Surveillance particulars must be served even if not relying on it at trial

Surveillance particulars must be served even if not relying on it at trial

A recent decision has held that a defendant who obtains surveillance must serve particulars of it, even if not relying on it at trial.

In Arsenault-Armstrong v. Burke, 2013 ONSC 4353 (S.C.J.), the plaintiff sought an undertaking that the defendant provide particulars of future surveillance, including date, time, name of investigator and so forth.  The defendant refused to provide particulars if she was not relying on the surveillance at trial.

Justice Hambly held that the defendant must provide particulars of surveillance even if she does not intend to rely on it at trial.  At paragraph 11, Justice Hambly stated:

[11]           The consequences of the defence not producing the full particulars of surveillance evidence in its possession, even if in the period leading up to the trial the defence is of the view that it will not rely on it at trial are well illustrated in Beland.  The surveillance evidence will assist the plaintiff in evaluating the strength of her case and arriving at her settlement position prior to trial.  Even if the defendant will not be able to use the surveillance evidence for impeachment purposes, as a result of its non-disclosure, the defence will gain knowledge of the plaintiff from the surveillance evidence which it will be able to use to its benefit.  A requirement that the defence produce it even if it does not presently intend to use at trial is consistent with what the Court of Appeal said in Ceci v. Bank (1992), 7 O.R. (3d) 381 quoted above by Justice Howden.  In Beland, after a 17 day trial a jury dismissed the plaintiff’s case.  The trial judge fixed costs against the plaintiff, exclusive of HST at $115,318. This is a devastating result for a plaintiff. Perhaps it could have all been avoided if the disputed surveillance evidence had been produced by the defendant.

The difficulty with this decision for the defence is that the value of surveillance as an impeachment tool may be lost if the plaintiff has knowledge of the particulars.  In addition, if the defence does not intend to rely on it at trial, how can it assist in settlement?  Lastly, the decision does not give guidance on how far in advance of trial the particulars must be disclosed.
"The insurance company came out and looked at my car. Doesn't that commit them to paying the claim?"

"The insurance company came out and looked at my car. Doesn't that commit them to paying the claim?"

No. Insurers are required to investigate claims, but the fact that they start an investigation doesn't obligate them to pay a claim that they wouldn't otherwise pay. Once the facts are gathered and reviewed, the insurer can then make a coverage decision.

That said, if you feel your claim has been wrongly denied, is delayed, isn't fair, etc., our consumer advocacy staff may be able to help you. (We're the state agency that regulates insurance in Washington state.) Email us at AskMike@oic.wa.gov or call us at 1-800-562-6900.

Not in Washington state? Here's a handy map to help you contact your own state's insurance regulator.

The Fruit That Really Does Keep the Doctor Away

Crisp, comforting and delicious, apples have remarkable health benefits, fighting everything from dental problems to diabetes, heart disease, at least 8 types of cancer, and possibly even Alzheimer’s.
One of the latest discoveries is that eating at least 2 servings a week of whole fruit—particularly apples, blueberries, or grapes—trims risk for type 2 diabetes by up to 23 percent, compared to people who eat less than one serving per month, according to new data from three long-running studies that include 187,382 participants. The research was published in British Medical Journal. The scientists also report that cutting out three servings of fruit juice and eating whole fruit instead would cut diabetes danger by 7 percent.
Other studies reveal the apple's long list of impressive health perks, reports Courtenay Smith, executive editor of Reader’s Digest and editor of the bestsellerFoods That Harm, Foods That Heal.
In fact, apples may be one of the best healing foods, but also carry a risk you should be aware of. “Because apples are vulnerable to worms and other pests, conventionally grown fruit can be high in pesticides because it’s sprayed several times,” cautions Smith, who recommends either buying organic or washing the fruit thoroughly before eating.
Here are some of the latest findings about this delightful autumn food:

Protection Against Cardiovascular Disease

An apple snack soaked with tangerine juice lowers cardiovascular risk in children, according to researchers at Universitat de València and other centers. The study included 48 obese kids ages 9 to 15 who followed a low-calorie diet for 4 weeks. Eating the apple/tangerine snack improved the kids’ blood pressure, lipid levels and antioxidant defenses, while also reducing inflammatory markers linked to heart risk. 

