Tuesday, August 30, 2011


Free Android and iPhone apps to create home inventory for insurance

The National Association of Insurance Commissioners has launched an Android application that lets you  use your mobile device to create a home inventory to document your possessions for insurance purposes.

The free app let you easily photograph your stuff, add descriptions and serial numbers, and stores the information electronically for safekeeping. It organizes everything by room and categoy, and creates an e-mailable backup file.

There's also an improved iPhone version, which is also free.

The apps are available through iTunes and the Android Marketplace. Search "NAIC" or "Scr.APP.book" at either site to download them.

Don't have a smartphone or other mobile device? You can still be prepared. Here's a simple, printable home inventory checklist, also from the NAIC.

Monday, August 29, 2011


Insurance and college students

As students head off to college, here are some things to consider:

Health insurance:
  • Federal health care reform now means that your children, up to age 26, can stay on your health insurance plan. That's likely to be the option that provides the most medical benefits.

  • Another option is to buy an individual insurance plan for the student. 

  • Or you could consider a student health plan, typically offered by the college. Be aware that these policies tend to have limited benefits and more exclusions than traditional health insurance plans.

Renter's insurance:
  • If the student lives off-campus, consider renter's insurance. It's pretty inexpensive, and covers personal property (computers, TVs, bicycles, furniture, etc.) if it gets destroyed, damaged or stolen. It can also provide coverage if someone gets hurt where the student lives.

  • If the student lives on-campus, the parent's homeowner's policy will generally cover his or her belongings. If they have expensive electronics, though, they might need extra coverage. Talk to your agent or company.

Auto insurance:
  • If the student drives a car to college, his or her existing auto coverage typically goes with them. But check with your agent to be sure.

  • It's also a good idea to let the agent know each quarter or semester if the student maintains good grades. Many companies offer a "good student" discount.

Need help? Feel free to give us a call at 1-800-562-6900. We won't try to sell you anything; we're the state agency that regulates insurance in Washington state.

Friday, August 26, 2011


Hurricane Irene storm tracker

For those of you with family, friends, property, etc. in the Northeast, we've temporarily added a Hurricane Irene storm-tracking widget created by the National Oceanic and Atmospheric Administration. It's the little map on the right side of this blog.

(Update: With the storm now largely over (8/29), we're taking it down. You can see what it looked like here.)

Thursday, August 25, 2011


What if the Japan quake hit the Pacific Northwest?

Living in the Pacific Northwest, you can't help but ponder or speculate about the "big one" - especially when quakes hit elsewhere. Today's article in Outsideonline.com "Totally Psyched for the Full-Rip Nine" will likely keep some of us up tonight.

Not sure you can handle it? Here's your teaser: What would happen in the Pacific Northwest, minute by minute, if the Japanese earthquake hit here.

NAIC cancels summer meeting due to Hurricane Irene

Just heard from the NAIC:

The National Association of Insurance Commissioners has decided to cancel its Summer National Meeting, which was scheduled for August 29-September 1 in Philadelphia. More than 1,500 insurance regulators, industry representatives and interested parties had registered to attend the conference.


“In evaluating the potential threat of Hurricane Irene, our decision to cancel the meeting was informed by considering the safety of all attendees and members,” said Susan E. Voss, NAIC President and Iowa Insurance Commissioner. “The first priority for all state regulators is responding to disasters and we are fully committed to assisting the states affected by this disaster.”

“Many of our members and attendees had already decided to cancel travel plans due to their responsibilities for assisting consumers in disaster situations, as well as weather-related travel safety concerns,” said Therese M. (Terri) Vaughan, NAIC Chief Executive Officer. “As the storm subsides, we will re-evaluate the priorities and establish next steps for conducting business.”

Information about committee work will be updated regularly on the NAIC website at http://www.naic.org./

The NAIC Fall National Meeting is scheduled for November 3-6 in Washington, D.C.

