Medical worker sentenced to year in jail, $472k in insurance fraud case

Medical worker sentenced to year in jail, $472k in insurance fraud case

Here's a press release we issued a few minutes ago:

A medical worker who pretended to be a doctor and submitted millions of dollars in bogus bills to insurance companies has been sentenced to a year in jail and $472,458 in restitution.

Kenneth R. Welling, 45, of Lake Forest Park, was sentenced Aug. 24 in King County Superior Court. He pleaded guilty to seven felony counts of theft in June.

“We found numerous cases in which Welling billed for surgeries that never happened,” said state Insurance Commissioner Mike Kreidler. Kreidler’s office was tipped off to the scam when a patient complained, saying that Welling had tried to bill her insurer $89,000 for six surgeries that never took place.

Welling is a registered surgical technologist and sole proprietor of Shoreline, Wash.-based Alpine Surgical Services. His license allows him to perform tasks like preparing supplies and instruments, passing them to the surgeon and preparing basic sterile packs and trays. But after patients had procedures done, he would often submit large bills with codes listing himself as a doctor or physician’s assistant. He is neither. Sometimes he would include post-operative reports, listing himself as the surgeon.

No evidence was found to indicate that Welling was playing an improper role in actual medical care. The fraud involved billing.

“As far as we could tell, the only time he pretended to be a doctor was when he submitted bills,” said Kreidler.

In one woman’s case, Welling billed $140,323 as assisting surgeon for nine surgeries that never took place. Over a five-year period, he billed another woman’s insurer 107 times for 51 different surgeries, listing himself as the primary doctor. Hospital records show she’d only had surgery twice.

From 2004 through 2011, according to medical records obtained by Kreidler’s Special Investigations Unit, Welling billed five insurance companies at least $4.1 million for services he did not provide. He was paid $461,000.

“Part of the reason he got away with this for so long is that he’d rarely challenge an insurer who paid little or nothing,” said Kreidler. “He’d just send them the bills and hope they’d pay.”
Interesting story about how the Apollo 11 astronauts got life insurance

Interesting story about how the Apollo 11 astronauts got life insurance

NPR has posted an interesting story about how the Apollo 11 astronauts sort of self-insured their lives when they headed for the moon.

Rather than try to get conventional life insurance, the three astronauts spent their spare moments during their month of pre-launch quarantine signing autographed envelopes, according to NPR's Chana Joffe-Walt. That way, if they died on their lunar adventure, their families could sell the autographs, which today command up to $30,000 at auction.

To make the autographs more valuable, each was on an envelope that a friend would have postmarked on key days, like the launch date and the date they landed on the moon. Writes Joffe-Walt:
It was life insurance in the form of autographs.
"If they did not return from the moon, their families could sell them — to not just fund their day-to-day lives, but also fund their kids' college education and other life needs," (space historian Robert) Pearlman said.
The life insurance autographs were not needed. Armstrong and Aldrin walked on the moon and came home safely. They signed probably tens of thousands more autographs for free.
The Summer of Stop-Loss

The Summer of Stop-Loss

While this blog took the summer off, we have been keeping a close eye on the numerous developments related to stop-loss attachment point regulation.  Now that most of these developments have slowed down, at least for now, some exclusive reporting and commentary should be useful as those in the self-insurance industry (including those involved with employee benefit captives) take a collective breath.

 Pushed and prodded by a collection of health care reform advocates, federal regulators invited interested parties to submit written comments regarding the smaller insured group health plans facilitated by stop-loss insurance with “low” attachment points.

 About 150 comment letters have been submitted to date and the talking points are largely predictable. 

For the critics of self-insurance, the usual canards are widely repeated.  This request for information (RFI) process signaled a clear focus on self-insurance unlike anything that has been seen in recent years.  But the path forward remains unclear.

 That’s because the Affordable Care Act does not provide any explicit statutory authority for regulators to promulgate new rules relating to stop-loss insurance arrangements…yet that may not preclude action that could achieve the same objective.

 The HHS, DOL and/or Treasury Department (tri-agencies) could potentially rely on their general rule-making authority under ERISA or the Public Health Services Act, to play with definitions or to engage in other revisionist rule-making mischief.   The most likely scenario is that a new definition of a self-insured group health plan is crafted based on risk retention/risk transfer arrangements – thereby allowing the feds to indirectly regulate stop-loss insurance.

 So how serious is this potential threat?   The answer is complicated.

 In a private meeting with self-insurance industry representatives over the summer, a senior DOL official downplayed the prospects that any action is imminent or even likely, explaining that they felt the RFI was necessary for the agencies to get a better understanding of how the self-insurance marketplace operates in the real world.

 But conspicuously absent from the meeting, despite previously confirming their attendance, were senior HHS officials involved with the stop-loss RFI process.  This was notable because it is believed that HHS has the most aggressive regulatory agenda when it comes to self-insurance.  The Treasury Department was represented at the meeting but that agency has remained guarded about its interest and intent. 

 Any of the three agencies could initiate a rule-making process, but it is less likely if there is not a consensus among the three.

 So with that in mind, industry lobbyists have been making the rounds to congressional oversight committees to encourage that they become engaged on this issue and request that the agencies stand down now that the RFI process has been concluded and there is no “smoking gun” which would justify new regulatory action.

The most substantive meeting took place just a few weeks ago with the senior policy advisors for the Senate Finance Committee.  Given that the committee is chaired by Democratic Senator Max Baucus, who has been supportive of self-insurance in the past, it is best positioned to intervene.

The biggest push back by committee staffers was centered on the fact that the ACA does not require that self-insured employers cover essential health benefits (EHBs).   They argued that because of this “loophole” there is incentive for smaller employers to self-insurer, facilitated by stop-loss insurance with low attachment points, in order to be able to offer skimpy health care coverage as a way to save money.

Industry experts at the meeting, including executives from two leading TPAs, explained why this fear is unfounded for practical reasons.  It was then pointed out that while self-insured employers are not required to cover EHBs, they will be subject to “minimum value” requirements, which essentially accomplish the same public policy objective.

 But a final argument seemed to box in the Senate staffers.  Even if you concede the EHB “loophole” (which this blog does not), the fact is that the law was drafted in a very deliberate way to distinguish self-insured group health plans from health insurance carriers.  In this regard, any proposed changes should come back to Congress in the form of legislation as opposed to letting unelected regulators arbitrate substantive policy issues.

