Kreidler: The insurance industry faces an unprecedented risk from climate change

Kreidler: The insurance industry faces an unprecedented risk from climate change

Commissioner Kreidler has been involved in climate change and insurance issues for years now. Currently, he chairs the National Association of Insurance Commissioner's Climate Change and Global Warming Working Group. Read his take in Climate Action on the unique opportunity the insurance industry has to prepare for the changes to our climate. 
I forgot to pay my auto insurance - is there a grace period?

I forgot to pay my auto insurance - is there a grace period?

Sorry to deliver the bad news, but if you forget to pay your auto insurance, you really could be canceled. There is no grace period. Call your company or agent right away to make sure you're covered.

Here's a couple more common questions we get:

I was in an accident and the other insurance company won't pay my ongoing medical bills. What can I do?

Unfortunately, when you're dealing with someone else's insurance company, they usually will not pay your ongoing medical costs. Only when you're done with your treatments will they consider settling your claim. If you have personal injury protection (PIP), you should contact your own insurance company to let them know about the accident and your injuries.

I was in an accident and the other person's insurance company says I have to get my car repaired. Is that true?

The insurance company is obligated to pay you for the loss. You have the right to decide to cash out your claim rather than have your vehicle repaired. But keep in mind that if you cash out your claim, the company may not consider any additional damage that you discover later. Also, the company will only pay the very least it can to repair your vehicle. So, if you have three estimates they'll only pay for the lowest cost one. Most companies will base your settlement on their own inspection and estimate.
Questions about health reform? Check out www.healthcare.gov

Questions about health reform? Check out www.healthcare.gov

For those of you who've followed the Affordable Care Act since it's passage, you've probably spent considerable time at the federal government site: www.healthcare.gov. Well, it just got a whole new look. They've streamlined the information and given it more of a consumer focus. We like it - a lot. Check it out for yourself. There's even specific information for people who already have health insurance. And even a live chat option 24/7 if you want your question answered right away.
Limitation Periods in Claims for Contribution and Indemnity

Limitation Periods in Claims for Contribution and Indemnity

The Court of Appeal recently commented on limitation periods in claims for contribution and indemnify, clarifying that s. 18 of the Limitations Act imposes a two year limitation regardless if the claim is based in contract or tort.

In Canaccord Capital Corp. v. Roscoe, [2013] ONCA 378 (C.A.), the defendant was an investment advisor employed by the plaintiff, an investment dealer.  The employment agreement provided that the defendant would indemnify the company for any claim arising out of his acts or omissions in the course of his employment.  In 2008, two clients sued Canaccord and Roscoe for losses they sustained in an investment for which Roscoe was their advisor.  Canaccord filed a joint defence and did not crossclaim against Roscoe for indemnity.  The claim was settled in 2009 without Roscoe's involvement.  Canaccord issued a claim for indemnity in 2011, more than three years after the initial claim.  Roscoe brought a summary judgment motion on the basis that the limitation period had expired.  The motions judge held that that s. 18 of the Limitations Act does not apply to indemnity claims arising out of contract.  She held that the claim was not one for contribution and indemnity, but rather one of a breach of the employment contract.  She held the limitation began to run from the settlement date.

Roscoe appealed and the Court of Appeal allowed the appeal.  Section 18 refers to "wrongdoers", not just "tortfeasors" and so is broad enough to include claims arising out of contract.  The limitation began to run when Canaccord was served with the claim, and accordingly, the action was out of time.

Foot Care in Summer

With the arrival of summer and the heat gets too sensitive for our health, like others parts of the body, foot also create uncomfortable situation. Due mainly to the change in type of footwear as new weather our feet may experience some problems. We go from closed to open footwear, plus without socks or stockings that largely protect the feet.

Foot Care in Summer


Common Problems of Foot in Summer

Chafing and blisters:
They are one of the most common problems. The first is due to the friction of bare skin against the new shoe or sandal and may even cause injury. The latter have the same etiology, but in this case, instead of lacerate the skin, it rises liquid accumulating beneath.

Excess sweating:
At the bottom there are a lot of sweat glands and in some people who sweat excessively high humidity occurs that leads to secondary problems such as cracks between the toes.

Excessive dryness of the skin:
The wearing of feet into the air and high temperature cause more dry skin this time of year. This is particularly evident in the heel area; the edges appear whitish due to lack of moisture and accumulation of hyperkeratosis (skin hardness).

Fungal skin infections:
During the summer there are a number of ideal conditions for fungal infections. The most typical of all is the Athlete's Foot, which appears in the fingers and causes skin red, dry and flaky. Sometimes also cracks or blisters may appear.

Tips to Overcome the Foot Problems 

It is very important to choose suitable footwear: comfortable, breathable, soft and airy with a sole buffer at the same time flexible. This prevents a considerable extent the occurrence of chafing and blisters.

In the event of a rash should be disinfected and covered with a dressing. If a blister is what has occurred, it must go through with a fine needle to drain the liquid, pressing on it, disinfected and covered with a dressing. You have to let the skin comes off by itself when the epidermis is fully regenerated.

For the sweating you can opt for products that regulate perspiration. There deodorants (not prevent moisture, only deodorized) and antiperspirants that clog the pores to some extent by leaving the sweat, controlling moisture. You must read its instructions and follow them to the letter to avoid further problems.

Foot Care in Summer


Since excessive sweating may cause cracking toes. In these cases we apply an antiseptic on them to facilitate healing and prevent infection, in addition to seeking dry off well between the toes after showering and use a desiccant such as talcum powder before cal-zones. It is to prevent the continued use daily and closed footwear.

