Failure to Submit Disability Certificate Disentitles Claimant to Accident Benefits

Failure to Submit Disability Certificate Disentitles Claimant to Accident Benefits

A recent arbitration decision confirmed the importance of a disability certificate in accident benefits cases.

In Anthonipillai v. Security National, FSCO A11-001168 (July 12, 2013), the applicant was injured in an accident on April 21, 2008.  Although the insurer requested she submit a completed disability certificate several times, she failed to do so until 3.5 years after the accident, after an arbitration pre-hearing.  Even when she did submit a disability certificate, it only addressed caregiver benefits and not housekeeping.  The applicant argued that by continuing to adjust the claim and pay benefits, the insurer waived the requirement for a disability certificate.

The Arbitrator held that the applicant was disentitled to housekeeping and home maintenance benefits as she never submitted a disability certificate.  The insurer did not waive the requirement for a disability certificate as it had an obligation to adjust the claim, even if the plaintiff had not complied with her obligation.  In addition, the treatment and assessments the insurer adjusted were applied for through OCF 18 and 22 forms, which contain the signature of a health professional confirming the information is accurate, the treatment reasonable and necessary and acknowledging that it is an offence to make a false statement.  The insurer was entitled to insist on the same assurances through a disability certificate relating to caregiving and housekeeping expenses.  In addition, the insurer was entitled to obtain s. 42 assessments, without being deemed to have waived compliance by the insured.

Agent charged with theft and forgery; collected commissions for fictitious customers

Agent charged with theft and forgery; collected commissions for fictitious customers

A former Vancouver insurance agent has been charged with theft and forgery for allegedly collecting about $15,000 in commissions by creating fictitious applicants for insurance policies.
Julie Anne Goss, 43, an independent agent for AFLAC, was arraigned last week in Clark County Superior Court.
The scam came to light after the owner of a restaurant in Battle Ground, Wash. told AFLAC that she’d received premium bills for two “employees” that had never worked there. 
AFLAC investigated, and it turned out that Goss wrote dozens of policies for 15 people that either weren’t employees at the named businesses or apparently didn’t exist. In other cases, she wrote policies for real employees, but they said they hadn't applied for the coverage.
In each case, Goss stood to get a commission for the policy. All told, the investigator found, between August 2010 and January 2011, Goss wrote 91 fraudulent insurance policies and collected more than $15,000 in commissions for them.
The company canceled its contract with Goss in March 2011 and reported the matter to our Special Investigations Unit. After investigating further, we revoked Goss’ insurance license in January 2012. The charges against her were filed in late June.
If you suspect insurance fraud and you live in Washington state, please report it.

Excess vitamin C is harmful to health

Excess vitamin C is harmful to health
Excess vitamin C in the body can be harmful to health and cause kidney problems.

The Vitamin C is a necessary substance to keep our body functioning properly. We require at least 70 to 90 grams for the body to function properly. These quantities are very difficult to overcome, but sometimes possible. But the excess vitamin C is harmful to health! Hearing this are you shocked then clarify this in the below.
Many people indiscriminately ingest high doses of vitamin C, thinking that this will help to prevent colds or other conditions. While artificial vitamin is beneficial for health in reasonable quantities, excessive consumption has negative consequences for health.
Vitamin C cannot be stored in the organism. The excess is excreted in the urine, so it is very rare that a high intake can affect us. However, take 2 or 3 grams more than the recommended dose can cause digestive discomfort, heartburn or diarrhea.
Excess vitamin C is harmful to healthWhile vitamin C is not toxic, constant and excessive consumption can reach cause kidney problems, liver and stomach.
 A research group has found that vitamin oxidant effect as an antioxidant in the DNA, where the human gene. The conclusions were that the consumption of the dose that causes genetic damage experienced part of the DNA, which had never previously been found in research on the antioxidant property.
It is best to try to get this vitamin c naturally and you avoid taking supplements for your health safety. 
How to find an old life insurance policy (and other unclaimed property)

How to find an old life insurance policy (and other unclaimed property)

We get a lot of queries from people looking for old life insurance policies that they think might have named them as a beneficiary.

Here are some quick tips. For more specifics and links, please see our brand-new "how to find an old life insurance policy" web page.
  • Try to track down as much information as possible. You'll presumably know the name of the policyholder (any name changes?), and it also helps to know the state or states that the person lived in.

