that there was no evidence of actual or implied dedication or acceptance and was held not to give rise to any issues requiring a trial.

He went further to state that the municipality had slept on their rights for over 150years and applied the doctrine of laches and acquiescence and that “quite apart from all of the other reasons expressed (in the 192 paragraphs), it would be unjust to grant Meaford’s claim”.

This post was prepared by our Associate Alison McBurney.

Is the weather really getting worse? Insurer's data suggests yes

Munich Re, a major reinsurance company, this summer released a very interesting report on natural disasters, and the data suggests that, as one newspaper columnist put it, it's not your imagination. The weather really is getting worse. Click on that link, and take a look at the chart you'll see.
Munich Re's full report is online and entitled the 2011 Half-Year Natural Catastrophe Review. There's also a 47-minute webinar on the topic posted online.
Red cars, insurance and speeding tickets

Red cars, insurance and speeding tickets

There's an urban myth out there that holds that the color of a car affects your insurance rate. The rumor is so pervasive that some insurers mention it on their corporate websites.

It's not true. In our experience, the color of a car has nothing to do with how much you pay for auto coverage. We review auto insurance rates (among many others) here in Washington state, and we can't recall ever seeing an auto insurance rate schedule that takes color into account. Insurers do often raise rates for high performance vehicles, which may be more likely to come in red, but color itself is meaningless in determining rates.

(Here are the sorts of factors insurers take into account, including things that might surprise you -- like your credit score.)

While we're on the topic, how about the widespread belief that red cars get more speeding tickets? Snopes.com, the rumor-busting website, says that doesn't seem to be true, either:

"...It does not appear that red cars get cited for speeding more often than they statistically should."

Don't get fooled by official-looking health insurance website

The federal Centers for Medicare and Medicaid Services (CMS) is warning consumers about a site that "has the appearance of being an official government website" but isn't. The website is http://preexistingconditioninsuranceplan.com/. Here's a partial screenshot:



From CMS:
This new website...is not maintained by any government programs and consumers are strongly urged not to submit any personal information requested by this website under the assumption that it is a government website.
The site includes a small disclaimer acknowledging that it's not a government-run site, but is:
"rather (a) solicitation by a licensed insurance entity/agent/broker seeking to assist and enroll individuals in the PCIP program or other insurance products."
Pre-existing Condition Insurance Plans -- PCIPs for short -- were created under federal health care reform. They're a good option for people who have a problem getting insurance due to a pre-existing medical condition. Here's our official, real website that explains more about Washington's PCIP program.

Not in Washington? Here's the official federal PCIP site.
Premera refiles rate request

Premera refiles rate request

Premera Blue Cross has refiled a rate change for its individual health plans - this time seeking a 4.7 percent increase. We disapproved it's earlier request for a 3.1 percent increase in September. We have 60 days to review the request and make a decision.

The new rate, if approved would take effect on Jan. 1, 2012 and would impact approximately 3,874 people.

You can view the entire rate filing, a summary of key date supplied by Premera and why we turned down their last request at www.insurance.wa.gov/health-rates.shtml
The Importance of Causation

The Importance of Causation

In Lancaster (Litigation Guardian of) v. Santos, [2011] O.J. No. 3706, the County of Dufferin was added as a third party in an action arising out of a MVA on November 21, 2001 involving a fully-loaded pickup truck being driven by Mr. Santos and the plaintiff’s vehicle.

The transport had tipped over when coming around a curve and slid into oncoming traffic. It was alleged that but for the County’s failure to properly sign the portion of the road in issue, Mr. Santos would have been aware of the hazardous road condition and would have reduced his speed such that he could have managed the curve.

Lemon J., found the cause of the accident, on a balance of probabilities, to be the shifting of the truck’s load as a result of it not being properly secured. Mr. Santos had testified that the signs which existed provided some warning and he reacted to it by slowing down. As a result of this testimony, the road conditions and signage were not found to be the cause.

Lemon J., went on to determine whether the County could have been liable had there been causation. The plaintiff argued that when the County breached the Manual of Uniform Traffic Control Devices (MUTCD) by not properly signing the road, it breached its duty of care.

Lemon J., stated: “while I agree that this sign did not meet the standard set by the MUTCD, and that other drivers in other circumstances might have been mislead, that was not the case for Mr. Santos…The sign as posted was doing its job”.

This case is significant in that that court confirms an obvious yet often overlooked principle – If there is a breach of the duty of care, it must have contributed to or caused the MVA. Municipalities should keep in mind that although they perhaps made a mistake at some point in time, it must be considered whether this mistake caused or contributed to the MVA.

Thanks to our articling student, Kristen Dearlove, for this post.
Insurance company not paying a life insurance claim? Here's what you can do...

Insurance company not paying a life insurance claim? Here's what you can do...

Generally, insurance companies can only deny life insurance proceeds within the first two policy years for two reasons. This is called the "contestability period." After the two years, the insurer generally cannot contest the benefits.