Lower Risk for Stroke

Contrary to the popular belief that the healthiest fruits and veggies are brightly colored, a large Dutch study found that eating white produce (in amounts equal to one medium or large apple) reduces stroke risk by 52 percent, compared to people who eat smaller amounts. Although the researchers looked at a variety of white produce, apples, pears and applesauce were the ones most commonly eaten by the 20,069 participants. There was no link between eating foods of other colors and rates of stroke, according to the study, published in Stroke.

Whiter, Healthier Teeth

“Apples are often called ‘nature’s toothbrushes,’ because they help clean and brighten teeth,” says Smith. “The crisp, abrasive texture stimulates the gums and removes debris from your teeth, while the mildly acidic flavor increases saliva flow to rinse away plaque.” A 2012 study reported that men who ate high-fiber fruits (particularly apples and bananas) were at lower risk for tooth loss and progression of gum disease. The study tracked 625 men for 15 years.

Help You Stay Slim

“Studies out of Washington State and Brazil show that people who eat 3 apples or pears a day lose weight,” Smith reports. “These fruits are low in calories (80 for a medium apple) and loaded with water and fiber, so they fill you up. They’re also digested slowly, so  you feel satisfied longer.”

May Prevent 8 Types of Cancer

A 2011 scientific review reports that people who eat one or more apples daily have significantly lower risk of oral cancer and cancers of the voice box (larynx), breast, esophagus, colon, kidney, prostate and ovary, compared to those who nosh on the fruit less often. The study included more than 6,000 people and this pattern held true even when the participants’ age, calorie intake, diet, smoking, and weight were taken into account.
“In lab studies out of Germany, there’s evidence that when fiber in apples ferments in the colon, it produces cancer fighting compounds,” says Smith. “Other lab studies show that procyanidins—natural compounds found in apple skins—trigger cancer cell death.”

Help Head off a Heart Attack

The same scientific review also reported that women who ate as little as 71 grams of apple daily (about half of a small apple) were 43 percent less likely to die from cardiovascular disease—the leading killer of Americans—than were women who didn’t eat the fruit at all. A study of elderly men found similar benefits to eating an average of 69 grams of apple daily, versus little or no apple consumption.

May Help Ward off Alzheimer’s

Animal studies suggest that apple juice may have a variety of positive effects on brain health, including reducing age-related memory and cognitive impairment. What’s more, in animals, daily consumption of apple juice appears to protect against brain changes and damage associated with Alzheimer’s disease, though it is not yet known if tasty drink has the same effect on the human brain.

11 Ways to Boost Your Metabolism All Day Long

You may not realize it, but while you're bumming it on the couch catching up on New Girl, your body is working hard to help you burn calories. How is that even possible? Your sweet, sweet metabolism. The cool part: You can speed it up to ensure it's torching the maximum number of cals. All you have to do is follow these 11 super-easy tips.

When You First Wake Up Eating breakfasts helps jumpstart your metabolism--especially if you do it within one hour of waking up. "Your metabolism went into rest mode over night, so your first meal of the day revs it up again," says Keri Gans, R.D.N., author of The Small Change Diet. To work the kick-start effect to the max, choose foods high in fiber and protein, like whole-grain cereal with low-fat milk and berries.

During Your Commute
 Parking farther away from your office may sound like a small step, but it can actually boost your metabolism in a big way because it forces you to move more. "Getting your heart rate up for a short period of time keeps it elevated afterward, which boosts your metabolism overall," says Doug Barsanti, M.A., strength and conditioning specialist and owner of ReInvention Fitness in Santa Cruz, California. Another good idea? Take the stairs to get to your floor.

When You First Get to the Office Go ahead and grab a cup of joe. Research shows that caffeine boosts your metabolic rate, albeit mildly, says David Katz, M.D., director of the Yale University Prevention Research Center and author of Disease Proof. Just watch all the caramel-cream--whatever concoctions--those are so sugary that they'll negate coffee's benefits.

