Landslides: Does homeowners insurance cover that?

Landslides: Does homeowners insurance cover that?

There was a large landslide on Whidbey Island early this morning, reportedly knocking one home off its foundation, destroying a road and threatening multiple other homes. Photos from the scene -- like this one, or this one -- are pretty amazing.

Anytime this happens in the rainy Northwest -- and it does happen with some regularity -- we get phone calls from people wondering if their homeowners insurance covers landslides.

The answer: Sorry, but probably not.

Mudslides and landslides are NOT covered by a standard homeowners policy, which is what most people have. So it can be very difficult to collect for losses caused by any form of land movement.

So what can you do if you're worried about a potential landslide affecting your home? You may be able to buy a special rider -- i.e. an add-on -- to your homeowners policy that includes coverage for contents for all perils, including earth movement, unless the policy specifically excludes it. But these types of riders typically only cover the contents of your home, not the structure, and some insurers don't offer this option at all.

For the structure, you may be able to buy separate earth-movement coverage from what's known as the "surplus lines" market, meaning insurers who specialize in risks that the traditional insurance industry doesn't cover. But know that if your home is on a steep hillside, it may be difficult to get this kind of coverage.

For the folks affected by the slide this morning, it would be worth checking with their lenders. Mortgage lenders in some cases require earth-movement coverage as a condition of a loan. Although such insurance protects the lender, rather than the homeowner, it could help if the home is no longer useable.
Complicating things for folks close to a landslide, insurers often declare moratoriums on new coverage until a particular event is completely over. We've seen this with earthquakes (due to the fear of aftershocks) and sometimes during wildfire season in parts of Eastern Washington.
Videotaping Examinations for Discovery

Videotaping Examinations for Discovery

In what circumstances will a court permit examinations for discovery to be videotaped?

J.M. v. Clouthier, 2013 ONSC 155 (S.C.J.)

This action arose out of allegations of historical sexual assault.  The defendant was in his 70s and had diabetes and high blood pressure, although he submitted evidence that he had no current health issues.  The plaintiff wished to videotape the defendant's examination for use at trial in case the defendant was not available to testify by the time of trial.  The defendant argued that the dynamic of the examination for discovery would change, forcing him to incur more cost in preparation time, and the editing and splicing of video to be shown at trial could be prejudicial to him.
The motion was brought under r. 34.19, which permits pre-trial examinations by videotape "by order of the court", rather than r. 36, which permits evidence to be taken de bene esse.  A witness examined under r. 36 may be examined, cross-examined and re-examined in the same manner as a witness at trial. 
Given the technology available, one could imagine that more examinations for discovery might be amenable to videotape, particularly as demonstrative evidence is readily accepted and the trier of fact is likely to be comfortable with and perhaps even absorb visual information more readily than reading in transcripts.

Given the technology available, one could imagine that more examinations for discovery might be amenable to videotape, particularly as demonstrative evidence is readily accepted and the trier of fact is likely to be comfortable with and perhaps even absorb visual information more readily than reading in transcripts.

Justice Hennessy allowed the motion.  Technical issues could be dealt with by the trial judge. The Court was not convinced there would be substantially more time or cost involved in videotaping the examination, and the video could be useful in terms of showing documents, photographs or charts.  There was a higher than normal probability that the defendant would not be available at trial given his age and health status.  The video was permitted under r. 34 rather than r. 36. 
"Wait a minute -- I thought insurance companies can't have waiting periods for pre-existing conditions!"

"Wait a minute -- I thought insurance companies can't have waiting periods for pre-existing conditions!"

We’re hearing this a lot these days, because people are aware that the federal health care reform law affects pre-existing condition waiting periods.
For kids under 19, this part of the health care reform law has already gone into effect. So insurance companies cannot apply pre-existing condition waiting periods when kids go on health insurance policies.
Here's where the confusion comes in: the rules are different for adults. But not for long.

Starting Jan. 1, 2014, the same rule that now applies to kids -- no waiting period for pre-existing conditions -- will apply to adults. For now, however, insurance companies can, and do, apply pre-existing condition waiting periods when adults go on policies.

So hang in there. Starting in January, health insurance companies have to cover treatment for pre-existing conditions starting as soon as you go on the policy.

Insurance companies will have to pay out an average of 32 percent more for medical claims on individual

WASHINGTON (AP) — Insurance companies will have to pay out an average of 32 percent more for medical claims on individual health policies under President Barack Obama's overhaul, the nation's leading group of financial risk analysts has estimated.
That's likely to increase premiums for at least some Americans buying individual plans.
The report by the Society of Actuaries could turn into a big headache for the Obama administration at a time when many parts of the country remain skeptical about the Affordable Care Act.

While some states will see medical claims costs per person decline, the report concluded the overwhelming majority will see double-digit increases in their individual health insurance markets, where people purchase coverage directly from insurers.

The disparities are striking. By 2017, the estimated increase would be 62 percent for California, about 80 percent for Ohio, more than 20 percent for Florida and 67 percent for Maryland. Much of the reason for the higher claims costs is that sicker people are expected to join the pool, the report said.
The report did not make similar estimates for employer plans, the mainstay for workers and their families. That's because the primary impact of Obama's law is on people who don't have coverage through their jobs.

The administration questions the design of the study, saying it focused only on one piece of the puzzle and ignored cost relief strategies in the law such as tax credits to help people afford premiums and special payments to insurers who attract an outsize share of the sick. The study also doesn't take into account the potential price-cutting effect of competition in new state insurance markets that will go live on Oct. 1, administration officials said.

At a White House briefing on Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can't be compared to the comprehensive coverage available under the law. "Some of these folks have very high catastrophic plans that don't pay for anything unless you get hit by a bus," she said. "They're really mortgage protection, not health insurance."

A prominent national expert, recently retired Medicare chief actuary Rick Foster, said the report does "a credible job" of estimating potential enrollment and costs under the law, "without trying to tilt the answers in any particular direction."

"Having said that," Foster added, "actuaries tend to be financially conservative, so the various assumptions might be more inclined to consider what might go wrong than to anticipate that everything will work beautifully." Actuaries use statistics and economic theory to make long-range cost projections for insurance and pension programs sponsored by businesses and government. The society is headquartered near Chicago.

Kristi Bohn, an actuary who worked on the study, acknowledged it did not attempt to estimate the effect of subsidies, insurer competition and other factors that could mitigate cost increases. She said the goal was to look at the underlying cost of medical care.

"Claims cost is the most important driver of health care premiums," she said.
"We don't see ourselves as a political organization," Bohn added. "We are trying to figure out what the situation at hand is."

On the plus side, the report found the law will cover more than 32 million currently uninsured Americans when fully phased in. And some states — including New York and Massachusetts — will see double-digit declines in costs for claims in the individual market.

Uncertainty over costs has been a major issue since the law passed three years ago, and remains so just months before a big push to cover the uninsured gets rolling Oct. 1. Middle-class households will be able to purchase subsidized private insurance in new marketplaces, while low-income people will be steered to Medicaid and other safety net programs. States are free to accept or reject a Medicaid expansion also offered under the law.

Obama has promised that the new law will bring costs down. That seems a stretch now. While the nation has been enjoying a lull in health care inflation the past few years, even some former administration advisers say a new round of cost-curbing legislation will be needed.
Bohn said the study overall presents a mixed picture.

Millions of now-uninsured people will be covered as the market for directly purchased insurance more than doubles with the help of government subsidies. The study found that market will grow to more than 25 million people. But costs will rise because spending on sicker people and other high-cost groups will overwhelm an influx of younger, healthier people into the program.