The Athlete's Foot, a typical problem in summer, is a fungal infection caused by a concentrated moisture extreme sweating feet. It is usually cured with anti fungal and consistently in treatment. To avoid this it is advisable:
Use slippers or rubber slippers pools, saunas, gyms and public areas where it is in direct contact with moisture.

Wear shoes allowing perspiration, preferably leather or natural materials.
Never share towels or footwear.

Daily hygiene of the feet, drying them thoroughly especially between the toes
Another frequent problem is the papilla virus infections (plantar warts) that abound in warm, moist areas such as swimming pools, gyms, saunas, etc. They are very common in children. With the use of appropriate flip-flops in these places is prevented contagion. Appear if you should see a dermatologist for treatment.

Summer must duplicate the skin hydration to prevent drying problems, which are much more evident in summer. It is recommended to apply moisturizers, preferably in the evening to avoid increase sweating during the day. Also recommend the use of a file or pumice stone and rough areas of your feet a couple of times a week, with the goal of eliminating the accumulation of hyperkeratosis or hardness of the same. 

Following the tips you should take care your foot in summer.
Spokane man's own smartphone is a witness against him in insurance-fraud case

Spokane man's own smartphone is a witness against him in insurance-fraud case

Last summer, a Spokane man named Bryan Gilbert Robb filed an insurance claim, saying that his home had been burglarized. The police report listed an $800 loss.

Robb's claim, however, totaled $26,569, most of it from computers, games and DVDs. He included several photographs of the items that he said had been stolen.

Digital cameras and smartphones typically record the date and time that an image is taken, with what device, etc. This information, which is embedded in the photo file, is called metadata.

The problem: The metadata for 7 of the 9 photos submitted by Robb showed that the images were taken after the burglary date.

Robb's company, Assurant, denied the claim and turned it over to our Special Investigations Unit, which found a very similar 2004 burglary claim at Mr. Robb's previous address. That claim reported the loss of almost identical computers, a game console and DVDs.

Robb was charged June 14 in Spokane County Superior Court with one count of felony insurance fraud and one count of second-degree attempted theft. Arraignment is set for July 1.

To report insurance fraud or insurance scams here in Washington state, here's how to reach us.
Allianz Life Insurance fined $150,000

Allianz Life Insurance fined $150,000

Washington State Insurance Commissioner Mike Kreidler has fined an insurance company $150,000 after its agents sold unapproved annuities.
Allianz Life Insurance Company of North America has agreed to pay the fine.
Several Allianz Life agents have been fined, suspended or have lost their insurance licenses in recent years for selling unapproved annuities to Washingtonians. In some cases, the customers were flown to Idaho; in others, the agents falsely claimed that the forms had been signed in Idaho or Florida. Kreidler’s office had been raising concerns with the company about these problems since at least 2007.
As required by law, Allianz Life reported the agents to Kreidler’s office and offered refunds to the affected customers. In April 2012, the company implemented procedures designed to prevent illegal cross-state insurance sales.
“I’m glad to see that the company’s taking efforts to rein in this ongoing problem,” said Kreidler. “I understand the pressure to make sales, but agents and companies selling to Washingtonians have to use products that are approved here.”

For more, please see the press release.

Threshold Motion Successful

Threshold Motion Successful

The defendants in a recent jury trial succeeded on a threshold motion.  In Ryckman v. Pottinger, 2013 ONSC 2857 (S.C.J.), the plaintiff had been in two motor vehicle accidents 11 months apart.  The plaintiff entered into a Pierringer Agreement with the first defendant and proceeded to trial against the second defendant.   The jury assessed global damages at $175,000 and the defendant at trial was responsible for 10% of the figure.  General damages would have been $3,500.

In granting the threshold motion, Justice Parayeski noted that an accident by accident analysis is required; just because a plaintiff met threshold in one case does not mean she will in another. Justice Parayeski inferred from the jury awards that they did not accept the submissions of the plaintiff as to her damages. It appeared the jury did not find the plaintiff credible. There was an observable difference between the plaintiff's appearance at court versus on surveillance. Ultimately, the damages awarded were so small as to lead to the conclusion that the plaintiff did not meet the threshold.  The second accident caused no more than a minor exacerbation of the injuries she sustained in the first accident.

Spokane man sentenced for insurance fraud and attempted theft



Four years after filing a bogus insurance insurance claim that tried to turn $4,000 in storm damage into a $200,000 payment, a Spokane man has been sentenced to 240 hours of community service, 15 days of electronic home monitoring and more than $7,000 in fines.

Keith R. Scribner, seen in the surveillance photo above, was sentenced Friday in Spokane County Superior Court on felony charges of insurance fraud and attempted theft.

The case stemmed from a claim filed in late July 2009 by Scribner's mother, Marilyn Warsinske. 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.

5 LoL Healthy Eating Secrets


 Scientists, nutritionists, dietitians, experts, gurus and other annoying, opinionated people who are into health and nutrition love to dish out all kinds of crazy advice about healthy eating.

The problem is that it becomes nearly impossible to keep up with the flood of information and actually turn that into something simple and practical, that you can follow daily.

Does it have to be this hard? We don't think so! That's why, we've pulled together the real secrets to eating healthy.

 This won't guarantee you good health, but trust us, if you keep these simple secrets in mind, you'll have a fighting chance of not only becoming a healthy eater, but also capable of dishing out some monster (hopefully not annoying) healthy eating advice yourself!

1. BECOME A BLACK-BELT SALAD MASTER 

 

Salads don't have to be a handful of tasteless lettuce mixed with all other kinds of boring ingredients, saved by some fat creamy dressing that ruins the whole point of eating a salad in the first place.