At Work We hereby grant you permission to schmooze with your co-workers--as long as you don't do it over G-chat. "Moving more at every opportunity, even if it's just to get up to go to the bathroom, keeps your heart rate going and therefore boosts your metabolism," says Shirley Archer, an ACE-certified group fitness instructor. Try walking across the office to talk to co-workers rather than e-mailing them.

When You're Buying Lunch Pick the right foods, and you'll stoke your metabolism. "Nothing beats a turkey sandwich on whole-grain bread with lettuce, tomato, and mustard and a piece of fruit on the side," says Gans. "The protein-carb combo will give you energy to get through your day without dragging."

At the Water Cooler
 When it comes to water, colder is better. "Your body burns more calories in colder temperatures because it has to work harder to keep you warm--so by drinking cold water, you end up burning more than if you guzzled room-temp H20," says Lisa Gain, Ph.D., evolutionary biologist and founder of snack-girl.com. (Sadly, the same does not hold true for ice cream, which is too high-cal to get the effect. Womp!)

During Your Workout It's all too easy to get into a cardio routine and stay at the same pace for your entire workout--but don't! Intervals are your friend, says Barsanti. "Short, high-intensity exercise boosts your metabolism. So when you're on the treadmill or elliptical, sprint for 30 seconds, then rest for 30 seconds, and repeat this pattern for 10 minutes." Pro tip: Make a playlist with fast and slow songs to help you vary your rhythm without even thinking about it.

Post-Workout Good news for chocolate lovers! Drinking chocolate milk post-workout helps keep your metabolism going strong. "When you exercise, your body loses glucose," says Gans. "You need to restore it right away to keep your metabolism on track." Chocolate milk is ideal because it has the perfect combo of carbs and protein. Sweet!

At Dinner Some studies suggest that eating spicy foods may boost your metabolism--so top your meals with chili peppers and Tabasco. Bonus: Spices are naturally fat free, so there's no need to stress about calorie counts.

In the Evening Take a minute to relax, and your metabolism will thank you. Why? "When you get stressed, your body releases cortisol, and too much cortisol slows down your metabolism," says Archer. To prevent this, do whatever relaxes you most, like yoga, talking to a soothing friend, or meditating.

At Bedtime
 Sleep is key to boosting your metabolism. "Your body needs it to fully restore and recover from the day and keep your muscle mass and hormones circulating properly," says Archer. Aim for seven to eight hours a night to keep your metabolism in tip-top shape.
Why does my insurer ask such tough questions about my claim?

Why does my insurer ask such tough questions about my claim?


We get this question a lot. The insurance industry experiences millions of dollars of claims regularly, year after year. Many of the claims are legitimate, but unfortunately, many involve fraud.
 
Whether or not a claim is legitimate or fraudulent, it is important that insurance companies perform complete investigations and gather all supportive documentation to be able to evaluate a claim.
 
Of course, the claim process is not a fun thing to experience, but it is necessary that you cooperate with the insurer to help facilitate your claim. Expect them to want supporting documentation and to ask questions - it may take a bit of time. But, after you've answered their questions and provided the necessary information, you should expect a timely decision and a clear explanation of their decision. If you don't that you've been treated fairly, call us at 1-800-562-6900 or file a complaint. Maybe we can help!
"I've invented a new medical treatment. How can I get insurers to cover this?"

"I've invented a new medical treatment. How can I get insurers to cover this?"

Our consumer hotline gets this question periodically. Someone will have come up with a new way of treating some ailment, only to find that insurance companies don't want to cover it.

Insurance companies are far more likely to cover a treatment is it's "evidence-based. Typically, a treatment is deemed evidence-based after extensive clinical trials, for which the inventor (or inventor's company, actually) usually pays. In the scientific community, evidence-based treatments are considered more reliable, and therefor a better value for insurance companies' money -- and more likely to lead to success for the patient.

That said, insurance companies can pay for any treatment, so there's nothing stopping them from covering a treatment that's not evidence-based. However, with many health conditions, there are already numerous treatments available.