  • Ideally, you'll be able to locate a copy of the policy itself, which will have a number on it. But sometimes there's a wrinkle: the insurance company or its name may have changed, especially for older policies. That can be a challenge, but your state's insurance department can probably help you track down the current company information. If you live in Washington state -- we're the state insurance regulator there -- feel free to call us at 1-800-562-6900 and talk to our consumer advocacy staff.

  • If you can't find the policy, try going through the person's financial records, looking for payments made to an insurer. Also, look through old mail: the company may have sent periodic statements or billing reminders. It's also worth checking with the person's auto- or homeowners insurers, since people sometimes buy life insurance from the same company.

  • You could opt to pay a search company to run a check for the person's name through industry databases or send queries to a large number of insurers.

  • If a policy goes unclaimed for a long time, insurers are supposed to turn the money over to state-run unclaimed property programs. They hold the money, often forever, in case someone files a claim. You can easily run the person's name through these free, state-run online search sites. Washington state's is at, and you can easily find other state's unclaimed property programs at

Second Defence Medical Ordered

Second Defence Medical Ordered

In Galea v. Firsker, [2013] ONSC 1666 (S.C.J.), there is an interesting twist to the usual motion to compel the plaintiff to attend a second defence medical examination.

The plaintiff alleged soft tissue injuries.  The defendant's first defence medical with a neurologist was obtained prior to the plaintiff serving any reports.  After being served with reports by an orthopedic surgeon and a physiatrist, the defence sought to have the plaintiff examined by a physiatrist. 

McDermot J. ordered the plaintiff to attend the defence medical.  Even though there was an element of "buyer's remorse" in the defendant's request for a second assessment, denying the request would work an injustice, as the defendant would have no way to respond to the plaintiff's medical evidence.  The fact that there was no affidavit from the neurologist, there was no change in circumstances and there was a possibility the trial may have to be adjourned, the primary concern was trial fairness.

The decision in Galea seems to follow the recent case law where the emphasis is on trial fairness above other factors.

COBRA and Medicare: How to avoid a common (and costly) mistake

COBRA and Medicare: How to avoid a common (and costly) mistake

If you're continuing your employer health coverage through COBRA and you become eligible for Medicare, it's important for you to sign up for Medicare during your Medicare eligibility period.

Here's why: Health insurers generally include language in their policies that says they can refuse to pay bills if they find out that you stayed on COBRA coverage after you were eligible for Medicare.

A lot of consumers get caught in this trap. Many people who are on COBRA don't know that they should sign up for Medicare when they become eligible. Instead, they assume that COBRA will continue to pay their medical bills, so they delaying signing up for Medicare until their COBRA coverage ends.

Then, months after becoming eligible for Medicare, they find out that their COBRA plan is refusing to pay for medical care that the consumer already received. They can't backdate their Medicare enrollment, so they're stuck with those medical bills. Yikes.

Don't get caught in this trap. If you're on COBRA and become eligible for Medicare, sign up.

Cellulite and Your Skin Health

What is cellulite?

Cellulite is fat that is deposited in pockets just below the skin surface and occurs around the hips, thighs and buttocks. Since it is very close to the outside of the skin, celluliteleads to a dimpled appearance present in these areas of the body.

Cellulite and Your Skin Health

These fat deposits form a pocket under the skin, with the characteristic appearance of swelling and a texture similar to the skin of oranges, so it is also known as "orange peel".

It usually occurs more in women than in men due to hormonal differences, constitutional and physiological in between. Most of the medical community does not see the cellulite as a disorder of health condition, but as a normal condition of many women and some men.

Cellulite is not a disease, consisting of a common skin infection caused by bacteria.

Symptoms of cellulite

The most visible sign of cellulite is called orange peel. Cellulites is seen when the skin surface becomes irregular and starts to have small dimples and bumps.
Other symptoms of cellulites include:
The persistence of the touch marks
Pink skin
Dryness of the skin
Loss of skin softness is becoming more rustic feel

Causes of Cellulite

Cellulite is a skin problem that affects most women and can be caused by a variety of reasons such as:
Poor blood circulation.
Hormonal changes (estrogen excessive concentration).
Poor lymphatic drainage
Inadequate nutrition
Excess smoking and take drugs or alcohol
Sedentary in life

Treating cellulite

Here are the best home remedies for cellulite we have collected.
Rosehip oil for cellulite
Fucus vesiculosus poultices for cellulite
Ivy and sage compress for cellulite
Almeria compresses for cellulite
Hydrotherapy for cellulite
Horsetail infusion for cellulite
Rosemary for cellulite
Sarsaparilla for retention

Food / diet against cellulite

Cellulite and Your Skin Health As a preventive measure should maintain a balanced diet rich in fruits, vegetables and fiber without excess fat, especially saturated, which tend to accumulate in the blood vessels and impede circulation.
We also were paying attention to the sugar consumption, because these can be raw materials for the manufacture of fat when they are burned in their entirety.