 The discussion was concluded with a formal request that Chairman Baucus consider exercising the committee’s oversight authority and communicate to the Treasury Department accordingly.   We understand that the request is still under consideration, so be sure to check back with this blog for updates.

Of course, the focus on self-insured plans with stop-loss insurance extends beyond Washington, DC. 

Many of our friends at the National Association of Insurance Commissioners (NAIC), have been led by the nose over the past year by health care reform advocates to take action on making it more difficult for smaller employers to self-insurer through tighter stop-loss attachment point regulation.

 At the NAIC summer meeting held a few weeks ago in Atlanta, the ERISA (B) Working Group considered a proposal to endorse “guideline amendments” to the current stop-loss insurance model act related to attachment point requirements. 

 Clearly aware of the blowback that would be directed at the NAIC if it took aggressive action that was seen to be disruptive to the health care marketplace, Working Group Chair Christina Goe of Montana tried to diffuse concerns by explaining the proposal is only advisory in nature and that the NAIC does not intend to formally amend the model act for a variety of procedural reasons.  And for good measure, committee members made it clear that they did not overstep their charge and attempt to redefine stop-loss insurance as health insurance.

 Well, it is certainly nice to hear this self-awareness of the limitations to their “charge,” but multiple federal court rulings have already confirmed that stop-loss insurance cannot be defined as health insurance, so no real favor here.

 And as far as considering a guideline amendment versus an amended model act, it’s a distinction without a meaningful difference.

 Of the 26 states that currently regulate stop-loss attachment points, only a few have adopted the model act without variation.  So it is unlikely that an amended model act would take root across the country any time soon.   No matter, as a simple NAIC recommendation on how states should regulate stop-loss attachment points could accomplish the same objective (restricting the ability of smaller employers to self-insure) much quicker.

That is because individual insurance commissioners who are already inclined to push stop-loss legislation in their states will use the NAIC recommendation as justification for action.  Given the technical nature of this issue, it’s easy to understand how this would be enough to persuade most state legislators to go along without asking too many questions.

 The NAIC working group deferred action on the proposal until its winter meeting, which in hindsight was predictable because insurance commissioners, like all political creatures, normally put off major policy decisions when Election Day looms.  Let the dust settle after November 6 and get ready for more action.

This brings us to California.

 As this blog has previously reported, the state’s insurance commissioner, Dave Jones, is a political creature who is interested in beefing up his credentials within the Democratic Party.  So it should not be surprising that he has come out as a major proponent of health care reform, and more specifically the establishment of California’s health insurance exchange, which is expected to come online in 2014.

 Self-insurance therefore became a target for political reasons every bit as much as for misinformed policy reasons in order for Commissioner Jones and his allies in the Legislature to claim credit for protecting the viability of the state’s health insurance marketplace as the exchange begins to be implemented.   A nice populist message for sure.

 One health care broker in California perhaps summed it up best when he referred to SB 1431 as the “California Health Insurance Exchange Protection Act of 2012.”

 Now that it has been confirmed that SB 1431 has been shelved, at least until a special session this December, we can look at the past as prologue.

The same stale arguments are certain to be dredged back up when some version of SB 1431 is brought back for consideration after the November elections, and the political posturing will be predictably crass.

 Equally unfortunate is that many stakeholders who will oppose SB 1431 “2.0” will likely concede the central principle once again of whether stop-loss attachment points should be regulated at all and immediately begin negotiating the numbers and formula.   Yes, political realities often dictate short term lobbying strategies based on compromise, but the longer view should not be ignored in this case.

It’s been a long hot summer for stop-loss insurance indeed, which has ended without much certainty for the future of the self-insurance marketplace.    We will see whether the coming autumn chill cools off the debate or if partisan health care reform advocates continue to overplay their hand.

Mask for Remove Pimples

Apple and Melon Mask Remove Pimples

The homemade masks are usually an excellent solution to combat certain skin problems. Is that plant, source of life, having within them the best elements to eliminate those things we do not want. The apple and melon will wonders for your complexion.

The melon and apple together form an excellent homemade mask against blackheads and other facial imperfections. Simply, you must be prepared to join them.

Grab an apple, peel and cut into cubes. Then do the same with a good slice of melon.

Put them together in a blender and blend until they take proper consistency. You know if you do not take the mask consistency, just add a little flour or oatmeal, especially the latter which is excellent for the skin.

Once it is ready, apply with rotating movements, following the direction of the muscles of the face and ever upward.

When the mask and acted for 15 minutes, remove it with water or a paper towel.
Sept. 13 hearing set re: Sagicor Life's acquisition of PEMCO Life

Sept. 13 hearing set re: Sagicor Life's acquisition of PEMCO Life

Insurance Commissioner Mike Kreidler has scheduled a hearing for Sept. 13 at 10 a.m. at his Tumwater, Wash. office to consider approval of Sagicor Life Insurance Company's request to acquire Washington-based PEMCO Life Insurance Company.

Sagicor Life is proposing to acquire all outstanding stock of PEMCO Life Insurance Company, and is also proposing to merge PEMCO Life with and into Sagicor Life at a later date after receiving approval of the acquisition.

PEMCO Life Insurance Company, which has been a Washington-based insurer since 1963, provides life and disability products to approximately 15 thousand Washington individual and group policyholders, and is wholly owned by its parent company, PEMCO Mutual Insurance Company. PEMCO Mutual Insurance Company is a mutual property and casualty insurer located in Seattle, WA and is licensed in Idaho, Oregon, and Washington.

Sagicor Life is a Texas-based insurer licensed in Texas to offer accident, health and life insurance and has been authorized to conduct life and disability insurance in Washington since 1961. Sagicor Life operates primarily in the US and is wholly-owned by Sagicor Financial Corporation. Sagicor Financial Corp. is a Barbados corporation which operates internationally in various European and Caribbean countries, and is publicly traded on the Barbados, Trinidad and Tobago, and London Stock Exchanges. Sagicor Financial Corp. had $142.6 million in US revenue in 2011, $1.35 billion in total revenue (both US and international) and 632,123 individual life policies in-force overall. As of December 31, 2011, Sagicor Financial Corp.’s consolidated stockholders’ equity was $797.5 million.

For more information, including how to submit letters of support or objection, please see the hearing notice.

Withdrawing Deemed Admissions

Withdrawing Deemed Admissions

When will a party be permitted to withdraw deemed admissions arising from the failure to respond to a Request to Admit?