Some of the higher-cost cases will come from existing state high-risk insurance pools. Those people will now be able to get coverage in the individual insurance market, since insurance companies will no longer be able to turn them down. Other people will end up buying their own plans because their employers cancel coverage. While some of these individuals might save money for themselves, they will end up raising costs for others.

Part the reason for the wide disparities in the study is that states have different populations and insurance rules. In the relatively small number of states where insurers were already restricted from charging higher rates to older, sicker people, the cost impact is less.
"States are starting from different starting points, and they are all getting closer to one another," said Bohn.

The study also did not model the likely patchwork results from some states accepting the law's Medicaid expansion while others reject it. It presented estimates for two hypothetical scenarios in which all states either accept or reject the expansion.

Larry Levitt, an insurance expert with the nonpartisan Kaiser Family Foundation, reviewed the report and said the actuaries need to answer more questions.

"I'd generally characterize it as providing useful background information, but I don't think it's complete enough to be treated as a projection," Levitt said. The conclusion that employers with sicker workers would drop coverage is "speculative," he said.

Another caveat: The Society of Actuaries contracted Optum, a subsidiary of UnitedHealth Group, to do the number-crunching that drives the report. United also owns the nation's largest health insurance company. Bohn said the study reflects the professional conclusions of the society, not Optum or its parent company.
Report: Claims cost of individual health insurance in WA likely to rise 13.7 percent by 2017

Report: Claims cost of individual health insurance in WA likely to rise 13.7 percent by 2017

A new report by the Society of Actuaries predicts that medical claims costs for individual health insurance plans -- meaning coverage that people have to buy on their own, rather than get through an employer or government program -- will rise 13.7 percent in Washington by 2017. That's substantially less than in many other states.

About 300,000 Washingtonians now buy their own insurance on the individual market. That number's expected to increase sharply next year as people who are now uninsured start buying coverage.

It's too soon at this point to say what the final rates will be. We don't expect to see the first rate proposals for these policies until next month, and premiums include more than just medical claims costs.

There is, however, some good news for many of these folks. The report does not attempt, for example, to factor in the federal subsidies that many people in the individual market will qualify for, starting in January. Under federal health care reform, a family of four earning up to $94,200 could qualify for help paying for their insurance.

Also, under health care reform, the vast majority of policies will cover much more than they do today. It's rare, for example, to find an individual health plan that covers prescription drugs. Many don't cover the birth of a child. Starting in January, most policies will have to cover those things and more.

Lastly, the sad fact is that the individual health insurance market is no stranger to big increases in rates. In 2009 -- well before health care reform -- those policies in Washington rose an average of 16.5 percent. That's in a single year. And the year before that was even worse: an average increase of 18 percent.
Tacoma man arrested for insurance fraud

Tacoma man arrested for insurance fraud

A 24-year-old man facing multiple charges in an insurance fraud case was arrested this morning by the King County Warrant Team at a residence in Tacoma.

Andre Romeo Zamora Sarmiento was charged last year with second-degree theft, forgery and insurance fraud for allegedly filing altered and fake medical bills after a car accident. He failed to appear for arraignment on Dec. 24, 2012, resulting in the warrant that led to his arrest this morning.

The fraud case involves a November 2011 auto collision in Tacoma. A car turned in front of Zamora's car, cutting him off, and leading to the crash.

Zamora subsequently filed a claim with the other driver's insurer for injuries to his back and $2,542 for vehicle damage to his vehicle. For the medical claims, Zamora filed several bills totalling $14,857.

A subsequent investigation by our anti-fraud Special Investigations Unit revealed that several bills were altered and grossly inflated. A bill for $360, for example, had a "9" added, to make it look like a bill for $9,360. A bill for $33.50 was turned into what looked like a bill for $3,358.80.

All told, Zamora submitted claims for $13,236 more than he actually paid. The insurer paid Zamora $5,497 before discovering that the bills were fraudulent.
Q: "My homeowners insurer sent an inspector to look at my home. Can they do this?"

Q: "My homeowners insurer sent an inspector to look at my home. Can they do this?"

It is not unusual for home insurers to periodically inspect the homes they insure.

Generally an inspection might be done after years of providing insurance when an insurer may ask if it's still insuring the same risk that it started out with.

The company might ask your agent to do a site inspection, or might hire an independent company to do site inspections and write reports about what they see, such as maintenance, property/landscape care, and any dangerous conditions that might increase the chance of a loss or injury at your home or on your premises.

There are no insurance laws that prohibit site inspections. Of course you’ll want to set up an appointment so you can be there when the site inspection is made. If a site inspection is made on a ‘drive by’ basis, there is a chance that a report may not be accurate, as you won’t be there to answer questions about any issues that could cause an inspector to be concerned, maybe unnecessarily. If you have questions about the process, we recommend that discuss the issue with your agent.

105 US kids died of flu; most didn't get vaccine

 NEW YORK (AP) — The flu season is winding down, and it has killed 105 children so far — about the average toll.

The season started about a month earlier than usual, sparking concerns it might turn into the worst in a decade. It ended up being very hard on the elderly, but was moderately severe overall, according to the Centers for Disease Control and Prevention.

Six of the pediatric deaths were reported in the last week, and it's possible there will be more, said the CDC's Dr. Michael Jhung said Friday.

Roughly 100 children die in an average flu season. One exception was the swine flu pandemic of 2009-2010, when 348 children died.

The CDC recommends that all children ages 6 months and older be vaccinated against flu each season, though only about half get a flu shot or nasal spray.

All but four of the children who died were old enough to be vaccinated, but 90 percent of them did not get vaccinated, CDC officials said.

This year's vaccine was considered effective in children, though it didn't work very well in older people. And the dominant flu strain early in the season was one that tends to cause more severe illness.

The government only does a national flu death count for children. But it does track hospitalization rates for people 65 and older, and those statistics have been grim.

In that group, 177 out of every 100,000 were hospitalized with flu-related illness in the past several months. That's more than 2 1/2 times higher than any other recent season.

This flu season started in early December, a month earlier than usual, and peaked by the end of year. Since then, flu reports have been dropping off throughout the country.

"We appear to be getting close to the end of flu season," Jhung said.
Job opening: Deputy insurance commissioner for legal affairs

Job opening: Deputy insurance commissioner for legal affairs

Due to a retirement, we're recruiting for one of the top jobs at the Office of the Insurance Commissioner: the deputy commissioner for legal affairs.

The person will be responsible for forming the agency's legal positions related to enforcing compliance with the state insurance code and related federal laws, including matters related to insurers, agents, brokers and unauthorized insurance transactions.

He or she will manage a division of 20 employees and serve as general counsel for the insurance commissioner. The division includes staff attorneys and investigators who support the agency's consumer protection mission.

For more, including detailed responsibilities, requirements, salary and application process, please see the full job listing.
Insurance questions: "What's an `examination under oath,' and do I have to take it?"

Insurance questions: "What's an `examination under oath,' and do I have to take it?"

Q: "My insurer asked me to attend an `examination under oath.' Can they make me do this?"

A: The company has the right to request that you be examined under oath, but it's your decision whether to actually attend and participate. So you can refuse. But keep reading.

Here's the big caveat: As the insured person, you have a responsibility to cooperate with your insurer during an investigation and to provide support for your claim. If you refuse to attend an examination under oath -- these are often known by the shorthand "EUO" in insurance documents -- your insurer has the right to deny your claim and close their case based on what they will call non-cooperation.

The upshot: We recommend that you attend an examination under oath and that you cooperate with your insurer in support of your claim.

After your insurer has the information it's requested and has completed the exam, then it's their responsibility to provide you with a timely coverage decision. If they deny your claim, they need to clearly explain to you why they made that decision.

If you live in Washington state and have insurance questions or want to file a insurance complaint, you can reach us by e-mail or call us at 1-800-562-6900. You can also file a complaint 24/7 through our new online complaint form.