It is also very important to stay hydrated by drinking plenty of fluids (water and fruit juices), but it is also essential to get rid of excess liquid. This requires carrying out a diet diuretic.

 Exercise against Cellulite

Cellulite and Your Skin Health Squats: This is one of the most complete exercises to combat cellulite and, incidentally, work all area below the waist. You spread your legs a little more than the width of your hips, keeping your feet parallel or slightly outward, Contract the abdomen, place you’re back straight and down, making the movement as if you sit down. Do three sets of 10-15 repetitions.

Exercise weight lifting with the legs: This is ideal to work it in a gym, but if you have appliances and means to do so, nor hesitate to implement it in your own home. The muscle tone is a major enemy of cellulite. For this reason, make such a localized exercises can be a great solution.

For any purposes in health Prevention is better than cure. We can easily prevent cellulite; just need our awareness to cellulite.
"My doctor says I need a treatment, but my insurer won't cover it. What can I do?"

"My doctor says I need a treatment, but my insurer won't cover it. What can I do?"

Q: "My doctor says that I need a particular medical treatment, but my health insurance company won't cover the cost. Is there anything I can do?"

A: Yes, there definitely is. Contact your health insurer, tell them you want to file an appeal, and ask what you need to do to start the process.

Then collect materials to support your argument, such as letters from your doctors describing why this is the best treatment for you, any medical journal articles or studies showing the treatment's effectiveness, etc.

You may also want to point out the health problems that will or can arise if the company doesn't pay for the treatment. Be sure to provide and estimate of the costs of treating those problems, especially if those costs would be significantly higher than paying for the treatment.

After you send in your appeal to your insurer, don't give up. Most people don't win the first round, but the odds of winning increase as you reach higher levels of appeals. The change of winning is highest when your appeal reaches the final level, called an "independent review organization."

For more tips on appeals, including templates, sample letters and detailed pointers, please see the appeals section of our website or call our consumer advocates at 1-800-562-6900. (If you live in a state other than Washington, please contact your own state's insurance department.)
Statement on U.S. House vote re: delaying the individual mandate

Statement on U.S. House vote re: delaying the individual mandate

Note: The U.S. House of Representatives is scheduled to vote today on a bill that would delay for a year the individual mandate requiring most Americans to have health coverage starting in 2014. The penalty for not having coverage next year would be $95 or 1 percent of income, whichever is greater.

Statement from Washington Insurance Commissioner Mike Kreidler:

“Delaying the mandate would be unwise. This is an issue of personal responsibility. It’s unfair for people who can afford coverage to not have it, and to expect the rest of us to cover the cost of their care if they become seriously sick or injured. ”
“A critical part of the Affordable Care Act was the provision requiring that insurers take all applicants. No more screening out people because they have pre-existing medical conditions. But to make that work, you have to have as many people as possible in the insurance pool.
“Without an individual mandate to have coverage, people would likely just buy insurance when they knew they needed it. That’s like letting people get homeowners insurance only when their house catches fire.”

More states asking insurers if they're ready for climate change

More states asking insurers if they're ready for climate change

From a press release we just sent out:

Insurance companies are facing growing scrutiny over their preparedness for climate change, an issue that could potentially affect insurance affordability and availability.

“I’m very pleased to see more states joining this effort,” said Washington Gov. Jay Inslee. “Being prepared is clearly in the best interests of both insurers and the families and businesses they insure.”

Last year, insurance regulators in Washington, California and New York surveyed major insurers about what steps they’re taking to address risks to their underwriting and investment portfolios.

This year, regulators in Connecticut and Minnesota have also joined the survey.

“Climate change is a potential game-changer for insurers,” said Washington Insurance Commissioner Mike Kreidler. “We want to make sure that this issue is on their radar.”