In Epstein Equestrian Enterprises Inc. v. Cyro Canada Inc., 2012 ONSC 4653 (S.C.J.), the plaintiff served a Request to Admit eleven days before trial was scheduled to begin in 2010.  Trial was adjourned initially for one week and then again until 2012.  One of the defendants, Jonkman, failed to respond to the Request to Admit.  Rule 51.02(1) provides that a party is deemed to admit the contents of a Request to Admit if it does not respond to it within 20 days after it is served.  Jonkman sought to either set aside the Request to Admit or to withdraw the admissions.

Justice Morgan held that even though the Request to Admit was not served 20 days before trial, once the trial was adjourned and did not start for 20 days, the deeming provision applied. The main issue therefore centred on whether Jonkman was entitled to withdraw its admissions. The court may grant leave to withdraw the admissions if the following conditions are met:

  1. The proposed change raises a triable issue;
  2. There is a reasonable explanation for the change of position; and
  3. The withdrawal will not result in any prejudice that cannot be compensated for in costs. (citing Antipas v. Coroneos, 1988 CarswellOnt 358)
Justice Morgan permitted the admissions to be withdrawn. At the time the Request was served, Jonkman was basically without legal representation as its counsel was in the process of being removed from the record. It had instructed counsel not to respond to the Request to Admit.  It subsequently brought a coverage application and was now being defended by an insurer.  The plaintiff supported the coverage application and must have understood that if coverage was achieved, a defence would be pursued. Jonkman's new counsel and insurer were unaware of the Request Admit and it would be unable to defend itself if the admissions stood.  The coverage application had been settled, and Justice Morgan speculated that the insurer's position may have been different had it known that Jonkman had effectively deprived itself of a defence by failing to respond to a wide ranging Request to Admit.

Justice Morgan was of the view that any prejudice to the plaintiff would not be inordinate as a trial would have been needed to canvas issues with the co-defendant in any event. The plaintiff further argued it was prejudiced as it had entered into a Pierringer Agreement with the remaining defendants and was concerned Jonkman would attempt to pin liability on those parties at trial. Justice Morgan held that the plaintiff had previously assumed Jonkman was insolvent when it entered the settlement and so this factor was to the plaintiff's benefit not prejudice.  The admissions were withdrawn.
Insurance tips: What to know before renting your home/boat/etc.

Insurance tips: What to know before renting your home/boat/etc.

We get a number of calls from folks who rent out their homes, vacation cabins, vacant lakefront sites, boats, RVs, motorcycles, etc. to others every once in a while. They want to know if that affects their insurance.

It very well could. Here's why: When property is rented, that's considered a business activity. And that can affect any existing coverage for property damage and liability protection.

There may also be coverage limitations or exclusions built into the policy that activated by your renting the property.

We recommend that you talk to your agent or the insurer before you rent, so you're not left personally responsible for property damage costs or legal costs in a lawsuit stemming from renting the property.
Do I have "minimal essential" insurance coverage?

Do I have "minimal essential" insurance coverage?

As part of health care reform, starting in January 2014 most Americans will need to have “minimum essential” health insurance coverage or face a tax penalty.

We've gotten a number of calls from consumers wondering if their current health coverage qualifies. (In particular, a number of people who get their medical care through the Veterans Administration have called to check.)

In many cases, the answer is yes. Many existing plans qualify as minimal essential health insurance coverage. Here are some examples:
• Medicare Part A

• Health programs administered by Washington state (such as Medicaid or the Children’s Health Insurance Program)

• TriCare

• Coverage through the Veteran’s Administration

• Coverage from an employer, regardless of whether the employer is a government agency, a private-sector employer, or an Indian tribe.

• A individual plan (i.e. a plan that you buy on your own directly from a health insurance company).
“Hole-in-Won” Golf tournament insurer charged with felonies after not paying up

“Hole-in-Won” Golf tournament insurer charged with felonies after not paying up

OLYMPIA, Wash. _ A Connecticut businessman who specializes in insurance for golf tournament hole-in-one prizes has been charged with multiple felonies after repeatedly failing to pay up.

Kevin Kolenda, of Norwalk, Conn., was charged Wednesday in King County Superior Court with five counts of transacting insurance without a license, a class B felony. His arraignment is slated for Sept. 5.

Kolenda, 54, ignored a previous cease-and-desist order and a $125,000 fine from state Insurance Commissioner Mike Kreidler.

“We’ve been warning the public about Mr. Kolenda’s scam for years,” said Kreidler, whose Special Investigations Unit did the investigation that led to the charges. “He has a long history of selling illegal insurance, refusing to pay prize winners, and thumbing his nose at regulators.”

In some cases, charities have had to come up with the prize money. In others, the prize winners agreed to forego a prize.

Kolenda in 1995 started a business called Golf Marketing, working out of a home his parents owned in Norwalk. Since then, the business’ name has changed several times, including: Golf Marketing Worldwide LLC, Golf Marketing Inc.,, and currently Worldwide. The company also has a regional office in Rye, N.Y.

Kolenda has repeatedly failed to pay winning golfers in Washington. Among them:

• In 2003, Kolenda illegally sold insurance for a tournament in Bremerton. But when a golfer got a hole in one and tried to claim the $10,000 prize, Kolenda wouldn’t pay.
• In 2004, Kolenda sold insurance for a Vancouver tournament. Again, a golfer got a hole in one. Kolenda refused to pay the $50,000 prize. After a hearing at which Kolenda failed to appear, he was ordered in 2008 to pay a $125,000 fine. He never did.
• In 2010, Kolenda sold coverage to pay $25,000 for a hole in one during a golf tournament in Snohomish. A player got a hole in one. His golf partners signed notarized forms attesting to the hole in one. The prize remains unpaid, despite numerous calls and emails from the partners and tournament officials.
Similar allegations have been made against Mr. Kolenda and/or his business in numerous other states, including Montana, Ohio, Georgia, California, New York, Hawaii, Alabama, Massachusetts, Florida, Connecticut and North Carolina.
Action Dismissed for Failing to Comply with Municipal Act Notice Requirement

Action Dismissed for Failing to Comply with Municipal Act Notice Requirement

Argue v. Tay (Township), 2012 ONSC 4622 (CanLii)

A municipality was recently successful in having a case dismissed based on the failure of the plaintiff to comply with s. 44(10) of the Municipal Act.  The section requires written notice be given to the clerk within ten days of the incident.  Section 44(12) provides that the failure to give notice can be excused if the plaintiff has a reasonable excuse and the defendant is not prejudiced by the lack of notice.