Salads can not only be packed with nutrition, but also with amazing taste! To get black-belt-level salad chops, follow this 5-Step guide to make super-salads and also check out these amazing protein-packed salad recipes. No one is telling you to eat salad for every meal. We know; you have a life!

2. GET SUPERPOWERS WITH SUPERFOODS 


 

A superfood is a food that is extremely high in antioxidants. When measured by weight, the more disease-fighting, wrinkle-preventing antioxidants packed into one food - the more "super" it is.

 In today's toxic world, it is essential to include them in your diet for optimal performance, rejuvenation and vitality, so check out this guide to determine which foods are right for you and try out these superfood bars, snacks and powders.

3. CURB YOUR ENTHUSIASM FOR SUGAR



 Is all sugar evil? No way! There are good sources of sugar (the natural one's) and then there are the bad sources (the processed ones).

It gets a little more complicated than that, but you essentially need to manage how you're getting your sugar to strike the right balance and follow these surprising ways to curb your sugar cravings. Now, that's SWEET!

4. SLAY THAT EXCESS SALT



Our bodies need salt to maintain fluid balance and nerve function, so consuming it is definitely good for you. However, too much of this good thing is in fact, very bad for you (hypertension, heart disease and kidney problems!).

 To make matters worse, salt is everywhere (especially in processed foods) and learning how to manage your intake may be challenging. Follow these simple tips and check out some amazing sodium alternatives that you could consider using.
5. NIBBLE ON SOME NUTS AND SEEDS



 All nuts contain heart-healthy fats and fatty acids, fiber, vitamin E, and other beneficial substances.

Learn about the amazing health benefits and just how much you should be consuming. Seeds on the other hand are tiny wonders that are packed with disease-fighting minerals and enzymes, they can be used in just about any recipe.

Check out these three favorites that are easy to incorporate into your everyday diet explore the wonderful world of seeds with the Ultimate Seed Guide. Nibble Away!
New report cites increased flood risk in coming decades

New report cites increased flood risk in coming decades

FEMA on Wednesday released a report on flood risk and the potential impact of climate change, particularly sea level rises.

The upshot: the report said that areas considered flood-prone could substantially increase, particularly here in the Pacific Northwest, by the end of this century. The impact on federal flood insurance -- the National Flood Insurance Program -- would be profound, with substantial increases in both cost and the number of policies.

Mother Jones magazine summarized the report here.

Wildfires and homeowners insurance: Five things you need to know



As wildfire season approaches, here are five important things to know about fire danger and your homeowners insurance:

1) Homeowners insurance generally covers all fires, including wildfires, unless the policyholder intentionally set the fire. Outbuildings and unattached structures are also generally covered.

2) If possible, review your policy to make sure you have enough coverage. Things like fine art and jewelry may have limited coverage under a standard policy. But you can buy special coverage that gives you more protection. Here's information to help determine how much

3) Prepare a household inventory, which will help a lot if you have to file a claim. You can do it with these easy-to-use paper forms, or you can try free iPhone/iPad or Android apps that do the same thing.

4) You can help protect a rural home and limit the danger by clearing a natural firebreak between your home and surrounding trees, brush and uncut fields. The Federal Emergency Management Agency has much more information on how to protect yourself and your home, before, during and even after a wildfire.

5) Have an emergency kit and a family communication plan. Know where your valuable papers (including insurance policy and contact info), mementos and anything you can't live without are, so that you can evacuate with them if needed. Here's a list of recommended emergency supplies. And if you're advised to evacuate, do so immediately. Don't be the person in the photo above.

Help your Hair growth naturally

Hair growth naturally

Hair loss is a common problem for men & women, many of them spend more time and money to protect their hair, so it is necessary to know techniques to achieve hair growth naturally, without spending more times and money.

Hair growth naturally


One of the techniques recommended to get hair to grow naturally is to apply olive oil before washing in the morning, another option is to combine the mixture of aloe and honey, for that you should remove the pulp to several leaves of Aloe Vera, mixed with honey and apply this mixture to the scalp, this stays in the hair for twenty minutes and then wash it, you can cut an onion and add it to your everyday shampoo, let it sit for fifteen days and then use it normally, this will help to grow hair fast and shiny.

A good diet can help in the process of achieving hair growth, for example in the morning you can have breakfast a mixture of one tablespoon of soy lecithin, a tablespoon of wheat germ, a tablespoon of honey, a tablespoon of brewer's yeast and a yogurt, you mix all the ingredients with yogurt and breakfast this every day along with what normally eat breakfast, in a period of one week you should start to see results.

When cooking potatoes keeps the water used and the same day use it to rinse your hair.

Although its primary use is not for this, birth control pills help hair grow faster, so it takes about fifteen pills and put them in a plastic bag and crush them until they become a powder, the powder and pour it takes the bottle of shampoo you use, you mix well and let stand for at least a day, after that you will use the shampoo regularly.

Following the above techniques you will see how your hair growth naturally
Heads up: New travel insurance license rules in WA

Heads up: New travel insurance license rules in WA

New rules are taking effect July 1 for travel insurance licensing in Washington state. Here's a summary, albeit one that's pretty heavy on insurance-ese:

  • Under the new rules, any individual or business entity that will sell, solicit, or negotiate travel insurance must have the travel line of authority specifically listed on their Washington state insurance producer license.
  • There is one exception to this new requirement. If a licensed business entity (agency) wants to transact travel insurance business, it must a) have a producer license with the travel line of authority and b) have a designated responsible licensed person for the agency who has a producer license with the travel line of authority.
Got questions? We've prepared an FAQ page on this topic, and if that doesn't help, you'll find contact info (email and phone) at the bottom of the FAQ page.
Leave Required for Refusals Motion After Set Down

Leave Required for Refusals Motion After Set Down

Does a party need leave to continue a refusals motion after it has set the action down?