Tuesday, August 23, 2011


Earthquake insurance 101

An earthquake rumbled across much of the East Coast today, startling folks in a region not known for quakes. So it seemed like a good time to highlight the basics of earthquake insurance. Among them:

  • A standard homeowner's or renter's policy does not, repeat not, cover earthquake damage.

  • Unlike homeowners coverage, earthquake insurance is designed to cover catastrophic damage. Deductibles of 10 percent to 25 percent of a structure's value are common.

  • Earthquake insurers often temporarily suspend sales of new coverage after a quake. They do this to limit their exposure in case of aftershocks.

For more, including tips on what to do before and during a quake, see the earthquake insurance page.

Gross Negligence Standard for Municipal Sidewalks

In Richer v. Elliot Lake [2001] ONSC the plaintiff slipped and fell on ice on a sidewalk. In accordance with s. 44(9) of the Municipal Act, the standard of care is lowered from ordinary negligence to gross negligence.



Koke J. referred to the 1927 Supreme Court of Canada decision, Holland v. City of Toronto, that defined gross negligence as “very great negligence”. Thum v. Elliot Lake [1999] O.J. No. 3158 held that the degree of negligence is context specific and listed elements to consider: 1) notice of the existence of a dangerous condition which authorities actually had or which should be imputed to them; 2) their opportunity to remedy it; 3) the state of weather immediately before the accident; and 4) the relative situation of the place where the accident occurred.



In the current case, the court found as a fact that there had been a thaw-freeze cycle, there was a sheet of ice which caused the plaintiff to fall, there was no evidence of any sand at the scene, city crews had been sent out to clear and sand the streets and sidewalks following the snow fall, and there were not any other reported complaints that evening.



Koke J. appears to have given the most weight to the plaintiff’s own testimony that he walked to work that morning and walked about ¾ of a kilometer after leaving work before falling. He stated that he didn’t have any problems walking on the sidewalks prior to the fall.



The court held that overall the plaintiff was not able to show that on the evening in question the condition on the city’s sidewalks was generally slippery or icy. There was nothing to suggest this was not an isolated incident. Koke J. went on to say that even if the court were to find the city negligent for not spreading sand on the sidewalk at that location, this would constitute negligence, not gross negligence.

Monday, August 22, 2011


Auto glass company owner ordered to pay $1.6 million in insurance fraud case

A Burien auto glass company owner has been ordered to pay more than $1.6 million in restitution to several insurance companies for an overbilling scam.

Michael Alan Perkins, 44, on Friday was ordered in King County Superior Court to pay the following:
  • State Farm Insurance: $864,640

  • Allstate Insurance Co.: $726,700

  • Metropolitan Property & Casualty Insurance Co.: $24,888

Perkins pleaded guilty July 1 to three counts of first-degree theft. He was sentenced to 9 months in jail, with 30 days of the sentence converted to 240 hours of community service.
  
Perkins is the owner of Autoglass Express Inc. and Premier Auto Glass, LLC., both run out of Perkins' Burien home. An investigation by Washington Insurance Commissioner Mike Kreidler's anti-fraud Special Investigations Unit, which spent months combing through more than 10,000 records, found more than $1.5 million in deceptive billing by Perkins' companies between September 2005 and December 2009.

In some cases, the insurers paid full price for car windows that Perkins had gotten from auto wrecking yards. One Toyota windshield billed at more than $1,000 actually cost $92. A Lexus windshield that cost $145 was billed at $1,082.

State Farm was tipped off to the scheme by Lynx Services, a third-party administrator that handles glass claims. Lynx became suspicious after a random search of their database turned up an unusually high percentage of OEM (original equipment manufacturer) glass being installed in cars worked on by Autoglass Express.

State Farm investigators began contacting policyholders, inspecting the recently-installed glass, and comparing it to the bills. State Farm turned the case over to the insurance commissioner’s Special Investigations Unit, which obtained search warrants and seized more than 50 boxes of invoices and hard drives belonging to Perkins’ companies.