In Argue v. Tay (Township), the plaintiff alleged she sustained soft tissue injuries in a motor vehicle accident caused by potholes in the defendant municipality's road.  She provided written notice through her lawyer almost two years after the incident.  By that time, the surface of the road had changed materially.  The plaintiff argued the municipality had either actual or constructive knowledge of the accident as the municipal volunteer fire department attended the scene and would have received a copy of the police report.  The municipality brought a summary judgment motion seeking to have the action dismissed for failing to comply with the Municipal Act notice requirement.

DiTomaso J. held the plaintiff did not comply with the notice requirements.  Section 44(10) requires written notice be given to the clerk and the fact that the fire department attended or may have received a copy of the police report was insufficient to comply with the section.  There is no support in the jurisprudence that actual or construction notice pre-empts the requirement to give written notice to the clerk, and the section cannot be dispensed with in favour of notice to a different municipal department.

The plaintiff had no reasonable excuse for the failure to give notice.  She was discharged from hospital the same day as the accident, had no broken bones and was able to return to work two to three weeks after the accident.  She was aware people could bring lawsuits and believed the state of the road contributed to the accident, yet took no steps to inform herself about the law.  She was physically and mentally able to instruct counsel. 

The municipality had been prejudiced by the lack of notice.  There is a presumption of prejudice where notice has not been provided and the plaintiff bears the onus of showing there was no prejudice.  She failed to do so.  Neither she nor the municipality had photos or measurements of the road, the condition of the road had changed materially since the accident and the municipality had lost the opportunity to interview witnesses.  As a result, summary judgment was granted.

Argue is a useful summary of the relevant authorities relating to s. 44(12). Those defending municipal claims with notice issues should consider whether it would be useful to bring a summary judgment motion in the circumstances.
"Auto accidents have decreased. Why did my insurance rates go up?"

"Auto accidents have decreased. Why did my insurance rates go up?"

Q: I read that auto accidents in Washington state have decreased, as have accident-related deaths. But my insurance premium just went up 15 percent. What's going on?

A: As Washington state's insurance regulator, we do our best to hold down insurance costs. But there are things other than accident rates that can affect your auto insurance premiums. Theft rates, auto glass costs, health care costs (for injuries in a crash) can all play a role. So can the fact that modern vehicles, with more airbags, high-strength steel and sophisticated safety features can be more expensive to repair.

Rates are driven by insurers' actual claim payments, administration costs and the company's cost and loss projections for the near future.
Why it's important to read "whole life" policy annual statements

Why it's important to read "whole life" policy annual statements

Q: I just got the annual statement for my "whole life" insurance policy. Should I just toss this, or do I really need to read this thing?

A: You should read it. Here's why: With whole life insurance, the monthly cost of insurance increases as you get older. If you have a loan against your policy, or if you chose a low premium option, then at some point the current level of premiums won't be enough to keep the policy in effect, and it will end.

By reading your policy's annual statement on a regular basis, you'll be able to increase the amount you're paying in premiums so that you can prevent this from happening.

Chocolate Reduce Heart Risk

Dark Chocolate Reduce Heart Risk

The very dark chocolate assists reduce the risk of heart disease, and even counteract the contradictory consequences of smoking by the occurrence of polyphenols, a substance that helps to advance blood flow in the arteries, according to a study published in the BBC digital.

An investigation by the University Hospital of Zurich displays that eating a couple of images" of sweets a day can avert the hardening and constricting of the arteries in smokers.
Health Tips & Alert

"This happens only with dark chocolate," he told the BBC Dr Myriam Posada, a investigator at the School of Nutrition at the University of Antioquia, Colombia. "In the white sweets are not present polyphenols, which are compounds that contain antioxidants and produce cardiovascular effects," he added.

The research, released in the journal 'Heart', contrasted the consequences of black sweets (containing 74 per hundred cocoa) sweets with white on the circulation of blood flow in the arteries of 20 male smokers. fuming sways the undertaking of endothelial units (lining the artery walls) and to platelets, which are engaged in forming body-fluid clots.

Before you take 40 grams of sweets, smokers were inquired to abstain for 24 hours of consuming other foods wealthy in antioxidants, such as onions, apple fruit, and cabbage and cocoa goods.

After 2 hours, ultrasound scans revealed that dark sweets significantly advanced the arterial circulation flow, and that the effect continued eight hours.
"What occurs is that the content of polyphony that have the sweets helps decreases the grade of body-fluid clotting, which improves body-fluid flow in arteries," said M. Posada.

The polyphony in sweets, states the researcher, have an significant effect on platelets. The study displayed, for the body-fluid trials of persons studied, very dark sweets was lessened by almost half the undertaking of platelets. "When the undertaking of platelets declines, there is less possibility of thrombosis, stroke or heart attack," he said.

Furthermore, grades of antioxidants in the blood are substantially expanded inside two hours of eating the sweets. in addition to, the content of polyphony having chocolate helps to decrease the grade of blood coagulation, which advances the blood flow in arteries.

White vs Dark Chocolate

White chocolate, however, had no effect on endothermic units or platelets or antioxidant grades. "The key is the high antioxidant content of living black sweets, containing more per gram than any other nourishment or drink rich in these substances, such as red wine or green tea," said Colombian investigator.
Although, professionals furthermore warned about the high grade of calories comprised in all kinds of sweets, which generally contain 500 calories per 100 grams and an overall mean of 30 per hundred fat.
Health Tips & Alert

"I advise my patients that if they have no heaviness troubles, have a cup of sweets every day as a good source of antioxidants," said nutritionist. "If the persevering has heaviness troubles or are diabetic, take cocoa with sweetener," he added.

Former state insurance commissioner Dick Marquardt has died

Dick Marquardt Sr., who served as the state's insurance commissioner from 1977 to 1993, died Aug. 9th in Seattle.

Idaho-born Marquardt was the 6th of the eight people who've served as insurance commissioner since 1909. He was a University of Washington graduate, served in the Army during World War II, and worked as a longtime fuel-oil company executive.

He was appointed by then-Gov. Dan Evans to head the state's selective service system, and he also served a term as state senator representing District 45 in King County.

He served four terms as insurance commissioner, and continued to work as a consultant well into his 80s. He was an avid golfer, and loved baseball.

There's a long and touching obituary in the Seattle Times. From it:
Dick was the beloved patriarch of his large family. He was a devoted and proud husband, father, grandfather, great grandfather, and great-great grandfather.
A private service is planned at a later date.