In Jetport v. Jones Brown, 2013 ONSC 2740 (S.C.J.), the parties brought motions seeking answers to questions refused on examination for discovery.  Although the motions were commenced in May 2012, they were not completed and were adjourned to November 2012.  They were still not completed and further dates in April 2013 then October 2013 were scheduled.  In February 2013, trial was scheduled for May 2015.  

One of the issues on the motion was whether the plaintiff required leave to bring the motion pursuant to r. 48.04(1) since it had set the action down for trial.  The plaintiff argued that it did not require leave based on rule 48.04(2), which provides that r. 48.04(1) does not relieve a party from any obligation imposed by r. 31.07 (failure to answer on discovery).

Master Graham held that the plaintiff required leave.  There is no obligation on a party to answer questions refused on discovery and therefore a motion to compel answers does not fall within s. 48.04(2) so a party that has set the matter down must seek leave to initiate or continue a motion to compel answers to refusals. 

It appears there are two differing lines of case law on this issue.  Counsel should be cautious about setting an action down if there are outstanding refusals they wish to pursue.

 
Health Care Claims Tax to Live on in Michigan

Some fresh reporting from Michigan indicates that there is still quite a bit of certainty ahead for a health care tax scheme with big ERISA preemption considerations as it ropes in self-insured group health plans.  (See 11/23/12 blog post for prior reporting on this subject.)

While industry observers wait on a federal appeals court to rule on whether the state state’s Health Insurance Claims Act (HICA) violates federal law, there is one open question that appears to be settled, which is that the tax will not sunset at the end of the year as originally intended.

Governor Snyder is expected to sign legislation (SB 335) as early as this week that will extend the sunset provision for four years.  So this “temporary” tax sure has a permanent feel to it.

A proposal to hike the one percent tax was stripped from the legislation but that does not necessarily mean that it not going happen.  That’s because the Legislature has finalized the state’s 2013-2014 budget assuming $400 million in revenue coming from the HICA tax. 

The problem is that number likely overestimates revenue by at least $130 million based on the current year’s tax receipts.  Legislators hope to fill this revenue gap by tweaking the state’s no fault auto insurance system and related new vehicle fees, but if this is not done by October, they will be forced to pass what is known as a “negative supplemental appropriates bill” and the heat with again be on again to increase the HICA tax.

 And keep in mind that there is a two-to-one match from the federal government for all state revenue raise through the HICA tax, so a multiplier effect is in play, which further intensifies the pressure to maintain and increase the tax.  That said, It is sometimes easy to tune out when reading about predictable legislative maneuvering and lose focus on the real world implications, so let’s do that quickly now.

Last year, this blog spoke to a major multi-self-insured employer based on Michigan to gage how they have adapted to the HICA tax.   The response regarding the economic affect was largely expected – essentially that it raised the cost of doing business but that it has not prompted them to reconsider being self-insured.

 Their response regarding the compliance administrative burden was more telling.  While they have been able to figure how to comply with the law, if similar tax schemes pop up in other states the administrative burden will not grow incrementally, but rather exponentially and will force them to take another look at whether self-insurance is still the best option for them.  That’s compelling.

Absence intervention by a federal appeals court, it will be interesting to see whether this ERISA preemption assault can be quarantined with the Michigan state lines. 

Average health insurance premiums, by state

Premiums for family health insurance rose an average of 62 percent -- $9,249 a year to $15,022 a year -- according to the latest survey of employer-sponsored insurance by The Commonwealth Fund.

Employees' contributions to their premiums rose 74 percent during the same time period, from an average of $2,283 to $3,962. And deductibles more than doubled, to an average of $1,123 a year.

The report covers the years from 2003 through 2011; it will be a while before we get comprehensive data for health care reform, which takes full effect next year. In the meantime, we've posted the proposed rate filings for Washington on our website.



Among states in the West, Washington is a standout for below-average premiums compared to median household income, the study found. In Oregon, Idaho, California, Montana and Nevada, premiums compared to income were higher. (Click on the map above for more on this.) In pure dollar terms, Idaho is the fifth lowest-cost state in the country, although its average deductibles are significantly higher than Washington's.

The lowest average premiums were in Arkansas; the highest in Massachusetts.

Regardless, "Health insurance is expensive no matter where one lives," the report's writers concluded. "...Across the country, insurance premiums have risen far faster than median (middle) income for the under-65 population.)"

Here are the state average premiums in our region:
  • Washington: $5,144 single, $14,559 family
  • Oregon: $5,055 single, $14,283 family
  • Idaho: $4,553 single, $13,211 family
  • California: $5,255 single, $15,837 family
Long-term care insurance: Why have the costs been going up so much, and what can I do?

Long-term care insurance: Why have the costs been going up so much, and what can I do?

One of the most common complaints we hear -- and one of the most frustrating -- is from people who have been paying for long-term care insurance for years, but are on the verge of losing the coverage because they can't afford the cost of fast-rising premiums.

Unfortunately, this is a national problem.

So what can you do if the increase is more than you can afford? You can choose to reduce your benefits under the policy, such as:
  • Reduce your daily benefit
  • Reduce the benefit period duration, such as from five years to two
  • Reduce the amount of your optional inflation protections
 You can also choose what's called the contingent non-forfeiture option. Under this option, you keep your policy in force and stop paying premiums. Your coverage does not end, and the company provides benefits for qualified long-term care services covered under your policy -- here's the caveat -- equivalent to the premiums you've paid.

You may also want to look at the Washington state Long-Term Care Partnership Program, a new option to help consumers pay for long-term care costs and avoid spending down or transferring assets to qualify for Medicaid.