The two reasons are if the death of the insured:

1. Is due to suicide (this does not apply to group life policies).
2. Didn't tell the truth on the application for coverage. This is called the “contestability period.” After the two years, the insurance company cannot contest the benefits.

(Bonus round: Here's a link to our ever-popular post on "How to find old life insurance policies.")

If you’re the beneficiary of a life insurance policy and you think the insurer is wrongly denying your claim for benefits, file a complaint with our office, if you live in Washington state. (If you don't, here's a handy map showing how to contact your own state insurance regulator.) We'll look into the matter and see if we can help you resolve the problem. File a complaint online or give us a call at 1-800-562-6900.
Insurance agent who sold fake policies sentenced to more than two years in prison

Insurance agent who sold fake policies sentenced to more than two years in prison

An insurance agent who sold hundreds of thousands of dollars in fake business-insurance policies has been sentenced to more than two years in prison.

Brenda MacLaren-Beattie, 68, of Des Moines, Wash., was sentenced Thursday in King County Superior Court to 26 months in prison. She was immediately taken into custody. She was also ordered to pay back $532,659 in restitution.

“I’m very pleased that the court took this as seriously as we did,” said Insurance Commissioner Mike Kreidler. “This agent sold fictitious coverage to dozens of medical offices in Washington and Oregon, often for years. People thought they had coverage and they didn’t.”

An investigation by Kreidler’s office found that from late 2001 through 2009, MacLaren-Beattie issued fake insurance to 25 oral surgeons in Washington and 16 in Oregon. During that time, she is believed to have collected more than $532,000 in premiums for fictitious insurance policies, often issuing counterfeit certificates of insurance to doctors and clinics. Her insurance license expired in 2009. (And here's the cease-and-desist order issued at the time.)

In a few cases – a lost camera, some water damage – she paid out small insurance claims herself. One of her clients became suspicious after a claim check was issued by MacLaren-Beattie, rather than from an insurance company.

The fictitious policies were for business owners’ general liability insurance, which typically covers things like slip-and-fall accidents, employee theft, and damage to rented property.

MacLaren-Beattie pleaded guilty in August to eight counts of first-degree theft, a felony. On Thursday, she received eight 26-month sentences, which will run concurrently.
How to avoid buying a flood-damaged car

How to avoid buying a flood-damaged car

With hurricane and storm season winding down, an insurance industry organization is warning about the likelihood that flood-damaged vehicles will be sold to salvage dealers, their flood-damage history illegally hidden, and sold as normal cars in the used-car market.

An anti-fraud group, the National Insurance Crime Bureau, has created an online tool where you can look up -- for free -- a car's vehicle identification number and see if it's been declared a salvage vehicle by an insurer. (The VIN number is typically visible through the front windshield, where the windshield meets the car's hood. It's usually a long combination of numbers and letters.)

Also, the Insurance Information Institute suggests being on the lookout for several warning signs that a car may have been flooded:

 Mildew, debris and silt in places where it wouldn't normally be found, such as under the carpeting in the trunk, or around the engine compartment


 Rust on screws and other metal parts

 Waterstains or faded upholstery; discoloration of seatbelts and door panels

 Dampness in the floor and carpeting; moisture on the inside of the instrument panel

 A moldy odor or an intense smell of Lysol or deodorizer; this is a tactic frequently used by dealers to cover up an odor problem

If you suspect that your local car dealer is committing fraud by knowingly selling flooded cars as regular used cars, the III suggests contacting your insurance company, local law enforcement agency or the NICB at 800-TEL-NICB.
Court of Appeal Comments on s. 132 of the Insurance Act

Court of Appeal Comments on s. 132 of the Insurance Act

The Court of Appeal recently commented on s. 132 of the Insurance Act. Section 132 provides that a person who obtains a judgment against an insured person which has not been satisfied may recover that amount from the insured’s insurer.

In Walker v. Sovereign General Insurance Co., [2011] O.J. No. 4106 (C.A.), the Walkers obtained a judgment against Sun Shelters Industries Inc. for damages sustained in a parking lot slip and fall. Sun Shelters went bankrupt and could not pay the judgment, so the Walkers brought an action under s. 132 against Sun Shelters’ insurance company, Sovereign. Sovereign’s position was that it did not receive proper notice as required under the CGL policy and as a result was not required to defend the action or indemnify Sun Shelters or the Walkers.

The Court of Appeal held that notice of a claim can be given either by the insured or by a person on behalf of the insured. In this case, notice was given to Sovereign by a co-defendant. The Court noted that if notice is given by someone other than the insured, the person should have sufficient proximity to give adequate details of the claim:

36 Given its purpose and importance, if the notice is to be given for an insured instead of by the insured itself, the person giving it should have sufficient proximity to the claim to have knowledge of the information required by s. 3(a). Emshih was just such a person. It owned the property where the accident occurred; it was a defendant in the original action; and it cross-claimed against Sovereign's insured. In giving notice to Sovereign, Emshih was giving notice for Sun Shelters as contemplated by s. 3(a) of the policy.