For more, see the press release we issued when Perkins was charged last year.

Consumer hotline delays -- we're working on it

We are experiencing problems this morning with our toll-free insurance consumer hotline (1-800-562-6900). We believe this resulted from a power failure over the weekend that triggered network problems.

We have a temporary work-around, but callers are experiencing longer-than-usual wait times, and in some cases we cannot connect the call.

Our apologies. We're working to fix this.

Update: 11:54 a.m.: The problem -- which multiple state agencies are having this morning -- means that some of our phone numbers are not able to receive any incoming calls.

Thanks for your patience. We're working on the problem and will get it fixed as soon as we can.

Update: 3:53 p.m.: Still...working...on...it. But a number of our phone lines remain unable to receive incoming calls. If you have a complaint or question, the best thing for the time being is to email us for help or use our online forms for complaints against insurers and agents.

Update: 8:54 a.m. Tuesday: FIXED! Thanks much for your patience.

Friday, August 19, 2011


A little fun on a Friday: Macaroni insurance

OK, so this is really just a macaroni ad pretending to be an insurance commercial. (And we're not endorsing this brand, or pasta in general, or anything else, thank you very much.) But we chuckled.



(And thanks to our colleagues at the North Dakota Insurance Department, which tipped us off to this via their excellent @NDID Twitter feed.)

Wednesday, August 17, 2011


Health reform makes shopping for a health plan easier


When shopping for health insurance, most people base their decision on the plan's monthly premium. But there are a lot of additional costs to consider: How much is the deductible? What will you pay out-of-pocket for a doctor visit? How about an ER visit? Hard to know. And it's even harder to compare these costs between plans.

But help is on the way. A new regulation under health reform is forcing health insurers to use a standard form to show potential customers the true costs of each plan. You'll also get a copy of this form each time your health plan renews - showing you any changes in costs.

Aside from the plan's average premium, the new form will include cost for a primary care visit, medications, tests, surgeries and for ER visits. Also, it'll give three coverage examples so people can better understand what they'll likely pay for having a baby, receiving cancer treatment, or managing diabetes.

The new regulation is out for public comment now and takes effect on March 23, 2012. Want to weigh in?

Supreme Court comments on motions to strike

The Supreme Court recently commented on motions to strike on the basis there is no reasonable cause of action. In R. v. Imperial Tobacco Canada Ltd., 2011 SCC 42, Imperial Tobacco is a defendant in two cases in British Columbia: one where the government seeks to recover the cost of medical treatment provided to smokers, and the second a class action pertaining to class members who purchased “light” or “mild” cigarettes. Imperial Tobacco issued third party claims against the federal government, alleging negligent misrepresentation, negligent design and failure to warn. In addition, Imperial alleges Canada was a “manufacturer” or “supplier” of cigarettes.



The Supreme Court held that all of the third party claims failed to disclose a reasonable cause of action and struck them. The Court confirmed that the test remains whether the claim has no reasonable chance of success. The purpose of the test is described as follows:



[19] The power to strike out claims that have no reasonable prospect of success is a valuable housekeeping measure essential to effective and fair litigation. It unclutters the proceedings, weeding out the hopeless claims and ensuring that those that have some chance of success go on to trial.

[20] This promotes two goods — efficiency in the conduct of the litigation and correct results. Striking out claims that have no reasonable prospect of success promotes litigation efficiency, reducing time and cost. The litigants can focus on serious claims, without devoting days and sometimes weeks of evidence and argument to claims that are in any event hopeless. The same applies to judges and juries, whose attention is focused where it should be — on claims that have a reasonable chance of success. The efficiency gained by weeding out unmeritorious claims in turn contributes to better justice. The more the evidence and arguments are trained on the real issues, the more likely it is that the trial process will successfully come to grips with the parties’ respective positions on those issues and the merits of the case.