Climate change poses a double challenge to insurers. Extreme weather events and droughts, for example, can sharply increase claims. Climate-related issues could also have a significant effect on insurers’ investments, potentially affecting their long-term ability to pay claims.

“Unprepared insurers are much more likely to simply pull out of markets, leaving homeowners and businesses struggling to find alternative coverage,” said Kreidler, who chairs the National Association of Insurance Commissioners’ working group on climate change. “And when insurers abandon a market, government tends to end up as the insurer of last resort.”

Kreidler’s office has been surveying insurers on this issue since 2008.

“I wish some companies were further along,” said Kreidler, “but I’m encouraged to see that a growing number of companies are taking steps to incorporate climate change into their risk modeling and investment considerations.”

For a look at past surveys and responses for Washington, California and New York, please see California’s Climate Risk Disclosure Survey web page.
No Leave Required for Summary Judgment Motion After Set Down

No Leave Required for Summary Judgment Motion After Set Down

Does a party that sets an action down require leave to bring a summary judgment motion?

According to Justice Quinn in Fruitland Juices Inc. v. Custom Farm Service Inc. 2012 ONSC 4902 (S.C.J.), no leave is required.

In Fruitland, the defendant brought a summary judgment motion after it set the action down for trial.  The plaintiff objected pursuant to r. 48.04(1).  Justice Quinn granted leave.  He held:

[28]   The requirement for a substantial and unexpected change in circumstances is not a helpful or logical test where the motion for which leave is requested seeks summary judgment. The primary purpose of such a motion is to spare the parties and the legal system the expense and intrusion of an unnecessary trial or, at least, unnecessary issues within the trial. A party is not obliged to bring a summary judgment motion at the earliest opportunity; neither must there be a precipitating event such as a change in circumstances. So long as the motion, if successful, will be less costly and time-consuming than the trial, and will not unduly delay the start of the trial, I do not see why the moving party must explain his or her choice of timing. In other motions (such as to add parties, raise new issues or amend pleadings), the explanation for a delay in so moving is relevant, as is the issue of prejudice to the opposing party. However, none of that is relevant or required in a motion for summary judgment, at least in the circumstances of this case. A summary judgment motion brought at any time is a potential blessing for the administration of justice.
"I have two health insurance plans. Why do I still have to pay for some things?"

"I have two health insurance plans. Why do I still have to pay for some things?"

Q: "Why do I have to pay anything out of pocket? I have two health insurance plans. Between them, shouldn't they cover all the costs?"

A: Unfortunately, most insurers changed the rules under which they coordinate benefits within the past 10-15 years. Under the new rules, there's less economic advantage to have two (or more) health insurance plans.

As a general rule, if you have two health plans and you receive both of them on your own (i.e. you don't get either of the plans through your spouse), then generally the plan that you've had for the longest period of time should be the primary policy.

However, there are a lot of variables that can change the result. For example, if one of your plans is Medicare and you get the other plan through your employer, then having a Medicare plan can change the order of benefits, depending on the size of your employer.

Confusing? Yup. If you're having problems with an insurance issue and you live in Washington state, feel free to give us a call. We may be able to help. Our insurance consumer hotline is open from 8 a.m. to 5 p.m., Monday through Friday. The phone number if 1-800-562-6900. You can also reach us at
Insurance tips: Are my antiques and collectibles covered?

Insurance tips: Are my antiques and collectibles covered?

Q: "I have a number of rare antiques and collectible items of special value. Are they covered by my homeowners policy?"

A: Household goods usually are covered, but only to a limited value. If you have rare, valuable items, it's a good idea to talk to your agent or insurer about that, because you may need to insure them separately. This will likely cost more, but maybe not a lot more. And you'll know you're covered, rather than finding out after a fire, burglary, etc. that your policy was inadequate.

Also, you may need to get professional appraisals to establish the current, accurate value of the items.

For more tips, including inventorying your possessions, resolving claims, etc., please see our "insurance tips for homeowners" page.

Tips to Prevent Alzheimer

Alzheimer's is a type of dementia that causes progressive impairment of memory. It mainly affects the thinking, behavior and character of the sufferer.