If you're a patient, and your insurer is refusing to pay for a particular treatment that you think would be effective, see our "How to appeal a health insurance denial" guide. You can win an appeal, but it takes some work.

Also, here in Washington state, the health plans we regulate -- which are about 37 percent of them -- must, by law, must include access to every type of licensed medical provider. Meaning that if you want to see a naturopathic physician, chiropractor, physician, acupuncturist, etc. for treatment, the choice is yours, so long as the treatment is within the scope of their practice. The law doesn't change what health conditions are covered by your plan, but it gives you more choice in who -- i.e. which kind of provider -- will treat you.
Medicare open enrollment started this week and ends Dec. 7

Medicare open enrollment started this week and ends Dec. 7

Medicare's open enrollment period for prescription drug plans (Part D) and Medicare Advantage plans is Oct. 15 - Dec. 7. This is the time when you can enroll in a new plan or sign up for coverage.

If you need assistance understanding your options, we have trained volunteers in your community. Our Statewide Health Insurance Benefits Advisors (SHIBA) program offers free help to people with Medicare questions and can help you search for plans online. We even have free Medicare workshops across the state.

Remember, if you want to enroll in  new plan, you must contact Medicare. You cannot sign up through the state's new health benefit exchange, www.wahealthplanfinder.org.

If you have limited income and need help paying prescription drugs, check out Medicare's "Extra Help" program. To see if you qualify, contact the Social Security Administration at 1-800-772-1213 or go to www.socialsecurity.gov.

For more help, contact a local SHIBA office in your area.
Job seekers - We're looking for a legislative liaison and a policy/rules manager

Job seekers - We're looking for a legislative liaison and a policy/rules manager

Two jobs at the Insurance Commissioner's office just posted this week - a Legislative Liaison and a Policy and Rules Manager. Both positions are exempt, open until filled and salary depends on experience.

The Legislative Liaison is responsible for developing and managing our legislative and policy strategy, including developing our legislative agenda, legislative testimony, bill analysis, and stakeholder management. They're also the principal policy advisor to the executive management team on legislative and budget proposals impacting the agency.

The Policy and Rules Manager supervises staff in our Policy and Legislative Affairs division, prepares position briefs, decision memos, reports, coordinates rule-making for the agency, and drafts and adopts rules on behalf of the agency.

If you're interested or know someone who might be, encourage them to apply soon!


 

See most recent earthquakes in our area - are you ready for the big one?

 
We're getting ready for tomorrow's Great ShakeOut Earthquake Drill by cleaning out all the stuff under our desk - how about you? It's been a long time since the Nisqually Quake, but if you lived in Washington state then, you probably remember where you were and what it felt like. 
 
Some of us here in Olympia - only miles from the epicenter - heard what sounded like a freight train. Others saw the ground move like water. Are you ready for the next one? 
 
Check out the earthquake tracker on KIRO's mynorthwest.com. It'll show you the most recent quake, how big it was and where it occurred.  


And don't forget about earthquake insurance - here's what you need to know.
Is the Insurer Always Justified in Denying Coverage On the Basis of a Breach of a Statutory Clause?

Is the Insurer Always Justified in Denying Coverage On the Basis of a Breach of a Statutory Clause?

Every automobile insurance policy issued in Ontario contains statutory clause 4.1:
 
                The insured shall not drive or operate or permit any other person to drive or operate the automobile unless the insured or other person is authorized by law to drive or operate it.
 
Section 32 of Highway Traffic Act requires an operator of a motor vehicle to hold a valid driver’s licence. In Kozel v.Personal Insurance Co. [2013] ONSC 2670 (S.C.J), the applicant was a 77 woman year old woman who was involved in a motor vehicle accident in Florida. Her insurer denied coverage on the basis that she was in breach of the policy at the time of the accident because her driver’s license had expired. The applicant brought this application for a declaration that the insurer owed a duty to indemnify and defend her in a third party action against her.
 