[21] Valuable as it is, the motion to strike is a tool that must be used with care. The law is not static and unchanging. Actions that yesterday were deemed hopeless may tomorrow succeed. Before Donoghue v. Stevenson, [1932] A.C. 562 (H.L.) introduced a general duty of care to one’s neighbour premised on foreseeability, few would have predicted that, absent a contractual relationship, a bottling company could be held liable for physical injury and emotional trauma resulting from a snail in a bottle of ginger beer. Before Hedley Byrne & Co. v. Heller & Partners Ltd., [1963] 2 All E.R. 575 (H.L.), a tort action for negligent misstatement would have been regarded as incapable of success. The history of our law reveals that often new developments in the law first surface on motions to strike or similar preliminary motions, like the one at issue in Donoghue v. Stevenson. Therefore, on a motion to strike, it is not determinative that the law has not yet recognized the particular claim. The court must rather ask whether, assuming the facts pleaded are true, there is a reasonable prospect that the claim will succeed. The approach must be generous and err on the side of permitting a novel but arguable claim to proceed to trial.




Imperial argued that the motion to strike should be dismissed on the basis that future evidence might reveal more evidence against the government. The Court rejected this argument; the focus is on the pleadings, not the evidence and a judge cannot consider what future evidence might or might not show.



In addition to a useful summary of the test on a motion to strike, the Court goes through the Anns duty of care analysis. The decision is a good synopsis of these important principles.

Tuesday, August 16, 2011


How to appeal when your health insurer refuses to pay for something

Few people know that when their health insurer refuses to pay for something, you can appeal that decision.
 
Fewer still know how to do it.
 
To help, we've prepared a guide to appeals, including sample templates and example letters you can send.
 
It can be a complex process, mainly because the appeal rules are different depending on what kind of plan you have. But the guide helps you figure that out. We offer tips, things to avoid, and pointers for writing a good appeal letter.
 
Key things to remember: Your health plan CANNOT drop your coverage or raise your rates because you ask them to reconsider a denial. You CAN appeal. It's your right.
 
And you can win. Even if your insurer turns you down, you can appeal to an independent third-party, which has the power to reverse a denial. Over the past three years, nearly a quarter of consumers who took their appeals to an independent review organization were successful.
 
Check it out.
 

Monday, August 15, 2011


Kreidler fines Regence $100,000 for not covering contraceptives



About a year ago we told you of how Regence BlueShield unfairly denied contraceptive coverage to nearly a 1,000 women.

Today, we fined the company $100,000 for violating state law.

Washington State Insurance Commissioner Mike Kreidler learned of the denial from a consumer who called his office to complain. Regence covered the insertion of her contraceptive of choice -the intrauterine contraceptive device (IUD) but denied her claim for the cost of it removing it.

According to Regence, removing an IUD was not "medically necessary" simply because the device was outdated or the woman wanted to become pregnant. The company was ordered to reprocess all similar 984 claims from Jan. 1, 2002-May 25, 2010, totalling $148,740.37.

In addition to the $100,000 fine, Regence also must pay 8 percent interest to the policyholders on each the claims that were improperly denied. Here's a link to our order.

So what's the lesson here? If you believe your health insurer is treating you unfairly, give us a call (1-800-562-6900) or file a complaint online. Of the 984 women who were denied coverage by Regence, only three appealed the decision -- and all the denials were upheld. One woman's call to our office resulted in coverage for nearly a thousand other women.

Percentage of uninsured motorists, by state



Each year, the Insurance Research Council, an industry group, estimates the number of uninsured drivers, by state.

The IRC estimates that in 2009 -- there's a lag time in the data -- roughly 1 out of every 7 drivers on the road has no insurance coverage. That's a slight improvement from the previous year, when the recession is believed to have led to a spike in the number of uninsured motorists.