Also from the obituary:
He leaves behind a legacy of integrity, hard work, humor, unconditional love, and pure enjoyment of the good things in life. He will be greatly missed by all who were lucky enough to know him. Dad, you were unforgettable.
Insurance claims help, donations, and other resources re: the Taylor Bridge wildfire

Insurance claims help, donations, and other resources re: the Taylor Bridge wildfire

As fire crews work to rein in the Taylor Bridge fire, some families are being allowed back in to check on their homes, dozens of which have been lost in the first this week. Here are some tips and resources for those who lost property in the blaze.

  • Kittitas County Emergency Services is collecting information on the amount of losses in order to determine if federal disaster assistance will be available. Whether insured or not, it's important that the losses be documented. (Note: The website seems to be offline or overwhelmed; we've had a lot of difficulty opening the page this morning.)

  • According to the DOT, the contractor on the bridge project has set up a process for claims that potentially would be addressed by the contractor's insurer. The phone number provided by the contractor is 1-800-238-6225 for Travelers Insurance.

  • Insurance claims: For those with insurance, we have these tips about how homeowners and others can expedite their insurance claims. It's important to know that many standard homeowners' policies include some coverage for living expenses -- like a motel -- for folks who lose their homes. That's definitely something to check with your insurer or agent right away. And save receipts for everything, including meals and laundry, that might be relevant. If you need help or run into problems with your insurer, call us at 1-800-562-6900 or email us at and we'll do our best to help.

  • For those seeking updates or emergency shelter information, the state Emergency Management Division has information. Governor Gregoire has proclaimed a state of emergency in both Kittitas and Yakima counties to free up additional firefighting resources. 

  • If you want to make donations to the many fire victims -- including livestock that had to be evacuated -- please see this donation information from the state Emergency Management Division. It sounds like donation sites have been overwhelmed with stuff; they're now asking that people consider donating money instead. The link above includes numerous local and state organizations trying to help the fire victims.

Costs of Compliance Are Not Defence Costs

Costs of Compliance Are Not Defence Costs

At what point do costs of compliance become defence costs?

GE sought a declaration that its insurer, Aviva, had a duty to defend it in respect of a request by the Ministry of the Environment to provide information regarding contaminated groundwater near a property once owned by GE.  The Ministry asked GE to delineate the source area on its property.  GE did not oppose the request and incurred significant costs in complying.  GE argued that the costs associated with complying with the Ministry’s request were defence costs and therefore were payable under its insurance policy.  The application judge dismissed the application and GE appealed.

The Court of Appeal dismissed the appeal.

One of the key factors was that GE did not oppose, defend or investigate the Ministry’s request.  Since it voluntarily complied with the request, it did not suffer any defence or investigation costs.  The Court held that the costs incurred were compliance costs, not defence costs, and therefore were not covered by the policy.
Is it possible to OVER-insure my home?

Is it possible to OVER-insure my home?

Yes. If you think your home is over-insured, ask your agent or insurer when they last made a replacement cost calculation specific to your home. These are done by insurers to figure out what it would cost if they had to rebuild your home after a major covered loss. (Like your home burning down.) If the information used in the calculation is wrong, you can end up with an insured value that's too low or too high.

Your tax assessment value, by the way, is not the value used for insurance purposes. The insurer needs to use a value that reflects an actual and realistic rebuild cost.

Also, your home insurance policy should not have the value of the land included as part of the dwelling coverage. Land is not considered to be insurable property on a home policy.
Wildfire near Cle Elum has reportedly burned 60 homes

Wildfire near Cle Elum has reportedly burned 60 homes

A wildfire near Cle Elum, Wash. has reportedly burned 60 homes and 26,000 acres, with summer dryness and high winds making firefighters' jobs difficult.

The Seattle Times has posted some pretty scary photos of local homeowners and ranchers watching the wildfire approach. And the North Kittitas County Tribune is posting a running log of fire news, including a phone number for local evacuation information. The state has also activated its emergency operations center.

Our hearts go out to the victims, and we're monitoring the situation closely. Fire victims should contact their insurer or agent as soon as possible to start the claims process. Many policies include some coverage for emergency shelter, such as motels, if a home is uninhabitable. Our consumer advocacy staff (1-800-562-6900) will be available to help fire victims if they have trouble filing insurance claims.

Here are some more tips:
  • Cooperate fully with the insurer. Ask what documents forms and data you'll need to file a claim. Keep a journal of all conversations, including who you talked with and when.
  • Ask your insurer about additional living expenses if your home is destroyed. Save all relevant receipts.
  • Take photos or video of the damage.
  • If there's a disagreement about a claim, talk to the insurer. Ask the company to cite specific language in the policy. If you need help, call our office at 1-800-562-6900.
  • If the insurer's offer seems too low, be prepared to negotiate to get a fair settlement.
If you're not affected by the blaze but live in a wildfire-prone area -- and much of the eastern part of the state is very dry right now -- here's a list of tips to prepare and protect your home.

And here's a handy pdf document that will help you get started on a home inventory, which can be a big help in filing an insurance claim after a disaster. You can also use a video camera or one of several smartphone apps to do the same thing.
You bought a new car? How soon do you need to tell your insurance company?

You bought a new car? How soon do you need to tell your insurance company?

Q: I bought a new car a week ago, but I didn't want to call my insurance company yet, since I know my premium will go up. How long can I wait?

A: Do not wait. We're not kidding about this. Some auto insurance policies limit automatic coverage for a new or replacement vehicle to 14 days after purchase. Some others allow up to 30 days.

Here's why it's not worth the risk: If you wreck your new car and your claim is denied, you'll be out a lot more money than you saved on the premium.

The upshot: immediately contact your agent or insurer to add the vehicle and update your coverage.

Hair Treatments - Best Home remedies

Best Home remedies for Hair Health

Keep your hair healthy, shiny and full of vitality with these home remedies for dry hair, greasy and stained they are very effective and very economical best.

Hair treatments

Hair is a very important but often people neglect or do not realize the damage they do when we dye it, wash it or when we want to straighten hair. That is why we must always take into account the natural care and home remedies for hair we can do without spending a fortune on hair products to keep it neat.

Do not forget to pamper your scalp and keep it healthy, clean and healthy home remedies for hair that you like.