Approximately five months prior to the accident, the applicant received documentation from the Ministry concerning the renewal of her driver’s licence and vehicle plate sticker. Two weeks prior to the renewal date, the applicant gave the package of documentation to her dealership where she took delivery of a new vehicle. She was unaware that this package contained her licence renewal. Until the accident occurred, she was unaware that her licence had not been renewed. She reported the accident in a timely manner and renewed her license immediately upon discovering it was expired.
 
Justice Wood cited the 2011 Court of Appeal decision Tut v. R.B.C. General Insurance Company [2011] ONCA 644 where it was held that if an offence for breaching the regulation was one of strict liability rather than absolute liability, it was open to the insured to argue that he took all reasonable care in the circumstances to see that he was not in breach of the regulation. Were he able to argue this defence successfully it would follow that he remained authorized to drive within the meaning of statutory condition 4(1).
 
Justice Wood held that since an offence of driving with an expired licence is one of strict liability, an argument that the applicant exercised due diligence was available. Justice Wood found that the applicant took active steps to ensure that she met her duty, although mistakenly, she provided a believable explanation for her lack of perfect diligence and her actions were those of a reasonable person acting upon a genuinely mistaken belief.  As such, the court found that the applicant was entitled to a defence under the policy.
 
This case shows that breaches of the insurance policy are not always clear cut and can involve the consideration by the court of many subjective factors.    
How to report insurance fraud in Washington state

How to report insurance fraud in Washington state

Our agency -- Washington state's insurance regulator -- handles a wide variety of complaints about insurance fraud by individuals and by businesses.

To report insurance fraud or scams, please see our online reporting form.

We also offer tips to avoid insurance scams, starting with the old-but-true advice that if it sounds too good to be true, it probably is.

We also have some tips on how to identify and report Medicare fraud and abuse, such as being billed for services you didn't receive.
I know the new health subsidies are based on your household income, but how do they define 'household'?

I know the new health subsidies are based on your household income, but how do they define 'household'?

“Household” only includes you, your spouse, and anyone you can legally claim as a dependent on your tax return.

 It generally wouldn’t include a non-marital relationship (such as a boyfriend or girlfriend), except under very limited circumstances.

To get more details, see page 16 of the IRS instructions for filling out Form 1040 or call the IRS (after the government shutdown ends) at 1-800-829-1040.
Can a Plaintiff Avoid Discovery Due to Medical Reasons?

Can a Plaintiff Avoid Discovery Due to Medical Reasons?

Can a plaintiff avoid attending discovery or an independent medical examination due to anxiety or an inability to respond to questions appropriately?

In Lalousis v. Roberts, 2013 ONSC 5897 (S.C.J), the plaintiff sought $4 million in two actions relating to two motor vehicle accidents.  She alleged that she could not participate in oral discovery or an IME  due to medical reasons, including that she was not able to respond to questions, had poor communication and attention, and discovery would increase her anxiety and depression.  She sought to avoid the discovery process or have her husband act as a substitute.

Master Muir dismissed the motion.  A party has a prima facie right to a full and complete discovery of an adverse party, which includes oral examination and may include a medical examination.  The threshold to limit a party's right to discovery is a high one and should be ordered only in the rarest of cases.  In the circumstances, an examination for discovery might be unproductive as she may not provide responsive answer, and it could cause anxiety for the plaintiff; however, there was no evidence that it would cause her permanent damage.

In order to permit the defence to fully respond to the claim against it, it makes sense that the threshold for taking away those rights is very high.





When your insurance renews, remember to look at the statement

When your insurance renews, remember to look at the statement

When you get a new insurance policy or your current policy renews, be sure to review the statement. You need to be sure that you're getting the type and level of coverage you asked for. 

Most people simply file away the information -- or toss it. But take a few minutes to look it over first. You really don't want to find out after the fact that a) you were paying for coverage you didn't want or need, or b) worse, that you didn't have coverage for something important.

If you see something that doesn't look correct, contact your agent or insurer immediately, before a loss occurs. If you wait until afterward, you'll likely be stuck with whatever coverage was in force at the time of the loss.