With the advancement of the disease Alzheimer, you lose the ability to communicate or make decisions and completely change his/her personality when he/she is unable to remember how to perform the basic activities that were used or when, even in the later stages is unable to recognize their closest relatives. According to the Alzheimer's Association, about 5 million Americans suffer from this disorder. 

Tips to Prevent Alzheimer

Still do not know the exact cause that causes it, but it is known that advanced age, family history and the injuries sustained in the head are strongly related. Other modifiable factors, such as poor diet, sedentary lifestyle, smoking and lack of mental gymnastics can be triggers of the disease, so prevention is the key for Alzheimer.

Here gives some Tips to prevent Alzheimer.

Balanced diet with less fat, more vegetables:
Recent studies have shown that consumption of high amounts of vegetables of green leaf and fruit antioxidants, such as blueberries and strawberries, and eliminating fried foods and fats saturated, significantly reduces the risk of memory-related problems. And help to prevention from Alzheimer. Foods like chocolate, the green tea, the beans, the fish blue and fruits dry, rich in fatty acids Omega 3, are considered protective of the brain.

Tips to Prevent Alzheimer

Physical Exercise:
Make exercise is the most powerful means to prevent the disease from Alzheimerand improve brain function, says the latest report from the Mayo Clinic. According to the agency, if you lead a sedentary lifestyle, is 32% more likely to develop brain-related diseases, compared to if exercised five times a week? The reason is that physical activity oxygenates all the cells of the brain, activates the connections of neurons and promotes the release of neurotransmitters that promote motivation, creativity, memory and learning.

Active your brain:
Tips to Prevent AlzheimerThe most important key to prevent the degeneration of brain function is to keep your brain in permanent activity and activate those parts less used. To do this, you can try to do everyday activities with closed eyes, most often using their dominant hand, daily crossword puzzles or change things from the usual place as a gym for this important body.

So maintain a balanced diet, do regular physical exercise and active your brain more can help to release from the Alzheimer.

Banana and potato juice is healthy for ulcers

Banana and potato juice is perfect home remedy to combat ulcers.

Gastric ulcers are usually a fairly painful, complex and nobody wants to deal with regularly. For this reason, some natural elements become crucial to combat them. Try this banana and potato juice.

Banana and potato juice is healthy for ulcers

The gastric ulcers are really complicated and no need for me to tell you what they're for those who suffer regularly. What I can tell you is that there are many home remedies to treat them. They may not be panaceas, no definitive cures nostrums. No, that's not what I can suggest. But at least one good palliative juice help you not only to feed you better, but to ease the pain causes you damn ulcer daily. And when you see the ingredients, you will surely agree that evil cannot make. Try it and feel relax from ulcers.

A banana
A potato
A handful of peeled almonds (five or six) 
Two or three dates
Half cup of chamomile tea


Wash the potatoes and cut into chunks. Then place it in the juicer, peel and all, no problem. Extract the juice and place in the bowl of the mixer, where you'll add dates, almonds, bananas and chamomile infusion. Bate preparation until you liquefied stay a homogeneous good, you do not have any lumps. Now, since I can drink and even take two or three of these a day if really bothers ulcer. Try to do short sips, with pause and calmly. 

How does Banana and potato juice

First, the potato juice and starch will give freshness to the ulcer that is leaving you alone, causing them to suffocate those fires that you generate inside. The potato produces a similar effect. The dates and almonds are also often recommended in this type of digestive issues. Meanwhile, chamomile generates inflammation throughout the digestive tract and also working to get everything back to normal. Course, Banana and potato juice is not the only option you have to try, you can also try these other home remedies for stomach ulcers.
TRIA Captives and Republican Politics

TRIA Captives and Republican Politics

With the current version of the Terrorism Risk Insurance Act (TRIA) set to expire at the end of next year unless Congress takes affirmative action to extend it, one thing has become clear already: the politics are complicated.   More specifically, the Republican caucus in the House of Representatives appears to be divided as to whether the federal government should continue to play a role in the private insurance marketplace.

Those with an interest in the continued viability of TRIA captives should pay attention because this is shaping up to be a very fluid and uncertain legislative process.  But before getting too far into the political weeds, a quick historical refresher would probably be helpful.

TRIA was first passed by Congress on a bipartisan basis in 2002 with the intent of helping to stabilize the property insurance marketplace in the aftermath of the 9/11 terrorist attacks.   The Act created a reinsurance program providing for a federal backstop for industry losses exceeding $100 million per year connected with future terrorist attacks.