The highest number of uninsured motorists, the group says, is in Mississippi (an astounding 28 percent), followed by New Mexico (26 percent) and a three-way tie between Tennessee, Oklahoma and Florida (all at 24 percent). Washington comes in at 16 percent, along with states like Indiana, Arkansas, Ohio and Georgia. Oregon and Idaho are among the lowest in the country, at 10 percent and 8 percent.

(Here's the full list, posted by Automotive-fleet.com.)

Friday, August 12, 2011


How to make sense of your auto insurance policy


The National Association of Insurance Commissioners has put out an excellent interactive guide to that confusing-looking "declarations page" that your auto insurer sends you.

It explains -- shortly and simply -- what the form means. (Collision? Comprehensive? Uninsured/underinsured? PIP? What?)

Check it out.

Thursday, August 11, 2011


Insurance agent charged with theft

Branko Cekarmis, a 37-year-old insurance agent from Kent, Wash., has been charged with four counts of theft for allegedly misappropriating thousands of dollars from his customers.

When Cekarmis, an Allstate agent, collected premium payments, he was supposed to deposit the checks and cash into a specific bank account managed by Allstate. The company would then apply those premiums to the customers' policies.

But 20 times between early February 2009 and late January 2010, Cekarmis either failed to deposit the money or failed to properly allocate it to the appropriate customers' policies. In some cases, he only allocated part of the payment to a policy. In others, he put the money toward a different customer's policy.

All told, he's believed to have misappropriated $7,767.

Allstate's corporate security department investigated the matter and sent the case to state Insurance Commissioner Mike Kreidler's Special Investigations Unit.

On June 3rd, the insurance commissioner's office revoked Cekarmis' insurance license. On Monday, Cekarmis was charged in King County Superior Court with four counts of second-degree theft.

Wednesday, August 10, 2011


Discoverability - Identity of Vehicle Owner

After determining vehicle ownership, is counsel required to continue looking for contrary information?

Velasco v. North York Chevrolet Oldsmobile Ltd., [2011] ONCA 522 (C.A.), involves a car accident that occurred in 2005. The appellant’s vehicle was struck by two other vehicles. The ownership of the one vehicle (the “Denyer vehicle”) is the subject of this appeal.

The appellant issued a statement of claim in 2006. Counsel relied on a statement in the police report to determine that Denyer was the owner of the Denyer vehicle. This belief was confirmed later that year by way of the pleadings delivered by Denyer’s insurer stating that Denyer was the owner of the vehicle.

Early in 2007, counsel for the appellant received a 732 page Crown Brief that contained a license plate search which showed that Denyer was not in fact the owner of the vehicle. This search did not come to the attention of counsel until two years later when preparing for discoveries. At that time, a statement of claim was issued against the respondents on the basis of their ownership.

The respondents brought a motion to dismiss the claim against them on the basis that the limitation period had expired. The motion judge held that counsel for the appellant should not have closed their minds to the ownership issue and should have reviewed the Crown Brief promptly to settle that issue.

The Court of Appeal disagreed with the motion judge and held that counsel had acted with reasonable diligence in continuing to rely on the initial information they had received “until contrary information actually came to their attention”. The court did not find a duty on counsel to positively search for contradictory information after they were satisfied as to the ownership.

Thanks to our articling student, Kristen Dearlove, for this post.

Tuesday, August 9, 2011


Life expectancy table

We recently heard from an unhappy consumer who was searching our agency website:

"Could not find the life expectancy chart. As a result, have lost all of this time and effort -- thereby reducing my life expectancy."

Happy to help: Here's the life expectancy table. (It's not a new one; it's been in effect since late 2004.)



Job opening: life and health insurance compliance analyst

We're looking for a life and health insurance compliance analyst to work in our Consumer Protection division in Tumwater, Wash.

The person will help investigate consumer complaints against insurance companies and answer consumer questions about insurance issues. The person will also be a technical expert on helping consumers appeal insurance denials, as well as on writing and formatting consumer publications for the Web.