Eliminates Las Canas:
The first of the home remedies for hair is for women who want to eliminate the gray naturally or without using dyes. With this remedy may recover their natural tone
Hair treatments

Mix walnut leaves, 50 grams of crushed nuts, an egg shell and a little rosemary. With this mixture, apply it to wash hair in the last rinse. Repeat daily to get the favorable results that are desired.

Grease Shampoo:
Having an oily hair is one of the problems that most affect the people and for this reason it may look ugly if not washed daily, which is also somewhat damaging to the scalp. But this is one of the home remedies for hair that will help you eradicate the problem.
Hair treatments

Boil a liter of mineral water, the bark of four lemons and one tablespoon linden flowers. Let stand two hours and then add the juice of four lemons and filters content to rest for two days. Apply daily in the last rinse to give your hair in the shower.

Vitality and Strength:
There are many factors causing the wear hair that is why it is necessary to pamper you from time to time with any of these home remedies, especially when dyed or use many chemicals.

To make it look silky and vitality, an egg should be mixed with 150 grams of plain yogurt. Mix and apply on hair, place a plastic cap and leave on for ten minutes. Remove the mask with cool water to boost circulation and then wash as usual.

Hydrate your hair:
And who better than your hair look healthy with some home remedies for hair you can do very easily. Remember that just like our skin, hair needs moisture to make it look alive and not look dull or rough.
Hair treatments

Buy a little almond oil and heat for ten seconds in the microwave. When ready, you should spread it around the hair with an emphasis on the ends, cover with a plastic cap and a towel and left over 15 minutes to act it. Over time, wash as usual.

You should do this once a week and you will appreciate that your hair looks healthier.

Stop Hair Loss:
If you suffer from this problem, do not worry, there are many home remedies for hair you can do and are very simple to make. An example is this:

Pour one liter of alcohol in a glass bottle and add a few sprigs of parsley. Close the bottle with a cork and let stand in a cool, dry place. When the liquid turns green, shake and apply on clean dry hair. This will prevent you from falling. Use it daily until the problem is resolved.

Give Vigor:
If you want to polish it with some home remedies for hair, this is an excellent choice. The results will amaze you and soon you will notice the difference from this shampoo home.

You only have to make an infusion of sage with a little neutral soap. Once you wash your hair with this mixture, rinse with warm water previously mixed with half cup of vinegar. Use it three times a week for best results.

Woman charged with insurance fraud after pawning ring and claiming it was lost

Woman charged with insurance fraud after pawning ring and claiming it was lost

A Snohomish County Woman has been charged for claiming that she'd lost a diamond ring that she had actually pawned.

The Attorney General's Office has chaged Laura Anne Dunn with attempted first-degree theft and insurance fraud. Arraignment is scheduled for Aug. 23 in Snohomish County Superior Court.

In January, Dunn told her insurer, Liberty Mutual Insurance, that she'd lost her ring during a New Year's Eve stay at a casino. The ring was valued at more than $9,000.

Investigators for Liberty Mutual checked with the casino's security staff, which had no record of Dunn reporting her ring missing. They asked Dunn to provide a number of records, including all photographs taken during her stay at the casino.

The investigators also checked pawnshop records. They discovered that Dunn had actually pawned the ring back in September 2011. In fact, the ring was still at the pawnshop until she picked it up in mid-March 2012.

Two weeks after she filed the claim, Dunn sent a note to Liberty Mutual.

"I have been extremely lucky," she wrote, saying that she'd found the ring snagged in a glove. "...Thanks for your time and effort on my behalf."

The following day, the insurer's investigators visited a local pawnshop, where they found and photographed the ring that Dunn had reported missing. They closed the claim and reported the case to Insurance Commissioner Mike Kreidler's Special Investigations Unit, which specializes in insurance fraud cases.

Update: On Dec. 19, 2012, Dunn pleaded guilty to attempted first degree theft. She was sentenced to 80 hours of community service and $600 in costs.
"Hobo Prince Economic Project" founder fined $1 million by Oregon regulators

"Hobo Prince Economic Project" founder fined $1 million by Oregon regulators

Back in April, we issued a cease and desist order against Shelby H. Bell, a man who runs the "Hobo Prince Economic Project."

The Clark County, Wash. man was promising people seven years' worth of weekly $900 payouts in exchange for a $25 signup fee. He maintained that each person’s contract would be financed through a complex series of transactions, including issuance of a $500,000 “reverse” insurance policy purchased with a $25,000 payment from an unnamed bank.

Since he wasn't licensed to transact insurance at all in Washington, Insurance Commissioner Mike Kreidler ordered Bell to stop trying to sign people up for this highly dubious offer. (We subsequently received numerous calls from people across the country who'd signed up for the plan and blamed us for dashing their hopes of a big payout.)

Yesterday, the Oregon Department of Consumer and Business Services fined Bell $1 million, saying that none of Bell's investors have apparently made any money.

"Bell in less than a year attracted more than $187,000 from at least 7,480 people in multiple states and U.S. territories," the department said in a press release, accusing Bell of "offering false hope to thousands of people."

"Bell claimed to be worth billions with backing from the U.S. Treasury through an International Bill of Exchange, which actually has no value," Oregon regulators continued. "Also, investigators determined that Bell used investors’ money to pay for food, movie tickets, a vehicle, and other personal expenses."

Here's a link to Oregon's order.

Zinc Supplements For Health

Zinc Supplements For Our Health

Zinc is a metal. It is alleged an “essential trace element” because actual few amounts of zinc are all-important for human health.

Zinc is acclimated for analysis and blockage of zinc absence and its consequences, including bantam advance and astute diarrhea in children, and apathetic anguish healing.

Zinc Supplements

Zinc supplements provide a much needed mineral that is needed by every cell in your body. Our body is unable to produce zinc on its own, so we have to ensure we eat enough foods containing the mineral, water or drink enough or the right supplements that gives our cells the zinc they need.

Zinc is very important, as it plays a fundamental role with hundreds of processes in the human body. The main functions of zinc are including supporting the immune system, joints and tissues, along with aiding in cell growth. Zinc supplements have also been proven to eliminate sexual dysfunction, improve sexual function and help support healthy hair and helps with skin healing wound.

No matter how you look, zinc plays an important role in the function of most of our senses, including the ability to taste, smell and sight as well. Research has indicated that zinc can counter vision loss in the case of macular degeneration. A zinc deficiency may instead carry blunting the taste buds, along with the ability to detect smell.