If you live in a different state, here's how to reach your state's insurance regulator.
"An accident drove up my insurance rates, but I wasn't at fault. What's up?"

"An accident drove up my insurance rates, but I wasn't at fault. What's up?"

Some auto insurers base their rates only on at-fault accidents, but others take into consideration all claim activity, whether you were the one at fault or not.

Insurers operate on the statistical principle  that people with current claim activity represent a higher future potential risk than those who have no claims.

Here's the good news: insurers compete against each other, and in Washington we have a particularly vibrant auto insurance market. And rates can vary considerably from company to company, even among similar policies. So -- as we say often -- it really can pay to shop around for alternatives.
Amendments to the Minimum Maintenance Standards - Part 6

Amendments to the Minimum Maintenance Standards - Part 6

This week we continue our review of the amendments to the Minimum Maintenance Standards, which came into effect on January 25, 2013.

Part 6:  Sidewalks
The MMS were amended in February 2010 to require annual inspections of sidewalks for surface discontinuities and required treatment of surface discontinuities that exceeded two centimetres.  The standard has been amended to expressly provide that a surface discontinuity is deemed to be in a state of repair if it is less than or equal to two centimetres.  The standard also provides that sidewalks are deemed to be in a state of repair between annual inspections, provided that the municipality does not acquire actual knowledge of a surface discontinuity in excess of two centimetres.  It will be interesting to see the extent to which the constructive knowledge provision is applied in sidewalk cases.

Toddler With HIV Is Cured—So What’s Next?

In a landmark announcement, researchers said they'd cured the first child with HIV, the virus that causes AIDS. The 26-month-old toddler was born to a mother also infected with the virus, and was started on combination antiretroviral treatment (ART) when she was just 30 hours old. A press release issued by Johns Hopkins University School of Medicine, home to Deborah Persaud, Ph.D., a virologist and the study's lead author, said the news "may help pave the way to eliminating HIV infection in children."

'Do One Thing' With the AIDS Healthcare Foundation

The announcement of the case was presented in Atlanta at a conference on retroviruses and opportunistic infections. The researchers called the finding a "functional cure," which means that a patient shows remission of the virus over a long period of time without treatment and that tests can't detect HIV replication in the blood.

Karin Nielsen, M.D., M.P.H., a clinical professor of pediatric infectious diseases at the University of California, Los Angeles, calls the announcement "exciting news."  What seems to be most important about how this little girl was cured was when her treatment started: She began ART very soon after birth, which seems to have prevented what HIV/AIDS specialists call a "latent reservoir" where dormant HIV cells can hide, making them hard to treat and allowing for the infection to start up again once treatment stops. "Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place," said Persaud in a press release.

Adds Nielsen, who was not involved in the study, says the news supports "the hypothesis that many of us who work in perinatal/ pediatric HIV suspected—that early treatment with antiretrovirals can not only prevent or abort infection, but also impede seeding of reservoirs and revert what seems to have been an established infection," she explains. "If these findings are reproduced in further studies this could definitely change the HIV treatment paradigm in early infant infection, with the emphasis being 'treat to cure.' "

The child continued to receive treatment and by the time she was 29 days old the virus could no longer be detected in her blood. The study's authors say she continued treatment until she was 18 months old, then, for unknown reasons, stopped. Ten months later, she was tested again and the doctors could not find any trace of HIV or HIV-specific antibodies.

The current standard care for babies at risk for acquiring HIV is to give them a lower dose of combination ART for six weeks to prevent infection and continue with a therapeutic dose if an infection is found. But standard treatment may start to change as the result of this watershed case. "These findings will lead to studies of very early treatment in HIV-exposed infants at high risk of infection," notes Nielsen. "If further research confirms that early treatment reverts HIV infection in infants, early intense treatment of infected babies will likely become standard of care."

And is there anything in the announcement that might help HIV-infected adults—could they, too, benefit from very early treatment, right after infection? "Early intense treatment can be instituted, which is something that has been done in selected studies," Nielsen explains. "Cure, however has not been observed to date." The reasons may have to do with the timing of therapy, how the virus was acquired, or other factors that are different between adults and babies, she says. "Nevertheless, if the infant cure findings are duplicated, they serve as a model for achievement of a functional cure which can potentially be extrapolated to adults once details on the pathogenesis are better understood." And that's something to hope for and work toward—for infants, children, and adults.

14 HIV Patients Have 'Functional Cure'

Early and effective HIV treatment may, in a small fraction of patients, lead to a so-called functional cure, French researchers found.

Fourteen patients who were treated within the first two months of infection were later able to stop combination antiretroviral therapy without an HIV rebound, according to Asier Sáez-Cirión of the Institut Pasteur in Paris.

While all 14 still have HIV, in most cases it can only be detected with ultrasensitive laboratory tests and is undetectable by standard methods, Sáez-Cirión and colleagues reported in the journal PLoS Pathogens.

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But in all cases, the infection appears to be under control without the use of drugs – the definition of a functional cure, which unlike a "sterilizing" cure does not completely get rid of HIV.

The report is the second in several days of what appears to be curative early treatment for HIV.

Researchers reported at the recent Conference on Retroviruses and Opportunistic Infections that combination antiretroviral treatment in the first few hours of life appears to have eliminated HIV infection in a baby.

 Nonetheless, in general, stopping HIV treatment is not recommended, said Dr. Michael Saag of the University of Alabama Birmingham.

"In my practice," he told MedPage Today, "I would start everyone with acute infection on antiretroviral therapy, but in general I would just continue that therapy and not stop."

Several studies of so-called treatment interruption have showed that for most people, stopping therapy leads to sharp and dangerous increases in HIV replication, Saag noted.

The difference in this group, the researchers suggested, is that they were treated very early, in what's called primary or acute infection, and spent between a year and 7.6 years on therapy, with a median of 36.5 months.

Their reasons for stopping, Sáez-Cirión told MedPage Today in an email, included a desire to take a vacation from therapy and participation in a treatment-interruption study.

The 10 men and four women have now been off therapy for between four and 10 years. Their plasma viral loads are below 40 copies of HIV RNA per milliliter in all but three cases, and below five copies in five patients.

The virus is conventionally regarded as "undetectable" if the plasma viral load is below 50 copies per milliliter, although so-called single-copy assays – only rarely used outside the lab – can detect smaller amounts of HIV.

What Sáez-Cirión and colleagues are calling "post-treatment controllers" are not common, they noted.

When they looked at the French database of HIV patients from 1997 to 2011, they found just 756 patients who were treated within 6 months of infection and who maintained therapy for at least a year.

Of those who had a detectable viral load before therapy and an undetectable one afterward, just 70 stopped treatment and had subsequent viral load measurements.

Kaplan-Meier estimates of that population suggested the probability of maintaining viral control after a year was 15.3 percent.

That means, Saag noted, that about 85 percent of patients treated early will still face viral rebound if they stop treatment.

Although the phenomenon may not have immediate clinical implications, he said, it's "proof of concept" that the immune system can control HIV in some circumstances.

It may also offer hope for a vaccine, he said. "It shows there is some immune response," he said, "that can be stimulated not just to control infection but to prevent infection if that part of the immune system can be primed and activated."

Indeed, the researchers argued that study of these patients and others like them could "open up new therapeutic perspectives" for people with HIV.

Among other things, they found that the immune systems of post-treatment controllers don't resemble those of "elite controllers" – the 1 percent of the HIV-positive population that appears to have a natural ability to control the virus.
The elite controllers tend to have protective HLA class I alleles, but the 14 patients tended to have HLA variants associated with a higher risk of HIV progression, they reported.