It's also a good idea to periodically review your coverage with your agent or insurer. You may want to add or eliminate coverage as changes occur in your life situation.

Migraine? Avoid These Foods

 
  • Foods to Avoid Certain foods are believed to be responsible for up to 30 percent of all migraines. Here, a list of potential migraine-triggering foods you might want to avoid—and what’s in them that can cause migraines.


 
  • Pickled Foods Foods that have been pickled, fermented, or otherwise marinated sometimes contain monosodium glutamate, also known as MSG. MSG is a flavor enhancer that has been shown to trigger migraines. The Food and Drug Administration (FDA) maintains that MSG is safe, but it remains controversial. 

 
  • Chinese Food MSG is commonly added to Asian foods, particularly Chinese food, as a flavor enhancer. Other foods that may contain MSG: canned soup, frozen foods, processed foods, seasonings, and canned vegetables. Because of the controversy surrounding MSG, food manufacturers list it on the label
 


  • Chocolate contains caffeine, as in sodas, tea, coffee, and energy drinks. In small doses, the caffeine in these foods and drinks can increase alertness. Plus, caffeine can actually help the body absorb pain-relief medication more quickly when migraines do occur. But high doses of it (like the levels found in some energy drinks in particular) can cause irritability, insomnia, anxiety, and migraines. Additionally, long-term uses of caffeinated products can result in a chemical tolerance in your body. If you abruptly stop consuming caffeine, you may experience withdrawal symptoms that trigger a migraine.


  • Aged Cheese Tyramine, a monoamine found naturally in many foods, has been identified as a migraine trigger. Aged cheeses, such as blue cheese, Parmesan, and cheddar, contain tyramine, as do dried and cured sausages and smoked fish
Legal Challenge to ACA Contraceptive Coverage Mandate Could Portend More Complications for Self-Insurance Marketplace

Legal Challenge to ACA Contraceptive Coverage Mandate Could Portend More Complications for Self-Insurance Marketplace

The United States Supreme Court is now expected to consider Hobby Lobby’s legal challenge to the contraceptive coverage mandate implemented as part of the Affordable Care Act.  The owners of the national retailer claim that the law’s requirement that the company’s group health plan includes coverage for contraceptive services violates their religious beliefs. 

This blog remains agnostic with regard to the religious liberty issues, but there are evolving self-insurance angles related to this story that deserve attention.

We recently reported that federal regulators contend the final contraceptive coverage mandate rules incudes a practical accommodation for most self-insured religious organizations (non-profit entities), but  it’s really just a bureaucratic illusion.  The rules allow such organizations a functional exemption from the requirements by transferring all financial and administration responsibilities to their third party administrator (TPA) partners.

While this firewall approach may have satisfied the Administration’s political considerations, it is so far proving unworkable in the real world as multiple TPAs servicing this market segment report that they cannot perform the required responsibilities, citing specific substantive reasons.  The end result is that these self-insured religious non-profit organizations may simply have to dissolve their self-insured group health plans to the extent that they wish to stick to their religious convictions.

The Hobby Lobby case potentially adds a new twist specific to for-profit self-insured companies.  In other words, companies that do not have a primary religious mission but whose owners may have strong religious beliefs.

There are actually about 60 similar cases pending in various federal courts and we expect that some companies are self-insured and others are not.  (This blog has not independently verified the funding structure of Hobby Lobby’s group health plans, but it is likely self-insured given the company’s size.)   Hobby Lobby is the highest profile case both because of its size and because its position was affirmed by the 10thCircuit Court of Appeals in June of this year.

In addition to the central constitutional issue,  Court may also need decide whether the ACA is in conflict with the 1993 Religious Freed Restoration Act (RFRA), which says the government “shall not substantially burden a person’s exercise of religion” unless that burden is the least restrictive means to further a compelling government interest.

A broad ruling by Court declaring the ACA contraceptive coverage mandate provisions unconstitutional outright would take this issue off the table.  An equally broad ruling in the other direction would certainly not be welcome by Hobby Lobby and other similar plaintiffs, but it would at least bring some clarity to their legal obligations.