Why have long-term care prices been going up so much in recent years?

Long term care insurance is a fairly new product, with many companies not offering it until the early 1990s. As a result, they had little experience to base their prices on, and early policies were priced significantly lower than they should have been, based on how the cost of claims and the fact that -- unlike life insurance, for example -- few people cancel the policies. People get the policies, knowing they may well need them when they're older, and they tend to keep them.
 
As a result, most long-term care insurers have bumped up their premiums sharply in the past few years -- in some cases 40 percent or more -- angering customers who signed up for policies at relatively low cost years ago.   This puts insurance regulators in a bind. Consumers are understandably unhappy. But if regulators reject the rate increases, the insurance carriers could run into financial trouble, leaving them unable to pay claims. And nationally, a number of insurers have simply gotten out of the business of issuing new long-term care policies, which leaves consumers with even fewer choices. (In Washington, there are still a large number of companies approved to sell the coverage. Here's a list.)      
Stevens County woman convicted of insurance fraud over fake claims

Stevens County woman convicted of insurance fraud over fake claims

A Stevens County woman has been convicted insurance fraud for claims she filed after a fire of undetermined origin destroyed her home in 2011.

Jenny Rae Balsz, 44, of Colville, pleaded guilty May 28, 2013 in Stevens County Superior Court. She was sentenced to 30 days in jail, which she'll be allowed to serve as 240 hours of community service, plus fines and fees of $850.

(If you suspect someone of insurance fraud, here's how to reach our investigators.)

On the fifth of July, 2011, a fire at Balsz's home in Evans, Wash. burned the structure to the ground. Fire investigators were unable to determine the origin of the fire. At the time, Balsz was in Montana, visiting family.

Her insurance claim included several receipts for a total of $13,899 in items purportedly purchased from a home furnishings store. An investigator for Safeco, Balsz's insurer, later found that Balsz had not purchased any of the listed items at the store. In fact, the store didn't even carry some of the items listed, including antiques and a grandfather clock.

She also submitted a purported receipt for a $6,240 clarinet. The receipt also turned out to be false.

And she submitted a fraudulent $800-a-month lease agreement, claiming that she was paying rent to her landlord. The "landlord" turned out to be her live-in boyfriend; the insurance checks for living expenses went directly to Balsz.

Safeco, as required by law, reported their findings to our office's anti-fraud unit, known as the Special Investigations Unit. After they investigated further, our office sought charges against Balsz.

The charge on which she was convicted is a felony.
Important notice to insurers re: new online complaint system

Important notice to insurers re: new online complaint system

As Washington state's insurance regulator, a large part of what we do is try to resolve consumer complaints against insurers: delayed or denied claims, wrongful cancellation of policies, etc.

To speed up the process, we have developed a new online "Complaint Response System," or CRS. This allows us to contact insurers over the internet while still protecting people's private information.

Here's the key part for insurers to know: On June 28, 2013, companies with an active Washington license will be automatically registered for the new system. Any consumer complaints received by our office regarding those companies will be uploaded to the CRS beginning July 1, 2013. After this date, we will no longer be sending complaints to you via US Mail. The CRS will be the only avenue used to forward complaints to you and receive your responses.

We would like to invite those companes to participate in our CRS training. It will only take a couple hours of your time and will assist you in navigating the new system.

We strongly encourage any of your staff who responds to Washington consumer complaints to attend one of the below trainings.

There are two training times available:

• Tuesday, June 18: 9:00 a.m. – 11:00 a.m. (PST)

• Monday, June 24: 1:30 p.m. – 3:30 p.m. (PST)

We will email the WebEx invitations on June 10th to your company's complaint contact.

To learn more about the company Complaint Response System (CRS) project, visit our meetings page.
New report: Washington State Health Insurance Pool

New report: Washington State Health Insurance Pool

The state's high-risk health insurance pool, known as the Washington State Health Insurance Pool, has issued its annual report. From it:

  • The program saw a 5 percent decline in enrollment last year, probably due to the availability of a temporary (and now closing) federal high risk pool here in Washington state.

  • And claim costs increased 11 percent, from $93 million to $103 million.

Some 3,675 people are enrolled in WSHIP. These are folks that cannot find coverage at the current time in the individual insurance market or Medicare supplement market, due to pre-existing medical conditions such as kidney failure, cancer and HIV/AIDS. (Under federal health care reform, insurers next year will no longer be able to turn away sick applicants.)

Created in 1987 by the Legislature, WSHIP is overseen by a board of directors. The program is not state-funded: Premiums charged to members cover about a third of claim costs; health insurers pay the remaining costs. Administrative costs are about 3 percent of expenses.

Migraine and Food Selection


Migraine and your Food selection

Migraine can be defined as a severe headache, usually unilateral, accompanied by gastrointestinal signs and other visuals. It is a very common discomfort in women, common among the young adult population. Its causes are many, but the family history seems to have much of the responsibility.

Migraine


Some reports indicate that there are certain foods that are triggers of migraine symptoms in people who suffer from frequent episodes. However, this condition is so complex that it has been observed that not all persons with the same symptoms food or to consume the same quantities of them.

Four nutritional recommendations for people with migraine:

Keep mealtimes sorted and avoid spending more than three hours without eating. This helps to maintain stable blood glucose levels and avoid drastic reductions sugar for the brain, with the consequent dizziness, fatigue and headache.

Avoid eating too many sweets. Many sweet foods such as chocolates, candies, jellies, honey, corn syrup, desserts and preserves are related with the onset of migraine symptoms. Avoiding them can help not only with these headaches, but also with their weight.

Stay away from alcoholic beverages. Besides its hypoglycemic effect, i.e., they can produce significant decreases in blood sugar; alcohol containing favors the onset of migraine symptoms. Do not drink wine, beer, vodka, whiskey, or any other beverage of this kind.