As well, elite controllers have large numbers of highly efficient HIV-specific CD8-positive T cells; the post-treatment controllers have "very weak" and in some cases barely detectable HIV-specific CD8 responses.

On the other hand, there's at least one important similarity: Both groups have small HIV "reservoirs" -- groups of infected cells that give rise to new virus, leading to viral rebound when therapy is stopped.

The finding suggests that "limiting the pool of infected cells is crucial for the successful control of viral replication in the absence of therapy," Sáez-Cirión and colleagues argued.

And, they concluded, early therapy, continued over a prolonged period, "likely played an important role in reducing the reservoirs."

That said, it remains "unclear" what factors distinguish the patients who achieved control from those who did not.

New York mayor wants to ban stores from displaying cigarettes

New York Mayor Michael Bloomberg on Monday proposed requiring that cigarettes be hidden from view in retail stores as a means to reduce smoking in what he said would be the first law of its kind in the United States.

Bloomberg plans to introduce to the City Council on Wednesday two bills that would require retailers to keep cigarettes in a drawer, behind a curtain or in some other concealed location.
 Some retail trade groups and tobacco companies criticized the proposed display ban as an unnecessary burden.

Bloomberg, a former smoker, is accustomed to industry opposition from previous measures to improve the health of New Yorkers, including bans on smoking in most offices, restaurants, bars, parks and on beaches.

Bloomberg has also taken steps to curtail the use of trans fats and salt in the city's restaurants. Last week a court unexpectedly struck down his attempt to limit the size of sugary drinks, in part because it did not go through the City Council. The city is appealing that ruling.

"These laws would protect New Yorkers, especially young and impressionable New Yorkers, from pricing, discounts and exposure to in-store displays that promote tobacco products," Bloomberg told a news conference at a city hospital.

"Such displays suggest that smoking is a normal activity and they invite young people to experiment with tobacco. This is not a normal activity," he said.

Stores would still be allowed to advertise and display pricing information but the actual tobacco products would only be visible during a sale or restocking.

Under current federal and state laws, cigarettes must be accessible only to a store's cashiers, and in many city stores they are prominently stacked on a wall behind the cash register.

The proposal would also increase penalties on stores that illegally resell cigarettes smuggled in from states with lower tobacco taxes, which Bloomberg said cost the city $30 million in lost tax revenue every year.

Over the last 18 months, inspectors visiting 1,800 cigarette retailers found 46 percent were selling untaxed or unstamped tobacco products, city officials said. New York City cigarettes are the most expensive in the nation at around $12 or $13 a pack after federal, state and city taxes.

The legislation would also prohibit retailers from redeeming discount coupons on tobacco sales.

The Food Industry Alliance of New York State, a trade group representing groceries and convenience stores, said the display law would be an unnecessary additional and potentially costly burden on retailers without any proven effect.

"I'm not a proponent of smoking. I am a proponent of retailers who are licensed to sell a legal product being able to do so without undue government interference," said Michael Rosen, the alliance's vice president for government relations.

Altria -- the parent company of Philip Morris USA, the nation's largest cigarette manufacturer -- also said it opposed the display ban and that it should be left to the U.S. Food and Drug Administration to regulate tobacco sales.

"We believe it goes too far," said David Sutton, an Altria spokesman.

The company still needed to see the details of the legislation but suspected it could breach free speech rights, Sutton said.

Bloomberg expected to have the council's support, although a vote was not expected immediately, a spokeswoman for the mayor said.

Christine Quinn, the council speaker and a leading candidate to replace Bloomberg in the November election, supported the goals of the bills but needed to review details before commenting further, a council spokeswoman said.

Bloomberg's previous bans on smoking in public places have corresponded with a decline in the number of New Yorkers who smoke, from 21.5 percent in 2002 to 14.8 percent in 2011, according to the city's health department.

Smoking remains the leading preventable cause of death among New Yorkers, the department says.

7 Steps to Cut Cancer Risk in Half

Following six of the steps can even cut  cancer risk in half, said Laura Rasmussen-Torvik, a professor of preventive medicine at Northwestern University’s Feinberg School of Medicine. She said she and her colleagues just had a hunch that following healthy-heart guidelines would also decrease the risk of cancer.

And their findings confirmed that hunch. Adhering to four of the  steps in Life’s Simple 7 resulted in a 33 percent cancer risk reduction, and following  six or seven led to a 51 percent cancer risk reduction, according to the study, which was  published today in the journal Circulation.

“We just wanted to test that hypothesis,” Rasmussen-Torvik said. “We hoped the information would provide extra motivation for the public to check out  Life’s Simple 7.”

The American Heart Association developed the seven steps in 2010 with the goal of reducing heart attack and stroke deaths by 20 percent by 2020.

Rasmussen-Torvik and her fellow researchers examined two decades of data from the Atherosclerosis Risk in Communities study, looking at the health records of 13,253 patients from 1987 to 2006. They found that the more steps patients followed, the less likely they were to develop cancer.

Here are the steps in the Life Simple 7:

1.    Get active —  AHA recommends at least 150 minutes of exercise a week.

2.   Control cholesterol — Cholesterol should be lower than 200 milligrams per deciliter.

3.   Eat better — This means foods high in whole grain, fruits, vegetables and lean protein such as  fish. Limiting sodium, added sugars, trans and saturated fats is also important.

4.    Manage blood pressure — It should be less than 120/80.

5.    Lose weight — body mass index should be below 25.

6.    Reduce blood sugar — Fasting blood sugar level should be below 100, which can be achieved  by avoiding soda, candy and other desserts, as well as getting exercise.

7.    Stop smoking — AHA says  do “whatever it takes.”

The steps are cumulative, but quitting smoking was especially helpful, the researchers found.  There’s also a considerable amount of overlap in the steps, considering that getting active and eating better — steps 1 and 3 — help with cholesterol, blood pressure, weight  and blood sugar – steps 2, 4, 5, and 6.

The National Cancer Institute estimated that 12.5 million people had cancer in the United States as of Jan. 1, 2009. The Centers for Disease Control and Prevention estimated that 5.7 million people had heart disease.

Rasmussen-Torvik, who couldn’t say why these steps lowered cancer risk because cancer was not her area of study, said she hoped patients would  be willing to follow the Simple 7  because they decrease the risk of two potentially deadly health ailments.

“Any little added encouragement for people to adopt these recommendations is great,” she said.

Is Cancer Contagious? Could Hugo Ch vez Have Been Deliberately Infected?

Venezuelan officials announced this week that they would investigate whether enemies could have deliberately infected late President Hugo Chávez with cancer. Chávez died on March 5, apparently of a heart attack, after battling cancer for two years.

When the former Venezuelan president was diagnosed with an undisclosed form of cancer in 2011, he speculated that his enemies could have given him the disease. He also implied that U.S. agents could have developed a technology to induce cancer, according to a CNN news story at the time. The U.S. State Department called the accusation “absurd.”

The theory that someone could be infected with cancer is not biologically impossible, but it is unlikely. A healthy immune system will combat any foreign cells, including cancerous ones. Only three types of contagious cancers have been identified, and all occur in non-primates.

Scientific American spoke with Katherine Belov, professor of comparative genomics at the University of Sydney who studies a contagious cancer called Tasmanian devil facial tumor disease. She explains why contagious cancers are rare and whether cancer could infect another person.

[An edited transcript of the interview follows.]

What are contagious cancers?
 In humans, we know that you can catch viruses, like the human papillomavirus, which make you more likely to get cancer. [ HPV can cause cervical cancer in women, and genital warts and anal cancer in men.] In humans, environmental causes play an important role, too—cigarette smoke and radiation exposure can cause cancer. However, we don't have any clear examples of [naturally occurring] transmissible cancers in humans.