The program details are that 85% of insured losses would be paid by the federal government after an insurer meets a deductible of 20% of annual premiums.    For losses up to $27.5 billion, the Treasury Department will collect 133% of payouts through surcharges on property/casualty policies.  Regulators have been given discretion to develop specifics to recoup payouts in access of $27.5 billion.

The Act was extended without much opposition in 2005 and 2007 so what’s different this time around?  Those votes were cast prior to the 2010 congressional election, which swept into office many “Tea Party” Republicans and Democratic control was upended in the House.

There is no shortage of commentary with regard to whether or not the growing influence of these small government true believers within the House Republican Caucus is good for the party over the longer term so this blog will refrain from offering similar political commentary.

What we can say with some certainty is the emerging debate over TRIA re-authorization is exposing the same type of divide among Tea Party and “establishment” Republicans that has been seen repeatedly over the past three years on high profile legislation.  Sometimes the party coalesced and other times it did not.

The current TRIA extension legislation (H.R. 508) is now pending in the House Financial Services Committee, which is chaired by Rep. Jeb Hensarling (R-TX).    While a member of the party leadership, his conservative political orientation more often than not synchs with the Tea Party Caucus.

Clearing Hensarling’s committee is the first step to final enactment, but while the congressman has not explicitly ruled out moving the legislation, he has signaled real skepticism of maintaining the federal government’s role in the private insurance market, even in the cases of terrorism.

In recent meetings with Republican members of the committee (most of whom were not in Congress when the law was originally passed in 2002), industry lobbyists have confirmed conflicting positions.   Some acknowledge that practical marketplace realities dictate the extension, while others have indicated they will oppose the legislation, citing the overriding priority of reducing the size and scope of the federal government.  For their part, House Democrats are mostly sitting back at this point while the Republican politics play out.   

Obviously there is still quite a bit of time on the game clock for congressional action and political ideology could very well yield to practical realities, but it’s risky to simply assume another TRIA extension will be pro forma.   After all, if Congress can go to the brink over raising the debt ceiling, tax hikes and budget sequesters, why should we think that H.R. 508 will be pushed over the finish line by the tailwind from previous years?



For a recent summary of the doctrine of spoliation, see the decision in Stillwell v. World Kitchen, [2013] ONSC 3354 (S.C.J.).

The plaintiff brought an action against the manufacturer of a dutch oven that broke into four pieces as he was washing it, causing a severe laceration to his wrist.  The plaintiff told his wife to dispose of the product shortly after the incident.  He testified that he gave no thought to a lawsuit at the time; he simply did not want to see the pot when he returned home from surgery.

At trial, one of the issues was whether the jury should be charged on spoliation.  Justice Leach held he would not charge the jury on spoliation.  Spoliation gives rise to a rebuttable presumption of fact that the missing evidence, had it been preserved, would have been unfavourable to the party that destroyed it; however, an adverse inference does not arise merely because the evidence has been destroyed.  There must be intentional destruction in circumstances where it can reasonably be inferred that evidence was destroyed to affect the litigation.  There was no evidence that the plaintiff intentionally destroyed the dutch oven, so the doctrine of spoliation would not be put to the jury.
ACA Gobbles Up Self-Insurance Marketplace One Bite at a Time

ACA Gobbles Up Self-Insurance Marketplace One Bite at a Time

This week’s announcement that the ACA’s employer-mandate provision has been postponed has understandably gotten a lot of attention.  It’s a big deal for sure, but while federal regulators punted on this high profile provision, they demonstrated no such caution with the release of two sets of final rules over the past week that will have the likely effect of eroding the self-insurance marketplace.

So while everyone is talking about the employer-mandate development, it’s important to interject some exclusive reporting and commentary regarding separate finalized ACA rules related to contraceptive coverage and student health plans to demonstrate how self-insurance options are being quietly restricted in certain market segments.

The rule-making process for contraceptive coverage has certainly attracted much attention over the past two years, but this blog is agnostic regarding the ongoing religious liberty debate that dominates the headlines.   We have, however, been very interested in how the final rules will affect self-insured religious organizations, of which there are many.

As some may recall, when the controversy originally erupted over the prospect of religious organizations being forced to provide coverage for contraceptive coverage, Obama’s political operatives quickly hatched a plan: insurance companies would be required to include this coverage at no cost to the religious organizations.