The more interesting scenario is if the Court charts a middle course in its ruling and determines that the exemption arrangement designed for self-insured religious organization could satisfy the RFRA’s “least restrictive means test” and therefore opens this option up for companies like Hobby Lobby.

In other words, allow these for profit companies to self-certify as exempt organizations for purpose side-stepping compliance with the contraceptive coverage mandate.

But for self-insured companies it would not be that simple because their TPA partners will be put in the same tenuous position as the current non-profit exempt organizations have already done, which could force these companies into more expensive fully-insured health insurance arrangements or drop coverage altogether.

Yes, companies may be able to rely on legally permissible firewalls should the Court rule accordingly, but both their TPAs and sponsored self-insured group health plans may end up getting burned in the process.  Perhaps this may be an unanticipated example of being careful of what you ask for…or on this case, what you pray for. 
Hole-in-one insurer pleads guilty to three felonies

Hole-in-one insurer pleads guilty to three felonies

Kevin Kolenda, a Connecticut businessman who insurers golf tournament hole-in-one prizes but has a history of not paying, pleaded guilty today in King County Superior Court to two counts of selling insurance without a license and one count of first-degree theft.

Kolenda started Golf Marketing in 1995 and sold hole-in-one insurance coverage to charity golf tournaments across the country including in Washington state. He repeatedly failed to pay winning golfers, leaving charities to come up with the prize money. To skirt prosecution, he also changed the name of his business several times.

Other states where Kolenda sold bogus insurance including: Montana, Ohio, Georgia, California, New York, Hawaii, Alabama, Massachusetts, Florida, Connecticut and North Carolina.

Kolenda paid $10,000 in restitution today. He will pay another $5,000 in four months, when he returns to Seattle for sentencing.

Lemon is beneficial for health

There are many foods and natural products that have beneficial properties for the body and the human body. A good example are the lemons that in addition to providing vitamins and minerals, offers plenty of benefits to health and can be used  to alleviate some conditions. In this article we explain in more detail what the benefits of lemon.

Lemon is beneficial for health

Like other citrus, lemon is known for its high content of vitamin C, but also contains vitamins A, E, and B group and various minerals: potassium, magnesium, calcium, phosphorus. This will make lemons become a great source for the body's defenses that will help prevent disease.

The lemon helps to eliminate toxins, and also facilitates the movement of the intestines, helping to regulate traffic. This can be taken every morning a glass of hot water with lemon juice.

Furthermore, lemons are beneficial to blood circulation problems, since the active and improvement. Therefore, it will be appropriate in case of hypertension, varicose veins, hemorrhoids, and other cardiovascular conditions.

Lemon is beneficial for healthThey can be solved with lemon digestive disorders such as indigestion, slow digestion, lack of appetite, etc. Citric since this improves digestion. This can be taken in juice or as tea.

Another of the benefits of the lemon is the fact of being a great antioxidant, which helps prevent aging of cells and neutralize free radicals.

Another benefit of the consumption of lemon is the fact that citric acid promotes the dissolution of the calcium deposits, as well as kidney stones and gallstones.
What to do if your Medicare Advantage plan is going away

What to do if your Medicare Advantage plan is going away

Medicare open enrollment starts Oct. 15. Some people may have already received a notice saying their Medicare Advantage plan is going away. If you or someone you know has received a notice, here's some steps to take:

  • Check with your medical providers and find out what Medicare Advantage plans they accept in 2014.
  • Read about your rights
  • Avoid a gap in coverage by selecting a new plan before Dec. 31
  • If you can't decide between a Medicare Advantage plan or returning to Original Medicare, see page 59 of the Medicare and You 2014 booklet for help

Need more help? Contact our free Statewide Health Insurance Benefits Advisors (SHIBA), They can  help your evaluate and compare plans. 
WAhealthplanfinder will be down tonight for system improvements

WAhealthplanfinder will be down tonight for system improvements

Washington's Exchange - the Wahealthplanfinder.org - is up and running, but some people are still experiencing slow loading times and difficulty submitting their applications. The Exchange is taking the website down tonight starting at 10 p.m. until 6 a.m. tomorrow morning to work on system improvements. Want an update on their progress? Check www.wahbexchange.org often.