There is a transmissible cancer in dogs. It’s a sexually transmitted disease called canine transmissible venereal tumor, or CTVT. And there is also the Tasmanian devil facial tumor disease, which I work on. The devil’s cancer causes large ulcerations in their mouth and around their jaw. When they fight—and they fight a lot—they are biting other animals, and the cancerous cells are implanting in other animals’ wounds.

In both the Tasmanian devils and in the case of CTVT, the tumor evolved in really inbred populations of animals. There was a lack of diversity and so the cancer is genetically very similar to the animals it passes to.

Why does lack of diversity help the cancer jump from animal to animal?
 The cancer is transmitted to animals that are genetically similar to one another and also to the tumor. The immune system doesn't "see" it and doesn't mount an immune response. The cancer can then grow until it kills the animal.

Over time the devil’s facial tumor disease would have encountered animals that were genetically dissimilar to it. But the cancer found a way to down-regulate [or produce fewer] cell-surface molecules, which are sort of red flags to the immune system in genetically different animals. These flags are part of the major histocompatibility complex [a set of molecules attached to cells that regulate interactions with immune cells]—they are MHC molecules. Without those special immune molecules the cancer is able to fly under the radar of the immune system and pass from animal to animal.
So the immune system doesn’t just identify viruses and bacteria—it also keeps watch for any types of foreign cells?
 And even cells from your own body that are dangerous. Cancers are just from a mutation in a cell. Our immune system is patrolling and looking for those cancerous cells. If our immune system sees a cell is cancerous, it will kill it. So cancers arise often, but we don't really know about them.

Why hasn’t contagious cancer evolved in humans?
 One of the key reasons is our genetic diversity. In a population where there is a lot of genetic diversity, we all have very different versions of the flags I’m talking about. So if a cell gets into us and has a different combination of flags, our immune system will kill it.

And that's why, if you need organ transplantation, you go to close family members. They are more likely to share the same flags as you do, [making it more likely for the transplanted organ to be tolerated by your immune system]. Still, there will be some variation in the combination of these cell surface flags that they have, which is why usually recipients of organ transplantation are given immunosuppressant drugs.

There are rare cases when a cancer has been passed from one person to another. Can you describe any examples?
 A mother can pass cancer on to a fetus—for example, things like melanoma have been passed from mother to fetus.

Also, during organ transplantation, if the organ donor has cancer, it is possible to transmit cancer that way. Again melanoma is a clear example there. Someone may not even realize that they have a small melanoma that metastasizes and spreads to an organ. When they transplant that organ, the recipient develops melanoma as well.

Would it be possible to get cancer from a blood transfusion?
 I guess [that would be possible] if there are blood cancer cells in the transfusion. But normally the cancer cells would look foreign to yours, so there is a very good chance your immune system would mount a response. If that cancer in some way could be invisible to your immune system, either because it is genetically similar to your cells or the cancer has been modified or evolved in some way to be overlooked by the immune system, I suppose [a cancer] could [happen].

In the case of organ recipients they are being immunosuppressed to help their body accept the new organ—if you were on immunosuppressant drugs and you got a blood transfusion, then [a cancer infection] would be more likely to happen.

Would injecting someone with cancerous cells infect them with cancer?
 There has been a case where a surgeon received a cut during surgery and developed cancer at the site of the cut. And so presumably in that way the cancer cells found a way to implant in his skin and begin to grow.

You cannot catch cancer easily, however. These cases are rare. I know there have been cases in the literature where cancer has deliberately been transmitted between people and it has successfully taken. But it’s a situation where they've been close relatives. Otherwise the immune system would kill the foreign cell.

Would it be possible to induce cancer in someone else—not by giving the person cancer but by exposing him or her to something that causes cancer?
 I suppose it's possible. We know that viruses can cause cancer, for instance. If you could make sure that a cancer-causing virus infected a person, he or she could develop cancer. The same would be true with radiation, asbestos or other carcinogens.

I just can't imagine someone deliberately giving someone else cancer. What a horrible thing to have happen! It had never occurred to me before I had this conversation. But I suppose people have an amazing capacity to do horrible things to each other. I couldn't say it was impossible, but I'd like to think it is highly unlikely.
Labor Department Pick Signals New Concern for Self-Insurance Industry

Labor Department Pick Signals New Concern for Self-Insurance Industry

The announcement today that President Obama has nominated Tom Perez as the next Secretary of Labor arguably sets the stage for a strong federal push to restrict the ability of thousands of employers nationwide from sponsoring self-insured group health plans.

This provocative conclusion requires the connection of several dots, so we’ll lay them out for your consideration.

As this blog has reported previously, federal regulators have been asking lots of questions about self-insured group plans since the passage of the ACA.  More specifically, they are trying to determine whether smaller self-insured employers that purchase stop-loss insurance with “low” attachment points constitute a “loophole” to the health care law and that these employers are somehow “gaming” the system.

We’ve methodically discredited these assertions multiple times, but it’s important to set the stage as new developments are reported and additional context is provided.

Since insurance is largely regulated at the state level, the obvious question arises regarding how the feds can regulate stop-loss insurance should they wish to do so?  This can clearly be done through federal legislation or potentially through regulation. 

The regulatory route is more complicated as the ACA does not provide any explicit statutory authority for such action.  But regulators can be a creative bunch, especially under the current Administration.

The creative theory is that federal agencies with jurisdiction over the Public Health Services Act (PHSA) and the Employee Retirement Income Security Act (ERISA) may rely on the their general rule-making authority given to them under their respective laws to argue that the federal government may indeed need to regulate stop-loss insurance and re-characterize stop-loss policies with “low” attachment points as “health insurance” through regulations separate and apart from the new law. 

While this action would be controversial and subject to challenge by Congress and private citizens, it is possible that a rule-making process could be initiated to achieve this policy objective.

Based on discussion with key regulators as recently as last week, such a rule-making process is unlikely to occur this year.  This blog speculates that the primary consideration for inaction at this point is that regulators are simply overwhelmed with finalizing all of the rules and related guidance required for full ACA implementation at the end of this year.

Once these deadlines pass, however, the regulators will have more bandwidth to circle back on ancillary areas of interest.  Here’s where we connect the dot with Mr. Perez’ name on it.

While the career professional staffers within DOL (non-political appointees) are competent and at least reasonably objective in most cases, the new agency head is anything but.

Mr. Perez comes with baggage from his tenure within the Justin Department where evidence strongly suggests that at least some of his civil rights enforcement decisions were influenced by political considerations.   In short, he a “social justice” guy who fits nicely into the Administration’s template for policy-making.

His resume also includes a stint with HHS under the Clinton Administration and a senior staff position with the late Senator Ted Kennedy.  Rounding out his big government pedigree, he is a graduate of Harvard Law School and the George Washington Public School of Health.

All of this background suggests that Mr. Perez will be inclined to position DOL as a more activist agency with regard to health care reform issues, including stop-loss insurance regulation.   This motivation will likely be particularly acute if the SHOP exchanges run into early problems with lack of enrollment as many experts predict.

For the sake of discussion, let’s assume this analysis is correct.  In this case, then Secretary Perez could push for a rule-making process as described earlier, or perhaps lead an effort to close the self-insurance “loophole” through federal legislation.  Let’s connect another dot.

As a technical matter this would a “cleaner” approach and not subject to legal challenge.   Congress could simply enact legislation amending the definition of “health insurance” under the PHSA, ERISA and the Code to include, for example stop-loss policies with a “low” attachment point.

Given that Republicans control the House right now and are generally supportive of self-insurance, the politics do not support this potential strategy.   But if you believe recent public commentaries that the Administration’s grand political plan is focused on the objective of Democrats winning back control of the House in 2014, the legislative pathway becomes clearer. 