Notwithstanding the fact that this accommodation failed to satisfy religious liberty objections, the White House overlooked the fact that a large percentage of religious organizations operate self-insured group health plans, so the suggested insurance company fix would not apply to these plans.

Faced with this realization, regulators have floated various proposals during the rule-making process on how self-insured religious organizations can comply with the law.  Most of these proposals have been variations on the theme of forcing third party administrators to take responsibility for coordinating such coverage. 

For good measure, regulators offered a closing comment in the proposed rules essentially saying that such organizations can always convert to fully-insured arrangements if self-insurance is no longer viable.  You have to appreciate such bureaucratic thoughtfulness.

Based on the final rules released last week, it appears that the viability of self-insured plans will be significantly compromised.  At issue is that regulators are forcing TPAs to serve as plan fiduciaries solely for the purpose of arranging separate contraceptive coverage for plan participants.

Industry stakeholders have raised numerous concerns that such an approach is legally questionable and would expose TPAs to a variety of legal liability scenarios.  But the regulators flatly rejected these comments, asserting that “the Department of Labor’s view that is has the legal authority to require the third party administrator to become the plan administrator under ERISA section 3(16) for the sole purpose of providing payments for contraceptive services if the third party administrator agrees to enter into or remain in a contractual relationship with the eligible organization to provide administrative services for the plan.”  

Already acutely sensitive to potential fiduciary designations outside of the ACA context, it’s a reasonable conclusion that at least some TPAs will consider the new rules to be a tipping point, forcing them to part ways with their religious organization clients, which in turn will make it more difficult for such organizations to maintain their self-insured plans.

In separate news, CMS published the final rule last week clarifying exemptions to the individual mandate requirement in as provided for in the ACA.  As part of this, the rule also contained the final language on which "non-insurance” programs will be considered minimum essential coverage (MEC) for purposes of satisfying the mandate.

The earlier, proposed version of the rule had included self-funded student health plans in the list of allowable MECs.  Under the final version of the rule, however, self-funded student plans will only be considered MEC for plan years beginning before December 31, 2014.  After that date, such plans will have to apply to CMS to maintain the exemption.

Given the explicit goal of the Administration to steer as many young and healthy individuals into the exchanges as possible, this blog is highly skeptical that such exemptions will be forthcoming.  And of course, the real effect of this rule won’t be felt until after the 2014 elections. 

We’ll concede the fact that student health plans and religious organizations do not represent major segments of the overall self-insurance marketplace, but they are viable segments that are being quietly gobbled up by the bureaucracy.    So while everyone understandably is now talking about the employer-mandate delay, much of the real action continues to be in the details of the highly technical ACA implementation rules that cannot be easily distilled by the media nor understood by most health care reform observers.


Flood insurance changes run into resistance

Flood insurance changes run into resistance

From AP:
Just a year after Congress imposed significant changes in the government's oft-criticized flood insurance program, howls of protest from homeowners facing higher premiums have coastal lawmakers pressing for delays that would preserve below-cost rates for hundreds of thousands of people in flood-risk areas.

 Here's the full story, in case you missed it. Curious to see if  your community is scheduled for a rate update? Enter your zip code here.
Settlement Privilege

Settlement Privilege

The Supreme Court of Canada recently commented on Pierringer Agreements.  The issue was whether the non-settling defendants had the right to know the amount of the settlement between the plaintiff and settling defendants.

In Sable Offshore Energy Inc. v. Ameron International Corp. [2013] SCC 37, the plaintiff sued a number of defendants.  It entered into a Pierringer Agreement with several defendants and the non-settling defendants requested disclosure of the settlement amounts.  The non-settling defendants received all non-financial terms of the Agreement, had access to all relevant documents and other evidence in the settling defendants' hands and were assured that they would not be held liable for more than their share of damages.  In addition, the plaintiff agreed to provide the settlement amounts to the trial judge at the end of trial, so that if the non-settling defendants established a right to set-off, their liability for damages could be adjusted downwards. 

The Court held that the settlement amounts did not have to be disclosed to the non-settling defendants.  The amounts were protected by settlement privilege, which is a class privilege, meaning there is a prima facie presumption of inadmissibility.  The public interest in promoting settlement was greater than any prejudice to the non-settling defendants.  The Court rejected the argument that the non-settling defendants required knowledge of the settlement amounts to know and present their case, or to explore their own settlement possibilities.