Migraine and food selection


Pay attention to these foods. The following list corresponds to foods that commonly favor the occurrence of migraine attacks:


  • Ripe banana 
  • Chocolates 
  • Pickles and canned food 
  • Sour cream 
  • Nuts and seeds 
  • Peanut Butter 
  • Coffee and black tea 
  • Sausages: salami, bacon, ham, sausages, etc. 
  • Cheeses mature cheddar, Gouda or Edam 
  • Condiments artificial seasonings, packaged soups, chutneys

Foods are essential for our living, but sometimes they create some problems for our bad health condition or influence some diseases elements. If we are careful about food selection then it will help us to control some uneven problems like migraine.
Little-known fact: Many life insurance policies automatically end at a certain age

Little-known fact: Many life insurance policies automatically end at a certain age

Did you know that many life insurance policies have a built-in end date? It’s true -- and most people don’t learn about this until their policy ends and they find themselves without life insurance.

Life insurance policies often have language that says the plan automatically ends when you turn a certain age, such as 65 or 90. If you’re lucky enough to live until your policy’s end date, you may find yourself in the uncomfortable position of being without life insurance at a time when your health might not be good enough for you to buy another life insurance policy.

To prevent that kind of unpleasant surprise, read your policy. If the policy has an end date, and if you’re still healthy enough to qualify to buy life insurance, you might want to find a different policy that doesn’t have an end date.

For more information -- including about the 10-day "free-look" period, what documents to save, etc., please see our "Tips for buying life insurance" web page.

STD outbreak of epidemic proportions: The NYC zip code where HIV, gonorrhea, syphilis and other deadly diseases run rampant

Here's one neighborhood where you definitely shouldn’t have unprotected sex, share a needle or stand next to someone coughing.

The 10457 ZIP code in the Bronx — which includes Tremont, portions of Crotona, Belmont and Claremont — has the highest number of people afflicted by two of the following conditions: HIV, hepatitis B, hepatitis C, gonorrhea, syphilis, chlamydia and tuberculosis, according to the Department of Health.

All seven diseases are epidemic in 10457, with infection rates for all conditions in the top 20% of cases citywide.

It’s not just a 10457 problem. In fact, the Bronx has the highest number of ZIP codes — 70% — where residents are in the top 20% for at least two diseases.

In Manhattan, 45% of ZIP codes have two-disease rates in the top 20%, compared to 25% of Queens ZIPs and 22% in Brooklyn.

“It’s very disturbing, especially for our community,” Tom Murray, director of community affairs for St. Barnabas Hospital and the chairman of Community Board 6’s Health and Human Services Committee.

“The teenagers are engaging in very risky behavior. They think AIDS is a thing of the past.”
The ZIP code’s high poverty rate contributes to the disproportionate number battling two or more serious diseases.

 Roughly 70,000 people live in the 10457 ZIP code and the median household income is $24,537. Some 43% of Tremont/Crotona residents live below the poverty line compared a poverty rate of 21% citywide.

“While this is a disappointment, it’s not a surprise,” said Community Board 6 District Manager Ivine Galarza.

Residents blamed officials.

“I’m afraid,” said Yolanda Smith, 32, said. “The government needs to do something about it.”
Juan Santos, 63, a disabled veteran, called for more activities and education for young people.

“The main problem with venereal disease is a lack of information,” he said. “We have a lot of billboards about cigarettes and beer. Why are there no billboards about AIDS?”

It’s not as if condoms aren’t available, said one shop owner. It’s just that people aren’t using them.
“I got a lot of condoms,” said Andrew Garcia, manager of the Crotona Lotto Plus shop.

 “Nobody’s asking for condoms. When the hospital came and gave out the free condoms, I left them here. Nobody took them.”
 

Tools to help estimate the costs of medical procedures

Tools to help estimate the costs of medical procedures

Nationally, a number of consumer groups and government agencies have put together tools to try to make it easier to estimate the costs of a medical procedure before you have it. Among them:

Healthcare Blue Book, which describes itself as a "free consumer guide to help you determine fair prices in your area for healthcare services.

Fair Health Consumer Cost Lookup, an "independent, not-for-profit corporation whose mission is to bring transparency to healthcare costs and health insurance information."

If you're comfortable with Excel, the federal Centers for Medicare and Medicaid Services have also pulled together a lot of pricing data on the 100 most common inpatient services and 30 common outpatient services.

So what do you do if you're uninsured and are facing huge bills for a needed procedure? See our "can't afford health coverage" web page, which lists:






Further Defence Medical Ordered After New Evidence Produced

Further Defence Medical Ordered After New Evidence Produced

In Low v. Clarke, [2013] OJ. No. 1703 (S.C.J.), the defendant brought a motion seeking to compel the plaintiff to attend a further defence medical with a neurologist.

The plaintiff was examined by a neurologist, Dr. Upton.  Following the examination, the plaintiff served over 400 photographs of the plaintiff post accident.  According to Justice Glithero, the photographs appeared to show the plaintiff in various physical activities that were inconsistent with what she had previously reported to doctors.  The defendant filed a letter by Dr. Upton stating that a further examination would be important and useful to his opinion at trial.

Justice Glithero cited with approval a number of factors from Bonello v. Taylor, 2010 ONSC 5723:

1.  The request may be legitimate where there is evidence the plaintiff's condition has changed or deteriorated.  Justice Glithero added to this factor: where new evidence is disclosed and is material to the opinion and to any proper assessment of the extent and nature of injuries sustained.
2.  Trial fairness should be the guiding principle.
3.  Ordering further examinations may be just where they are necessary to enable the defendant to fairly investigate and call reasonable responding evidence at trial.