I hear new health plans must meet 'actuarial value' standards - what's that mean?

I hear new health plans must meet 'actuarial value' standards - what's that mean?

All individual and small employer health plans sold inside and outside the new Health Benefit Exchange - Wahealthplanfinder.org - must have an actuarial value of at least 60 percent.

This means the plan must pay for least 60 percent of your medical costs for essential health benefits. Sixty percent is the standard for the new 'bronze level' plans. You also can choose from a silver level or gold metal level plan. Silver plans pay for 70 percent of your costs and gold pay for 80 percent.

Here's answers to additional questions about how the new 'actuarial value' works:

If my plan has an actuarial value of 70 percent  does that mean I will not have to pay more than 30 percent of my entire insurance costs?
No, the actuarial value is only based on the level of coverage the plan provides for essential health benefits.  If your plan has an actuarial value of 60 percent, for example, that means that the plan will pay 60 percent of your covered expenses for essential health benefits and you pay 40 percent of the covered expenses for essential health benefits. 
Although the actuarial value of your covered expenses for essential health benefits will be covered, you may have other costs such as deductibles, copays and coinsurance, as well as costs for services that are excluded or are not covered benefits.

Make sure you read your policy to see what services are excluded services.  Benefits that are not covered would be subject to the terms of your insurance policy, so it is important to read your policy before getting the service or treatment. 
What are essential health benefits? As of Jan. 1, 2014, all individual and small employer health plans must cover these 10 benefits:

  1. ambulatory patient services
  2. emergency services
  3. hospitalization
  4. maternity and newborn car
  5. mental health and substance use disorder services including behavioral health treatment
  6. prescription drugs
  7. rehabilitative and habilitative services and devices
  8. laboratory services
  9. preventive and wellness services, chronic disease management
  10. pediatric services ‐ including oral and vision care

 
Restoring an Action to the Trial List

Restoring an Action to the Trial List

The Court of Appeal has provided guidance with respect to the test for restoring an action to the trial list.

In Nissar v. Toronto Transit Commission, 2013 ONCA 361 (C.A.), the plaintiff alleged she was injured while a passenger on a bus in 1999. Examinations for discovery took place in 2002, but transcripts were not ordered and the tapes were destroyed in 2010.  Although the matter was set down for trial in 2004, it was struck off the trial list in 2005.  The plaintiff changed counsel three times.  The motion to restore the action to the trial list was not brought until 2011, and not heard until 2012.  The motion judge dismissed the motion, holding there was no explanation as to why it had taken seven years to bring the motion to restore the action to the trial list, and there was prejudice to the defendant as pre-accident OHIP records were not available and the defendant might not remember details of an accident that occurred 13 years previously.

The Court of Appeal dismissed the appeal. The plaintiff bears the onus of demonstrating there is an acceptable explanation for the delay in the litigation and that, if the action were allowed to proceed, the defendant would suffer no non-compensable prejudice.  In the circumstances, the plaintiff had failed to meet the test.

The Nissar decision was release concurrently with the Faris case, which was the subject of last week's post. They may signal a new emphasis on moving cases swiftly through the system, rather than allowing them to languish for several years.
Washington's Healthplanfinder now up and running

Washington's Healthplanfinder now up and running

After a few hours of technical difficulties earlier today, Wahealthplanfinder.org is now up and running. There may be a few more glitches as additional issues are fixed, so if you're filling out an application, be sure to save your information. Also, the website will be down temporarily tonight at 8 p.m.

Eight health insurers have been approved to sell 46 different plans inside the Exchange. Remember, the Exchange is the only place you can go to receive federal tax subsidies to help lower your monthly premium - and there's only one official Exchange for our state - www.wahealthplanfinder.org.

If you earn more than the cut-off for a subsidy (about $46,000 for an individual and $94,200 for a family of four), you also can shop for insurance outside the Exchange. To see all of the plans available in your county - both inside and outside the new Exchange - check out this map.