For more details, including salary and application process, please see the job listing. Deadline is 4:59 p.m. on Aug. 19, 2011.

We're also still accepting applications for a financial examiner job, but time's running out. The deadline for applying for that job is Friday, Aug. 12 at 5 p.m.

To keep up with any job openings at our agency, please check our jobs page frequently.

Thursday, August 4, 2011


Health care reform update

Here's an update on health care reform from Barb Flye, our senior health policy advisor:


A song about insurance fraud? Really? Really.

It turns out that someone has actually written a song about, yes, insurance fraud.

A reporter for the Seattle Weekly (thanks, Jonathan) turned us on to the tune.

Wednesday, August 3, 2011


Insurance agent pleads guilty to theft for selling bogus insurance

Brenda MacLaren-Beattie, a longtime insurance agent in Des Moines, Wash., has pleaded guilty to first-degree theft for selling fake insurance to oral surgeons in two states.

Our investigation found that MacLaren-Beattie, 67, sold thousands of dollars in fake business-insurance policies, often issuing counterfeit certificates of insurance to doctors and clinics. She pleaded guilty yesterday in King County Superior Court to eight counts of first-degree theft, a felony.

From late 2001 through 2009, she 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. Her insurance license expired in 2009.

In some cases -- a lost camera, some water damage -- she paid out small insurance claims. 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. General liability insurance typically covers things like slip-and-fall accidents, employee theft, and damage to rented property.

Sentencing in King County Superior Court is expected later this month.

Leave to call nine witnesses denied

The rules of evidence allow for three expert witnesses to be called at trial. The plaintiff in Leonard v. Kline ,[2011] ONSC 2730 (S.C.J.) sought leave to call nine expert witnesses at her upcoming jury trial. The list of proposed experts included a psychiatrist, psychologist, vocational expert, vocational rehabilitation consultant, accountant/actuary and others.

The issue at the plaintiff’s upcoming trial was her earning capacity. The plaintiff sought to have each expert witness give an opinion on whether she would be able to engage in gainful employment. The plaintiff’s argument was two-fold: 1) each expert approaches the issue from a different area of expertise; and 2) the jury should know what the “weight of expert” evidence is on the issue.

The defendant argued that this would be duplicitous [sic - duplicative]. The defendant only intended to call two expert witnesses.

Ellies J. did not agree with the plaintiff’s “weight of expert evidence” argument expressing his concern with trials becoming battles of the experts. He went on to consider the eight factors listed in Burgess (Litigation Guardian of) v. Wu , [2005] O.J. No. 929. His decision focused on factor seven – the degree to which there is duplication in the proposed opinions of different experts.

Upon determining that some of the proposed expert witnesses were duplicitous [sic - duplicative]. , Ellies J. proceeded to divide them into groups based on shared opinions, whether they prepared joint reports, and whether they used similar tests upon the plaintiff in which their opinion was based. The plaintiff was then given the option to choose one expert witness from each group.

This decision seems to be a good example of the court fulfilling its "gatekeeper" role with respect to experts.

Tuesday, August 2, 2011


New guidelines expand preventive coverage for women

New guidelines issued by the federal government require health plans to cover many preventive services for women with no additional cost.
The Affordable Care Act requires health plans to include preventive services with no cost-sharing (ie. deductibles, copays, etc.). The guidelines issued yesterday describe the specific preventive services for women that apply. They include:

Well-woman visits
Screening for gestational diabetes
Human papillomavirus (HPV) DNA testing for women 30 years and older
Sexually-transmitted infection counseling
HIV screening and counseling
FDA-approved contraception methods and counseling
Breastfeeding support, supplies, and counseling
Domestic violence screening and counseling

Here's a chart showing the specific preventive service, a description of the service, and frequency (ie. whether the coverage is annual or for a specific occurrence.)