Although zinc is an essential vitamin for our bodies, taking it too much can be a bad thing. Medical research has shown that taking more than 100 mg a day for a long time can damage our immune system. Older people however, may benefit from taking zinc if they have a deficiency. The supplement can absolutely advice earlier bodies accompany their assimilation aback up to the levels they should be.
When taking zinc supplements, we should always remember that zinc can indeed interfere with copper absorption. For this reason, many experts recommend that must be taken together. Anyone who takes a zinc supplement should booty it as allotment of an able-bodied counterbalanced diet to ensure that added vitamins and minerals assignment calm with zinc.

With most dietary supplements in the U.S. are unregulated, you should always choose a manufacturer who is GMP. Manufacturers always follow GMP manufacturing standards of zinc, in order to minimize and possibly eliminate the risk of contaminants that might be getting from the supplement.

If you choose your supplement wisely, you should not have to worry about any problems. You can buy zinc supplements at GNC, online or other nutrition stores. Not expensive, making it a welcome addition to your diet. You should consistently argue your physician if you doubt able you accept a zinc deficiency, so that he or she can acquaint absolutely how abundant zinc you charge anniversary day. Thus, if you are not getting enough in your normal diet - you can get the supplements you need.
The Importance of Objecting to an Improper Jury Charge

The Importance of Objecting to an Improper Jury Charge

Vokes Estate v. Palmer, 2012 ONCA 510 (C.A.)

This appeal decision illustrates the importance of objecting to a judge's charge to the jury, as well as the difficulty in overturning jury verdicts on appeal.

The case involved a fatal motor vehicle accident.  The defendant appealed the jury`s verdict, arguing that the trial judge failed to properly charge the jury with respect to s. 139(1) of the Highway Traffic Act (concerning the duty owed by the deceased on entering a highway) and failed to instruct the jury on the proper range of damages for loss of care, guidance and companionship.  The defendant also argued the jury award was gross and excessive.

The trial judge advised that he intended to charge the jury by omitting the words underlined below.

That section therefore imposes a very positive duty on Michelle Vokes in this case, breach of which would clearly constitute negligence. On the other hand, this positive duty on Ms. Vokes does not relieve Mr. Palmer who was operating his motor vehicle on the [through] highway from exercising ordinary care in the circumstances.

Counsel for the defendant did not object to the charge and in fact described the charge as an
“exercise in perfection”.  The Court of Appeal held that while the failure to object is not fatal, in most cases, an alleged misdirection or non-direction will not result in a new trial unless a substantial wrong or miscarriage of justice has occurred.

The remainder of the appeal was also dismissed, as under s. 118 of the Courts of Justice Act the judge may give a range of damages, but is not obligated to do so.  In addition, the threshold for overturning a jury`s award of damages is very high.  The assessment must be so inordinately high as to constitute a wholly erroneous assessment of the loss of care, guidance and companionship, which was not the case. 
What's the "Washington Fair Plan?"

What's the "Washington Fair Plan?"

Q: My home (or business) insurance has been canceled, and the cancellation notice refers to the Washington Fair Plan. What is that?

A: The Washington Fair Plan was established in 1968 to provide basic property insurance to consumers who could not obtain property insurance in the voluntary, or standard insurance market. Although many years have passed and the home insurance market of today offers many options for home insurance, the Fair Plan still exists and functions under the rules and regulations of our office.

Participation in this program is mandatory for all property insurers in Washington. All companies writing property insurance are members of the Fair Plan. Every insurance agent or broker who is licensed to write property insurance in Washington is required to know about and help consumers if they want the services of the Fair Plan.

The Fair Plan application may only be completed by a licensed insurance agent, and must be signed by the agent and the applicant. Basic fire insurance coverage may be provided for dwelling and commercial risks.

Although you will need to have a licensed insurance agent file an application on your behalf, you may still get coverage information directly from the FAIR Plan.

How long can an insurance company take to investigate an auto claim?

How long can an insurance company take to investigate an auto claim?

Q: Another driver hit my car last weekend, and I haven't been paid yet. How long does an insurer have to investigate and pay my claim?

A: Generally, when a claim is uncompliated (no injuries, not a large number of witnesses, no specialized reports needed), 30 days is considered to be a reasonable time frame to investigate and make coverage decisions.

This is true whether you've made the claim against your own insurer or someone else's. Many claims are investigated and paid within 30 days.

Sometimes -- particularly in complex property damage or injury claims -- it can take longer to agree on a settlement. But you should expect reasonable promptness getting answers to your questions during the process.

You can help expedite things by providing requested information, giving statements and answering questions promptly. And if things drag on too long and you live in Washington state, you can file a complaint with our office. (We're the state agency that regulates the insurance industry in Washington.)
Auto insurance and diminished value

Auto insurance and diminished value

Scenario: Your car is struck by another driver, who is at fault. His insurer pays for the repairs, but you believe that your vehicle -- since it has been in a wreck -- is worth less than it was before the crash.

Can you demand that the insurer compensates you for that diminished value?

Yes, but it can be difficult to prove. Diminished value can be part of a claim, but it is up to the claimant -- that's you, in the scenario above -- to prove that the value of the vehicle is diminished after the repairs have been completed.

Doing that may mean getting dealer testimony or an appraisal showing the value of the vehicle before the accident and after the repairs.

Our office, unfortunately, cannot force insurers to pay diminished value claims. You may need to seek legal advice to negotiate a settlement.
7 Easy Ways to Add Years to Your Life

7 Easy Ways to Add Years to Your Life

You may have read recently that New York City residents are outliving the rest of America. According to researchers at the University of Washington, the life expectancy of the average New York City resident is 80.6 years—three years above the national average. What’s more, a New Yorker’s average life expectancy grew a staggering 13.6 years between 1989 and 2009. The researchers credit the extra years to the New York Health Department’s commitment to curbing the Big Apple’s worst habits: They’ve banned trans fats, added calorie counts to menus, and encouraged physical activity with more bike lanes and walking paths. But, trust me, New Yorkers haven’t cornered the market on healthy living. In fact, here are 7 simple ways anyone, in any part of the world, can break their date with death.

Skip the Soup, Order the Salad Italian researchers found that eating as little as 1 cup of raw vegetables daily can add 2 years to your life. Why raw? Cooking can deplete up to 30 percent of the antioxidants in vegetables. To eat your quota, fill a ziplock sandwich bag with chopped red and green peppers, broccoli, and carrots. Toss the bag into your briefcase, along with a packet of dressing—the fat will boost your body's absorption of certain nutrients. Just remember: Not all restaurant salads are good for you! Beware of the 20 Salads Worse Than a Whopper.  