Justice Glithero allowed the motion and ordered a further examination.  Although these types of motion are largely fact specific, it is important to remember the guiding principle of fairness when deciding what evidence to present to the court.
"Am I eligible for a subsidy to help pay for health insurance?"

"Am I eligible for a subsidy to help pay for health insurance?"

As a result of the health care reform law, you might qualify for a health premium tax credit -- often referred to as subsidies -- that you could use to reduce your monthly health insurance premiums, reduce the amount of taxes you owe, or both.

Here’s a calculator that will show whether you’ll qualify for the tax credit. (Note: If your employer offers what is deemed affordable coverage -- meaning that the employee's coverage to cover him- or herself costs less than 9.5 percent of income -- you aren't eligible for the Exchange.)

If you are eligible for the tax credit, then you’ll need to decide whether you want to receive it. If yes, then you’ll need to buy your health insurance through the Exchange, also known as the WashingtonHealthplanfinder.

Health insurance plans will be available on the Exchange website starting this fall, and you can enroll in Exchange plans from 10/1/13 through 3/31/14. Plans will start as early as 1/1/14, depending on the date that you enroll.

If you’re eligible for the health premium tax credit, you can receive it by:

• Taking the tax credit in advance, which will reduce your monthly premiums;
• Using the tax credit later, when you file taxes, to reduce the amount you owe in taxes for that year; or
• Taking part of the tax credit in advance to reduce your monthly premiums, and using the rest later to reduce the amount you owe in taxes for that year.

At the time that you sign up for a health plan through the Exchange, you’ll need to tell the Exchange how you want to take your tax credit.

There’s nothing that you need to do right now; just be aware that if you qualify for and want to take the tax credit, you’ll need to sign up for a health plan through the Exchange between October and March.

For more, please see our "Health care reform -- what it means to you" page.

10 Best Foods for Your Body



  •   Kiwi for Your Bones
Eating kiwi will not only help maintain clear skin, it will also promote healthy bones. Lisa
Drayer, MA, RD, author of The Beauty Diet, says one cup peeled kiwi contains more vitamin C than
the equivalent amount of oranges. Plus, it neutralizes free radicals that could lead to things
like cancer and heart disease
 
  • Avocado for Shiny Hair
"Long touted as the miracle hair food, they're high in vitamins B and E which promote a healthy scalp and the growth of new strands," says Cynthia Pasquella, certified clinical nutritionist, SoCal Cleanse founder. "They're also full of healthy, monounsaturated fats to plump up and moisturize hair follicles. Talk about shine!"

 
  • Garbanzo Beans to Fight Grey Hair
"Since hair is primarily made up of the protein, keratin, it's important to get enough protein to fight off hair breakage and loss," explains Pasquella. "These beans, also known as chickpeas, provide tons along with the trace mineral manganese. It's known to prevent changing pigmentation, a.k.a. gray hair!"
 
 
 


  • Oysters for Your Eyes
Not only are oysters full of zinc and selenium, according to Drayer, the high levels of these minerals serve as an antioxidant and help protect you against eye-related disease.

 
 
  • Cilantro to Prevent Hair Loss
"This herb works wonders for hair loss!" says Pasquella. "It works as a purifying agent to rid the body of toxic metals quickly. A good thing, since they can stop nutrients from getting to your scalp, resulting in hair loss and dull strands."


 

  • Salmon for Your Heart
Diets high in omega-3 fatty acids protect against heart disease. A study from Diabetes & Metabolism found that omega-3s keep the stress hormones cortisol and adrenaline from peaking.

  
 
  • Lentils for Hair Growth
"They're an ideal source of iron, which is so important for full, lustrous locks!" exclaims Pasquella. "Iron helps bring oxygen to the hair follicles, leading to growth and fullness. This is especially key if you have thin hair."
 
 
 
 
  • Ginger, Turmeric, Cocoa, Cayenne, and Cinnamon for Your Blood
These spices have potent antioxidant and anti-inflammatory effects on the body, says Paula Simpson, BASc, RNCP. They also help balance blood sugar and can be easily incorporated into beverages or even food. 




  • Hemp Powder for Dry Scalp
"Add a scoop to a smoothie to infuse your hair with essential fatty acids," suggests Pasquella. "This fortifier has the optimal ratio of omega-6 and -3 fatty acids, letting them work most effectively. Insuffiecient amounts of either can lead to a dry scalp and brittle hair."


  • Banana for Your Libido
Loaded with B vitamins, the well-hung fruit helps boost testosterone. According to Lynn Nezin, co-author of Great Food, Great Sex, low testosterone levels can make for a sluggish sex drive in men and women.

Sebelius won't intervene in girl's transplant case

 
PHILADELPHIA (AP) — The U.S. health secretary said she won't intervene in an "incredibly agonizing" transplant decision about a dying Pennsylvania girl, noting that three other children in the same hospital are just as sick.
 
Health and Human Services Secretary Kathleen Sebelius told a congressional panel Tuesday that medical experts should make those decisions.

However, relatives of 10-year-old Sarah Murnaghan said Sebelius' remarks confused them because they want a policy change for all pre-adolescent children awaiting lung transplants, not just Sarah.

The Newtown Square girl has been hospitalized at Children's Hospital of Philadelphia for three months with end-stage cystic fibrosis and is on a ventilator. Her family wants children younger than 12 to be eligible for adult lungs because so few pediatric lungs are available.

Under current policy, only patients 12 and over can join the list. But Sarah's transplant doctors say she is medically eligible for an adult lung.