Und this scenario, it’s hard to imagine that a Secretary Perez would not push for a legislative “fix.”  After all, it’s not fair that some citizens are saved from the exchanges in favor of receiving quality health benefits from their employers, right?   Social justice, indeed. 

And the last dot is connected.


The Coming Crossroads for LRRA Legislation

The Coming Crossroads for LRRA Legislation

It’s been a while since we’ve reported on efforts to modernize the Liability Risk Retention Act through federal legislation, but there may be some new developments this spring worth discussing.

A key congressional source confirmed today that draft legislation is currently being vetted in the House prior to potential introduction in the next month or two.  While previous versions of the bill included a federal arbitration provision to address situations where non-domiciliary regulators take actions against RRGs operating in their state that should be preempted by the LRRA, this provision will not be included in this year’s bill if it introduced.

This is largely a political consideration, as the chairman of the House Financial Services is extremely sensitive about any legislation that can be viewed as expanding the role of the federal government in the regulation of insurance.   This blog takes the contrary view in that such a provision actually strengthens the home state regulator, but the politics are what they are.

With the arbitration provision stripped out, the main focus of the bill will be to allow RRGs to write commercial property coverage.  In anticipation of this expected development, several captive insurance leaders were polled to take their temperature on the relative importance of such a change to the LRRA.

The feedback was mixed evidenced by the sampling of responses as follows:

On The One Hand….

“I think ART as an industry needs as many tools as possible in the toolbox and any victory we can get, however small, is a step in the right direction.”

“I would like to see this pass because people keep thinking this only expands to commercial property – not so – it would allow auto physical damage.”

On the Other Hand….

“I’m of the opinion that RRGs time as a viable ART risk funding mechanism is waning.  I say this because of the NAIC’s accelerating aggressiveness in its attempt to impose governance standards on RRG domiciliary states equal to or greater than those imposed on traditional insurance companies.”

“Even with reinsurance backing the level of property risk undertaken by an RRG is not likely to create the beneficial impact for RRG members compared to the liability segment.”
So for an industry that can be apathetic when it comes to federal legislative/regulatory developments, even when everyone is in agreement, it will be interesting to see if any meaningful support materializes if/when LRRA legislation version 2.0 is introduced given differing opinions on the relative importance.

Given that the probability of a 3.0 version anytime in the foreseeable future is close to zero, get ready for the crossroads.

"I got the check for my car repair, but it doesn't include all the damage."

"I got the check for my car repair, but it doesn't include all the damage."

Q: "The insurance claims adjuster sent me a check for my car repair, but what if there are added repairs that still need to be made?"

If there is other accident-related damage that was missed in the initial estimate, then have the repair shop call the claims adjuster to verify the damage and authorize repair.

Here's the key part, though: That call has to happen before repairs are made, since the adjuster must verify that the damage is related to the covered accident.

If there is no verification and repairs are made, you may be responsible for paying the added costs.
Jury convicts Spokane man of fraud in case of $200,000 patio cover

Jury convicts Spokane man of fraud in case of $200,000 patio cover

A Spokane jury this afternoon convicted a Spokane man of insurance fraud and attempted theft after a snow-damaged patio cover worth about $4,000 mushroomed into a fraudulent insurance claim for nearly $200,000.

Keith R. Scribner, 48, will be sentenced April 16th in Spokane County Superior Court. Both the charges are felonies.

In late July 2009, Scribner's mother, Marilyn Warsinske, filed a claim with Liberty Mutual insurance. She said a patio roof at a home she'd purchased had collapsed due to the weight of snow some 6 months earlier. The policy covered "like kind and quality" replacement. Her son, she told the company, would handle the claim.

Scribner told the insurance company that patio cover was an extensive structure, spanning the entire length of the patio and wrapping around the home's chimney. Claims officials, inspecting the site, wondered why was there no flashing or holes in the masonry. Scribner said that house painters must have made repairs.

He sent the insurance company three bids to replace the cover based on his description. The bids ranged from $195,586 to $213,815.

Claims officials asked Scribner for any photos of the roof prior to the damage or after it collapsed. Perhaps some were taken during a home appraisal prior to the purchase, they suggested. Scribner said there were no photos and was no appraisal.

But a claims handler discovered an aerial photo of the home on a real estate website. It showed a much smaller patio cover than Scribner claimed.

The company launched a fraud investigation and notified Insurance Commissioner Mike Kreidler's anti-fraud Special Investigations Unit.

As it turned out, there had been a home appraisal, the investigators discovered. In fact, Keith Scribner met with the appraiser. And the appraisal included photos of the patio cover. A real estate agent interviewed by investigators described the cover as being "small and nothing special or significant."

The home's previous owner also provided photographs of the structure. It was originally canvas. When that because troublesome to remove each year, the homeowner bought a polycarbonate cover. Cost: About $300.

An architect told a state fraud investigator that he'd met with Scribner in 2008 -- months before the snow collapse -- to discuss plans to replace the deck cover with new, larger one.

A local company, provided with measurements and photographs of the original structure, drew up replacement bids at the request of a state fraud investigator. The bids: $3,913 and $4,782.
Amendments to the Minimum Maintenance Standards - Part 5

Amendments to the Minimum Maintenance Standards - Part 5

This week we continue our review of the amendments to the Minimum Maintenance Standards, which came into effect on January 25, 2013.

Part 5:  New Ice Formation and Icy Roadways Standard
The MMS previously required municipalities to treat icy roadways within a prescribed time after becoming aware that the road was icy.  This remains the standard for roads that have become icy but is now part of a larger, more comprehensive standard for ice prevention and treatment. 
The standard for prevention of ice formation requires municipalities to monitor the weather and patrol as described above.  If, as a result of these activities, a municipality determines that there is a substantial probability of ice forming on a roadway, it must treat the road to prevent ice formation within a specified time, starting from the time it determines is appropriate to deploy resources for that purpose.  Treating a road means applying material, including but not limited to salt, sand or a combination. 
The ice prevention standard provides that roads are deemed to be in a state of repair until the time that the municipality becomes aware that the roadway is icy or the applicable time for ice prevention expires, whichever is earlier.  This should be read in conjunction with the constructive knowledge provision.  The icy roadways standard has also been amended to provide that roads are deemed to be in a state of repair until the applicable time for treatment expires.
As with the snow accumulation standard, the ice prevention standard is a response to the narrow interpretation of the icy roadways standard in Giuliani.  The discretion afforded to municipalities to determine when to deploy resources to prevent ice formation may be subject to challenge in future claims.  Nonetheless, compliance with the standard will assist in defending claims where it is alleged that a municipality failed to anticipate icy road conditions.
Hearing: Proposed acquisition of Western United Life Assurance

Hearing: Proposed acquisition of Western United Life Assurance

Commissioner Kreidler has scheduled a 10 a.m. hearing on March 21 to consider a request to acquire Washington-based Western United Life Assurance Company.

Central United Life Insurance Company is proposing to acquire common shares of Western United Life Assurance Company from Western United's current owners, Global Life Holdings Inc. The acquisition would allow Central United to acquire all common shares of Western United and become its controlling entity.

Central United Life Insurance is an Arkansas stock life insurer with its headquarters in Houston, TX. It has been licensed in Washington since 1974. It writes mainly life and accident and health policies in Washington. Western United Life Assurance is a Washington stock life insurer with its headquarters in Spokane, WA and was established in 1963. Western United writes mainly annuity considerations in 16 states.

Any interested parties may submit letters of support or concerns or objections and/or may participate in the hearing by appearing in person or by telephone at no charge.

For more on this hearing, please go to our hearings archive and look forWestern United Life #13-0033. There you'll find details on how to participate in the hearing and view all documents filed in this matter.