Stop Drinking Sugar Many see New York Mayor Michael Bloomberg’s proposed ban on sweetened drinks larger than 16 ounces is an infringement of their rights. Perhaps it is. But make no mistake: Sugar-laden drinks are killing you. New research in Circulation links men’s sugary drink consumption to an increased risk of heart attack. Meanwhile, scientists at Loma Linda University found that men who consume five 8-ounce glasses of water each day are 54 percent less likely to suffer a fatal heart attack than those who drink just two glasses or less every day. Hmm . . . Drop pounds and live longer with Drink This, Not That!, the essential guide to the most popular beverages in restaurants and on supermarket shelves.

 Cut Calories the Easy Way In 2008, New York became the first U.S. city to require calories on menu boards at fast food and chain restaurants. Now the Food and Drug Administration is working to make it a national requirement—and with good reason. A recent Health Psychology study found that when we’re given visual portion indicators, we tend to eat less. We all know the havoc excess body fat can cause: It raises your risk of diabetes, heart disease, stroke, and colon cancer. It also brings the reaper to your door sooner. University of Alabama researchers discovered that maintaining a body-mass index of 25 to 35 can shorten your life by up to 3 years. A healthy BMI is between 18.5 and 24.9. You’re not doomed if your local menus don’t flaunt calories. Nor do you have to spend hours online every day tracking down nutrition data. Start here: Avoid add-ons like cheese, goopy sauces, and mayonnaise, says Elizabeth Gross Cohn, R.N., D.N.Sc., an associate nursing professor at Columbia University. And wash everything down with water.  

Crack Open Some NutsWhen Loma Linda University researchers tracked the lifestyle habits of 34,000 Seventh-Day Adventists—a population famous for its longevity—they discovered that those who munched nuts 5 days a week earned an extra 2.9 years on the planet. Try the Planters NUT-rition Heart Healthy Mix, developed in conjunction with Men’s Health nutrition team. It contains all five key nuts, including walnuts, which are usually left out of nut mixes. Aim to eat 2 ounces a day.

 Cut Calories the Easy WayIn 2008, New York became the first U.S. city to require calories on menu boards at fast food and chain restaurants. Now the Food and Drug Administration is working to make it a national requirement—and with good reason. A recent Health Psychology study found that when we’re given visual portion indicators, we tend to eat less. We all know the havoc excess body fat can cause: It raises your risk of diabetes, heart disease, stroke, and colon cancer. It also brings the reaper to your door sooner. University of Alabama researchers discovered that maintaining a body-mass index of 25 to 35 can shorten your life by up to 3 years. A healthy BMI is between 18.5 and 24.9. You’re not doomed if your local menus don’t flaunt calories. Nor do you have to spend hours online every day tracking down nutrition data. Start here: Avoid add-ons like cheese, goopy sauces, and mayonnaise, says Elizabeth Gross Cohn, R.N., D.N.Sc., an associate nursing professor at Columbia University. And wash everything down with water.

 Explore Your Environment A 2011 study in Transportation found that increased availability of bike lanes means more people bike to work. (Shocker!) And while New York isn’t a cyclist’s paradise—that would be Portland, perpetually ranked the top cycling city by Bicycling magazine—Gotham is pushing the hardest to catch up, says Ralph Buehler, one of the study authors and an assistant professor in Urban Affairs and Planning at Virginia Tech. Not every city is known for its bike lanes, but most are building initiatives to keep their communities in shape: hiking programs in the mountains, kayaking on large lakes, or webs of running trails (here's proof: our list of the 20 Coolest Triathlons in America). You can jog anywhere—and doing so for just an hour a week can add 6.2 years to your life, according to a Danish study.  

Phone a Friend Regularly In a study of seventysomethings, Australian researchers found that those with the largest network of friends had the longest lease on life. For the average guy, this could add up to 7 additional years of existence. Yes, some buddies may encourage risky behavior from time to time, but friendship ultimately provides more protection than peril. So try to learn a few new faces at work, trade lifting tips at the gym, or simply say “hey” to that neighbor you've never met. You’ll have many years together to thank each other.

 Above All, Remember That There’s Life After Retirement In a Yale University study of older adults, people with a positive outlook on the aging process lived more than 7 years longer than those who felt doomed to deteriorating mental and physical health. Already envisioning decades of decrepitude? Volunteer for a cause you're passionate about: Selfless actions can put a positive spin on life and distract from unhealthy obsessing, reports a study in Psychosomatic Medicine.
Extrinsic Evidence in Duty to Defend Applications

Extrinsic Evidence in Duty to Defend Applications

The primary issue in this duty to defend application was the admissibility of extrinsic evidence regarding a lease. The applicant was the owner of a plaza. It was sued after a worker was electrocuted while installing a sign. The deceased had been hired to install the sign on behalf of a tenant of the plaza, Design Depot. Under the lease between 1540039 and Design Depot, the landlord was added as an additional insured. 1540039 brought an application seeking to be defended by Design Depot's insurer. It sought to introduce evidence that the deceased was hired by Design Depot.

The application judge refused to admit the evidence and the Court of Appeal dismissed the appeal.  It cited the Supreme Court decision of Monenco that held that extrinsic evidence will rarely be allowed in duty to defend applications. In addition, the evidence did not assist in any event as the allegations against 1540039 related to its ownership of the plaza and the lease agreement did not extend coverage in the circumstances.

The door is still open to allow extrinsic evidence in certain cases, but in general the primary focus on duty to defend applications will be on the policy itself.
What does personal injury protection cover?

What does personal injury protection cover?

Here in Washington state, auto insurance policies commonly offer personal injury protection, widely known as PIP. You can opt to add it your auto coverage. If you're in an auto accident, it will help pay for certain costs, up to certain limits.

Like what? It helps pay for:
  • Medical expenses
  • Lost wages
  • Lost services
  • and funeral expenses.

But there are some things that it won't cover. For example, PIP coverage doesn't cover injuries caused when using:
  • Farm equipment
  • Off-road vehicles
  • Mopeds
  • Injuries sustained while racing
  • Or injuries sustained while committing a felony.

Also -- and this is important -- PIP coverage does not cover services that your insurer decides:
  • Are not reasonable
  • Are not necessary
  • Are not related to the accident
  • or are not incurred within three years of the accident.