Sovereign had actual notice of the claim and made a conscious decision not to defend. If the insurer had no knowledge of the claim, no opportunity to investigate or negotiate a settlement, it may be that the decision would be different.

- Tara
Scammed seniors will be repaid more than $1 million

Scammed seniors will be repaid more than $1 million

Retirees who lost more than $1 million to an unscrupulous insurance agent will be repaid, under an agreement reached between the insurance company and state Insurance Commissioner Mike Kreidler.


Bankers Life and Casualty, one of the companies that the independent agent worked for, has agreed to replace the money allegedly stolen by the agent.

An investigation by Kreidler’s office found that several of Jasmine Jamrus-Kassim’s clients repeatedly cashed out large portions of their annuities with Banker’s Life and Casualty from late 2007 to late 2009. The money was then pocketed by Kassim.

Jamrus-Kassim, of Kent, was arrested in March 2011 and charged with 21 counts of first-degree theft. Her trial is pending in King County Superior Court.

“I commend Bankers Life for stepping up and making these victims whole, to the extent possible,” said Kreidler. “I’m deeply saddened that one victim, stripped of his life’s savings, has already passed away. In his case, restitution will go to his estate.”

The victims, who ranged from age 74 to 90, typically made out their checks to “S.A. Saad” and gave them to Kassim. Several said they believed that S.A. Saad was an insurance company official. They thought their money was being reinvested.

In reality, Kassim has two daughters, both with the initials and surname “S.A. Saad.” Most of the money was deposited briefly in the girls’ accounts, then moved to Kassim’s personal credit union account. Kassim’s financial records show thousands of dollars spent on clothes, jewelry, and a trip to Mexico. They also show large payments to online psychic advisors, including $20,000 in charges from one psychic website in one month.

The victims live in Bellevue, Renton and Seattle. The payment amounts are:

• $512,112

• $488,071

• $116,070

• $65,321

• And $929

Bankers has also agreed to pay interest.
Class-action settlement covers hundreds of thousands of insurance customers

Class-action settlement covers hundreds of thousands of insurance customers

Hundreds of thousands of people who were led to expect more interest than they got from annuities are eligible for a multi-million dollar class-action settlement – if they sign up on time.

“Consumers across the country were misled, and I’m very glad to see this case finally resolved with restitution,” said Insurance Commissioner Mike Kreidler. “I urge anyone who qualifies to sign up for their share of the settlement.”

The settlement involves Northern Life Insurance Company’s marketing of tax-sheltered fixed annuities, primarily to teachers, starting in 1995. (The company, which was based in Seattle, merged with Minnesota-based Reliastar Life Insurance Co. in 2002.)

The annuity documents, Kreidler said, misrepresented to consumers the way that interest would be calculated over the life of the annuities. Instead, Northern Life paid a high interest rate only in the first year of the contract, reducing the rate during all the remaining years.

Under the settlement, Northern Life has agreed to pay $29 to $40 for each $10,000 in value of a person’s annuity. The settlement provides up to $31 million for the payments. A King County Superior Court judge recently approved the mediated settlement, in which Northern Life did not admit wrongdoing.

Northern Life has notified 406,000 account holders that they are potentially affected by the settlement. An estimated 20,000 of those people are in Washington state.

“People are naturally skeptical of mailings,” said Kreidler, “but don’t just toss this one in the trash.”
The one-page claim form, also available at http://www.curtissettlement.com/, must be mailed back on or before Oct. 17, 2011. (It can also be scanned and emailed by that date.) Under penalty of perjury, signers must certify that they owned a fixed annuity issued by Northern Life sometime between Jan. 1, 1995 and the present time.

Typical payments are likely to range from $60 to $80, although some will be significantly larger.
The claimants were represented by private attorneys in the 10-year court case, which involved more than 1 million pages of documents.

Kreidler’s office investigated the issue and filed an amicus brief in the case, saying that consumers had been substantially harmed by misleading marketing.
Turned down for life insurance? Here's what you can do...

Turned down for life insurance? Here's what you can do...

If you apply for life insurance and get rejected, it's usually due to a specific health condition. Here’s what you can do to appeal their decision:


1. Ask the insurer to tell you, in writing, what specific condition disqualified you for coverage and where they obtained that information.

2. Review their information for accuracy. If you find any discrepancies, contact the doctor and ask him or her to correct the information. If the information is accurate, discuss the condition with your doctor. If the doctor thinks the condition is not a major health risk, ask him or her if they’d be willing to write a letter on your behalf to the insurer.

Other options:

• Asking the company if they would consider issuing coverage at what's called a "rated premium."

• Applying to other companies. Just because one company doesn’t want to take on your risk doesn’t mean another one won’t. Each company determines which risk they are willing to take. (Brokers can help with this.)

• If ultimately, you don’t qualify for coverage through a standard life insurance company, consider applying for coverage through a company that offers covereage specifically for high-risk people. You’d pay more, but at least you'd have coverage.