Help Your Liver Remove Toxins

In two previous articles (here and here) I examined liver function, detoxification and the environmental chemicals we all encounter. I also addressed serum liver testing and how to monitor your liver function without blood tests. In this article I’ll discuss what you can do to keep your liver in optimal health.

Clean Up Your Environment

There are hundreds of untested chemicals (endocrine disruptors) in our personal care products and cosmetics. There are fumes in household cleaners. There are chemicals like food dyes and additives in food. All these comprise your “body burden” and are known to exacerbate physical symptoms from allergies and asthma to headaches and fatigue.

But is it really possible to eliminate harmful environmental chemicals in this modern world? Not completely, I don’t think; but we can go a long way. Here are some ideas to consider for helping your body cope (the most important first).
 Eat mostly raw, whole foods. Start with fruit/nut smoothies. Drink fresh juice. Do all you can to eliminate processed and “fake” foods that contain additives, dyes and preservatives.
 Choose your personal care products (soap, deodorant, shampoo, face cream, etc.) carefully. All these products with ingredient names that are long and difficult to pronounce are likely to be synthetic chemicals that were never intended to make you healthier. At your health food store you can find natural alternatives containing herbs and plants instead. Expect to pay more for these and be glad you found them.
 Use plastics wisely. Don’t microwave food in plastic containers. Use only glass or BPA-free food containers and baby bottles.
 If you use Teflon pans, avoid heating to where they begin to smoke (generally beyond 450° F) and release toxic gases. Use glass bakeware and stainless steel or cast iron pots and pans.
 Switch from the standard cleaning products (containing chlorine bleach) to vinegar, baking soda and hydrogen peroxide. There is a great recipe for whitening laundry without using chlorine bleach here.
 Avoid toxic pest control in your home and on your lawn, garden or fruit trees.
 Clean your air by ventilating often. The more green plants you have indoors the better, because they serve as natural air detoxifiers.
 Clean your water by getting a shower filter and a drinking water filter.
 Reduce electromagnetic frequencies (EMF) from cellphones, laptops and other machinery that produce or use electricity.

Further Measures

Your liver is the “vacuum cleaner” of your bloodstream. Therefore, fewer toxins in your body cells and fluids allow the liver to more efficiently detoxify.

Drink six 8-ounce cups of water a day to help flush out metabolic by-products (though this really is not going to have a sufficient effect).

If you add lemon to your water, you’ll support phase 2 liver detoxification; but that is still not enough. Add on an exercise routine that causes a good sweat, and you’ll start to move toxins out of your body. Furthermore, a liquid cleanse can really jump-start your health and liver-cleansing function.

A liquid cleanse can be done safely without a doctor’s guidance if you understand some basic rules.

Liquid cleansing can be performed at one of three different intensity levels for three to 10 days or more. The easiest is a fresh juice “feast” with no solid food. The lemonade cleanse described below is one such cleanse. Alternatively, the most intense version of a cleanse consists of a water fast. (You ingest only water.) I recommend that water fasts should be done only under supervision of a healthcare professional.

Depending on the intensity of your cleanse method and your health level, you can expect to experience the symptoms of detoxification that include sweating, increased urination, diarrhea or decreased bowel movement, mild weakness, a change in breath odor, and possibly aches and pains. The aches and pains occur in weaker body areas and only during the first two to three days before improvement ensues. For example, if you have arthritis, then expect your joints to ache. We call this a “Herxhiemer reaction” (feeling worse before feeling better). This is thought to be an effect of tissue cells releasing stored chemical waste.

The Lemonade Cleanse

Ingredients needed:
 Grade B maple syrup. (Do not use grade A or “pancake” maple syrup.)
 Large bag of fresh lemons or limes. (Do not use from concentrate.)
 Cayenne spice. (This may already be in your kitchen)
 Six water bottles so you can prepare several at once and store in refrigerator for up to six hours.


Mix the following ingredients into 16-ounce water bottles to desired taste:
 Water. (Nearly fill up bottle.)
 Juice from half to one fresh-squeezed lemon or lime.
 Grade B maple syrup. (Can use stevia drops.)
 Cayenne pepper. (Begin with only a pinch and adjust amount for desired taste; greater cayenne amounts stimulate more cleansing.)

On the second and succeeding bottles, experiment with more or less citrus juice, more or less maple syrup and more or less cayenne. For lunch or dinner, consider using hot water (like a soup broth) with increased cayenne to get a powerful spice taste. Drink six to 12 of these full bottles per day. Remember, this is your food and your drink for each day you are on the liquid cleanse. You will find that your hunger decreases substantially after the third day.

Following a liquid cleanse, you must be careful to return slowly over three to seven days to cleansing foods (mostly raw whole foods). These liver-supporting foods are the raw whole foods. (Have you heard that before?) Some of the more powerful ones are garlic, onions, artichoke, beets, burdock and green leafy vegetables (kale, spinach, beet greens, dandelion greens). Of course, you can eat clean animal meats (organic, free range) and foods with healthy fats (fish, oils, nuts, avocado).

In my next article I’ll go into detail on what liver protective and cleansing supplements you’ll want to know about.

To your ongoing great health and feeling good,

What Dieting Does To You

Millions of Americans diet to lose weight, eating skimpy portions and struggling to control what they consume. Researchers in the Netherlands, however, find that these diets don’t keep off the pounds. But they do have another big effect.

Dieting, according to this study, produces huge helpings of depression, anxiety, lowered self-esteem and guilt. The Dutch scientists found that dieters, by the end of the day, eat just as much as non-dieters but they just feel a lot guiltier about it.

The researchers conclude: “(Dieting) is not an indicator of actual restricted food intake, but rather a reflection of concerns about food and eating manifested in eating-related guilt.”

The Habit That Doubles Your Risk Of A Fatal Brain Bleed

More than 45 million Americans do this activity every day. And it doubles their risk of a fatal brain bleed from a burst aneurysm.

The nasty habit is smoking. Research shows that smoking more than a pack a day doubles your risk of an aneurysm bursting in your brain and killing you.

 An aneurysm is a bulge in a weakened artery, which, if it bursts, causes blood to leak into the brain. The chances of surviving a ruptured aneurysm are only about 50-50; and if you survive, you’ll be disabled for life.

 In the short term, smoking thickens blood and drives up blood pressure, both of which can increase the risk of a brain bleed. These effects can be reversed by stopping smoking.

But smoking also induces permanent changes in the structure of artery walls, say the scientists. These changes may be greater in heavy smokers.

Students Lose Combined 756 Pounds at S.C. Boarding School

A dozen Missouri teens shed 756 pounds after spending a semester at a South Carolina boarding school, where getting fit is part of the curriculum.
 Set on 43 acres in Bluffton, S.C., Mindstream Academy caters to overweight middle and high school students who are serious about getting healthy but not missing class. The school offers a wide range of activities, from Zumba to horseback riding.

Cameron Larkin, one of the dozen students from Missouri who spent a semester at Mindstream Academy, said he learned how to exercise and build his endurance at the school.

"It's really not easy," he said. "You have to have the confidence to say, 'I can go do this.'"

Cameron, and his friends from Independence, had their nearly $29,000 tuition paid for by the Independence School District, along with their families and several charities.

A typical day at Mindstream Academy begins with stretching, followed by a light half-mile walk or run around the lake, according to the school's website.

Students then go to classes and have a pre-lunch workout, such as martial arts, that helps them focus on proper mechanics, the school said.

PHOTOS: Ups and Downs of Celebrity Weight

During the mid-afternoon, classes break for team sports activities, such as soccer or kick ball.

In the evening, a stroll around campus or a pick-up game of basketball rounds out the day.

At the end of the four month program, the 12 students from Independence shed a combined 756 pounds.

Chelsea Neely, one of the dozen students from Independence, said the investment was worth every penny.