It is clear that the Court highly values settlement and this decision aims to encourage settlement and the use of Pierringer Agreements in multi-party litigation.
What you need to know about boating and insurance

What you need to know about boating and insurance

Summer is finally here! And it arrive before the Fourth of July - a rarity in the Northwest. Many of us like to go boating, especially with crab season now open. If you own a boat or rent a boat, you should consider boat insurance. Here's why:

Boating liability insurance in Washington state is not mandatory, but it's a good idea if you want to protect yourself and your passengers.  You can purchase boat insurance for a fairly reasonable price.  Coverage protects your boat from physical damage as well as your passengers if they're injured.  It also protects your boating equipment.

Check with the insurance company that covers your home and auto to see if it'll cover your boat, too. You could get a discount for having multiple policies with them.  If you're not sure what type of coverage you need, just ask your agent.  He or she can help make sure you're properly insured. Some small boats, like rowboats or dinghies may be covered under your homeowner policy - check your policy to be sure.

Here's more information about boating regulations in Washington state.

Prevent Skin Cancer from Sun Exposure

UVA rays of sunlight can cause the appearance of skin cancer from sun exposure

With summer comes the good the good weather and the beaches are filled with people eager to soak up the sun and get a tan skin tone, which has its risks, and that over-exposure to ultra violet (UV) rays is directly related to the appearance of carcinomas. Here given some tips to prevent skin cancer from sun exposure:

Prevent skin cancer from sun exposure

Avoid sun during the midday hours
UVA rays are strongest between 12:00 h and 16:30 h, so we recommend that you avoid direct exposure to them during this time of day. If you have to go outside in sun exposure then used sunscreen properly.

Do not expose your whole body to the sun
The more parts of your body expose it to sunlight, the more likely you are to develop skin cancer. To avoid this, use long sleeve loose clothing (linen shirts & cotton pants). Not only blocked the UVA ray, but also help you beat the heat.

Cover your head
Especially if you have short hair, nothing worse than sunbathing summer without any protection. Do not cut; use a hat or a cap, also effective to prevent heat stroke.

Use sunscreen
And not worth to use either, you have to use one that fits your skin type, i.e. your skin type. You have to be aware that using sunscreen is one of the most effective measures to combat the harmful effects of UVA rays, and thus skin cancer. Apply it half an hour before sun exposure and renew the application every two hours or after swimming. 

In the water is more risky
For very refreshing that results take a dip in the pool or in the sea, do not think that water protects you from UVA rays. Moreover, in some cases, the reflection of sunlight on it can enhance its harmful effects. The best way to protect against UVA rays in these cases is to use a sunscreen. Do not forget that the radiation can penetrate up to a meter in clear water areas.

Taking care your child from Sun exposure
The little ones are much more sensitive to solar radiation than adults, so it is necessary precautions extreme. They must resort to baggy clothing to caps and hats and, once again, to the sunscreen. In any case, one must start from the premise that no child under three years must be directly exposed to UVA.

Are you taking any medications?
If so do not forget to consult the prospectus, as certain medicines increase skin sensitivity to UV radiation, making sunbathing is much more dangerous. If you have any doubts talk to your doctor or your pharmacist, they will advise you better than anyone.

Where you go on vacation
The sun's rays affect much more in the areas of the Earth near the tropics and Ecuador, so if you are traveling to a destination that is in the area should be especially careful when exposing yourself to the solar radiation. Moreover, you also have to keep in mind that, as altitude increases, so does the strength of solar radiation. To give you an idea, for every 300 meters 4% increases the strength of UVA. From this we conclude that people in the mountains veraneen the same precautions must keep facing the sun than those who do on the beach.

UV booths
The self-tanning booths can become harmful to health if they do not have all these considerations into account. Even before undergoing protecting a tanning session like this is necessary to do so as infrequently as possible, and that UVA affect with great intensity on the skin.

Beware of burns from sun
If after taking the sun notes any skin lesion is important that you stop exposing yourself to UVA come up soon and the dermatologist. The sunburn may be the first indication that solar radiation has damaged epidermis. Moreover, the tone cobra skin tan when exposed to the sun is a defense of it against UVA rays.

Enjoy your summer time and take care your skin from the frequent sun exposure.