"I've proven to myself that I am important," she said. "And what's to come is the greatest thing."

13 Secrets the Weight Loss Pros Don't Tell You

" Good Morning America" teamed up with Reader's Digest on a special series, " 13 Things Experts Won't Tell You."

This month, Reader's Digest unveils the secrets weight loss professionals won't tell you, like how to maximize your workouts, what may be holding you back from losing weight and how to get the most bang for your buck.

*Special thanks to Sports Club/LA for letting "GMA" film in their San Francisco location.
 1. Do not arrive at a training session in the following states: a. on an empty stomach, b. coming off a cold/stomach bug, or c. on four hours' sleep. It wastes your time and a personal trainer's when your body isn't fueled, hydrated and ready to work.

2. If you find your workouts are getting a little stale, a trainer is a great way to put some pep in your push-ups. If you can't afford one, get some friends together for a small group session. They cost less per person - and working out with friends is proven to improve your commitment and overall weight loss.

3. To kick start your metabolism, opt for intervals. In a recent study, women who did 20 minutes of cycling sprints lost three times as much fat as those who cycled slowly and steadily for 40 minutes.

4.When you hit the point where you think you can't go on, imagine you have a trainer right next to you, cheering for you. Studies show that actively encouraging yourself improves outcomes.

5.You can do OK at the drive thru. There are now some reasonable options if you look for them. Stay away from anything with the word "crispy," steer clear of all mayo-heavy sauces (use mustard instead) and stick to no-fat dressing.

6.Nibble on the move. If you are shopping and fading from hunger, avoid settling in at the food court and, instead, nibble your way through a shopping marathon. Pick up a snack, such as a hot pretzel, a small bag of roasted nuts from a kiosk or even a chicken taco and nibble on the move. Portable meals can still weigh you down, so check calorie counts on your mobile phone before you go.

7. Douse your afternoon slump or hunger pangs with water. The energy drop that hits in afternoon is likely a combination of perfectly natural factors - the results of a light lunch, mild dehydration, a momentarily lack of iron or a crash off that coffee you had at the late-morning meeting. Before wandering to the cafeteria or fridge, start your recovery with a tall glass of water, which boosts your blood flow and, as a side benefit, makes you feel full.

8. It's hard to win against a cookie. While food is not addictive the way cocaine or alcohol is, there are some uncanny similarities. When subjects at Monell Chemical Senses Center in Philadelphia were shown the names of foods they liked, the parts of the brain that got excited were the same parts activated in drug addicts.

9. Your bedroom, not the kitchen might be making you fat. Sleep deprivation upsets our hormone balance, triggering both a decrease in the hormone leptin (which helps you feel full) and an increase of the hormone ghrelin (which triggers hunger). As a result, we think we're hungry even though we aren't - and so we eat. Sleep may be the cheapest and easiest obesity treatment there is.

10. Your weight really is genetic. When scientists first discovered a gene in certain chubby mice, they called it simply the fatso gene. Turns out, people with two copies of the gene were 40 percent more likely to have diabetes and 60 percent more likely to be obese than those without it. Those with only one copy of the gene weighed more too. But your "destiny" is no excuse.

11. Ear infections can taint your taste buds. In one study of more than 6,000 people, researchers found that people over age 35 who had suffered several ear infections had almost double the chance of being obese. Why? These infections can damage a taste nerve running through the middle ear. When researchers found the at former ear-infection patients were a little more likely to love sweets and fatty foods, they theorized that the damaged nerve might cause them to have a higher threshold for sensing sweetness and fattiness.

12. Fat might be your mom's fault. A growing body of science suggests that sugary and fatty foods consumed even before you're born can mess with your weight.

13. At dinner, make yourself useful serving people and cleaning up. It gets you away from your plate, but still makes you a vital part of the meal.

*Web Extra Tips: What Your Personal Trainer Won't Tell You*
If you concentrate on the exercise you are doing with the same intensity as talking about the latest gossip about your life, you would find it easier.
Trainers know you are eating more than you tell them.
It takes more than writing a check or showing up for training sessions to make you fit and healthy. It's what you do before and after you meet with your trainer, including choices with food, alcohol and workouts, and a commitment to a new lifestyle.
Ask you trainer what she or he does to keep educated in the field. An educated trainer will get better results and provide variety to keep you engaged and motivated in your workouts.
When you are late, it is a waste of your money, a waste of my time and disrespectful.
Trainers see through your stall tactics. "I think I need to fill my water bottle." "Let me get a dry towel real quick." "Oh, I need to go to the bathroom again." Nice try. But you're paying for the session, so make every minute count.
There is a difference between pain and burn, and you need to be honest with your trainer about which you're feeling. If you push so hard that you injure yourself, you both lose.
Whatever the text or email says, it can wait until you're done with your workout. And no, you cannot text and put forth 100 percent effort at the same time.
The trainer does not have time to get sick. Cancel your session if you're carrying germs.
Gear matters. Don't expect to get maximum performance and results by working out in the ratty gym shoes and shorts you dug out of that old box of college dorm clothes. Invest in a good pair of sneakers. Your feet and joints will thank you, and so will your trainer.
Remember that a 30-minute session at max effort is better - and cheaper - than 60 minutes of dawdling and half-effort.
Stop whining and push through those last few reps.
"My agent said I had `full coverage' but won't pay my claim. What gives?"

"My agent said I had `full coverage' but won't pay my claim. What gives?"

Q: My agent said I had "full coverage," but when I turned in a claim, I was told that the claim was excluded. What's going on?

In insurance, there's rarely any such thing as "full coverage." Virtually all (if not all) insurance policies have conditions, limitations and exclusions.

It's critical to find out what those conditions, limitations and exclusions are before buying a policy and before you have a claim.

If an agent won’t explain the conditions, limitations and exclusions, then find one that will. If you don’t ask, then you may be surprised and angry when you are told there is no coverage.

What does insurance have to do with climate change?

What does insurance have to do with climate change?

A lot, as it turns out.

Last year, three states -- Washington, California and New York -- surveyed dozens of major insurance companies about what they're doing to adapt to risks posed by climate change, a potential game-changer for insurers' investments and the risks they take on.

An independent climate-change group, Ceres, this morning released its analysis of the responses to that survey.

Of the 184 companies surveyed, Ceres concluded that only 23 of the companies had comprehensive climate change strategies. "Those companies provide a roadmap for the rest of the industry as it begins to wrestle with the issue," the report's authors wrote.

Amendments to the Minimum Maintenance Standards - Part 4

Amendments to the Minimum Maintenance Standards - Part 4

This week we continue our review of the amendments to the Minimum Maintenance Standards, which came into effect on January 25, 2013.

Part 4:  New Snow Accumulation Standard
The MMS previously required municipalities to clear snow within a prescribed number of hours after becoming aware of the fact that specified snow accumulation depths were reached.  This part of the standard is essentially unchanged, though it now requires municipalities to “address” snow accumulation and “reduce the snow depth” rather than “clear” the snow.   
However, there have been several additions to the standard.  The most significant addition is a provision which states that if the depth of snow accumulation on a roadway is less than or equal to the specified depth for that class of roadway, “the roadway is deemed to be in a state of repair with respect to snow accumulation”.  This provision is clearly intended to address the restrictive interpretation of the snow accumulation standard in Giuliani and should provide municipalities with a strong defence in cases where the standard is met.  The standard also sets out how the depth of snow accumulation on a roadway may be determined and how it may be addressed. 
The requirement that municipalities address snow accumulation after becoming aware of it must be read in conjunction with the constructive knowledge provision in section 1 of the MMS, which provides that a municipality is deemed to be aware of a fact if circumstances are such that the municipality ought reasonably to be aware of the fact.