The change would add perhaps 20 children from ages 8 to 11 to the adult waiting list, which has more than 1,600 people on it, according to Sharon Ruddock, Sarah's aunt.
"One moment they say we're asking for an exception for Sarah. The next moment they say we're asking for sweeping changes and it has to be studied," Ruddock said Tuesday.

Sebelius has called for a review of pediatric transplant policies, but the Murnaghans say Sarah doesn't have time for that.

"I'm begging you. ... She has three to five weeks to live. Please suspend the rules," Rep. Lou Barletta, R-Pa., urged Sebelius at a House Education and the Workforce Committee hearing on her department's budget.

Sebelius conceded the case was an "incredibly agonizing situation" but said many complex factors go into the transplant-list formula.

Researchers have less data on lung transplants in pre-adolescents because only about 20 a year are done. And young children suffer from different lung diseases, making it harder to weigh their risk versus their chance of surviving a transplant, according to a letter to Sebelius from Dr. John P. Roberts, president of the Organ Procurement and Transplantation Network.

Amid concerns about the higher mortality rate in pediatric patients waiting for lung transplants, the network has tweaked its policies in recent years, Roberts said. The new rules give the younger children priority over adults when adolescent lungs become available and give the sickest children priority in a 1,000-mile radius, a broader range than used in the adult system, he said in the letter, which was shared by the office of Rep. Patrick Meehan, R-Pa.

Meehan, in a letter to Sebelius, said Sarah's doctors are confident they can perform a successful transplant on her. And he said she would jump to the top of the adult list if placed there, given the stage of her disease.

Ruddock, the aunt, called it "a question of morality" that children get a place in the adult line, given that a far higher percentage of children die waiting for pediatric lungs than do adults on that waiting list.

"Do you put them at the back of the line if you're not sure how to measure (their potential outcome)? Or do you put them in the line?" she said.

Daily Sunscreen Use Can Slow Skin Aging (And It's Not Too Late To Start Now)


Top dermatologists agree. "I've been talking about this now for many years, and I know this to be true," Dr. Debra Jaliman, a cosmetic dermatologist and the author of "Skin Rules: Trade Secrets From a Top New York Dermatologist," told Yahoo! Shine in a phone interview. "I can't say I've done a study, but I known this for many many reasons, and I've worked on skin for so many years."

The study, published this week in the Annals of Internal Medicine, also looked at whether taking beta-carotene supplements could have an anti-aging effect. Bete-carotene is a type of antioxidant known as a carotenoid, and has been linked to a reduced risk of skin cancer.

For the randomized-controlled trial, the researchers assigned 903 participants to one of four groups: Those who used broad-spectrum sunscreens daily and take 30 milligrams of beta-carotene, those who used daily sunscreen and took a placebo, those who took the beta-carotene but only used sunscreen periodically, and those who used sunscreen periodically and took a placebo. (All participants were age 55 or younger; the researchers decided it would not be ethical to have a group in which participants used no sunscreen at all.)

The two daily sunscreen groups used UVA/UVB blocking products with a SPF (sun protection factor) of 15 or higher; they applied the product to their head, neck, arms, and hands each morning after bathing, and reapplied it every few hours.

The other two groups applied sunscreen where and when they thought they needed it.

The researchers tracked participants for four and a half years, and used putty-like skin molds to document fine lines and wrinkles. They found that the groups using sunscreen every day showed 24 percent less skin photoaging than those who only applied it periodically.

The results were the same regardless of age, so even the middle-aged participants benefited from regular sunscreen use.

"The cost-effectiveness of promoting daily sunscreen use based on skin cancer prevention alone is probably substantially higher after accounting for the additional prevention of skin photoaging," wrote the researchers in their report.

Taking beta-carotene had no overall effect on skin aging, the researchers added.

In 2012, the U.S. Food and Drug Administration decided that sunscreen makers could state on the labels that their products reduced the risk of skin cancer and skin aging if used as directed, as long they also advised people to take other precautions, like reapplying sunscreen at least every two hours (more often if you're sweating or swimming), avoiding going out when the sun is most intense (usually between 10 a.m. and 2 p.m.), and wearing long-sleeved shirts, pants, and broad-brimmed hats to shield the skin when possible.

If you only have a few minutes in the morning, it makes sense to apply sunscreen to the areas most likely to see the sun — your face, neck, and hands. All types of sunscreen, even "sport" or "waterproof" formulas, need to be reapplied regularly, and you should wear sunscreen even if you spend all day driving or working indoors, advises Dr. Jaliman, the cosmetic dermatologist.

"Let's say they walk to work and they're only outside for 15 minutes, or they take the subway and they're only outside for 5 minutes," Dr. Jaliman told Yahoo! Shine. "Sun damage is cumulative. That 5 minutes or 15 minutes, it adds up over a lifetime."

Even indoors, UVA rays come in through the windows along with the sunlight, she pointed out.
"Just put sunscreen on every morning like you brush your teeth and don't think about it," Dr. Jaliman told Yahoo! Shine. "It takes 30 seconds. Literally, I've timed it."

Papa Joe Lost 250 Pounds on the '99-Cent Diet' Read More.


Ask anyone who’s lost a large amount of weight what jumpstarted their journey to better health, and they’ll probably tell you about their “light bulb moment,”the instant that they decided they’d had enough and were willing to do whatever it took to change.

For LA-based musician and clothing designer Papa Joe Aviance, that moment arrived in 2009 when his first house music release, “Last Night a DJ Saved my Life,” hit #6 on the Billboard Magazine Dance Charts. When he saw the music video for the song—which at that time was playing on MTV and VH1—he couldn’t get over how large he’d become.

“I was 450 pounds—I was two cheeseburgers away from diabetes or high cholesterol,” recalls Aviance. “I had been big for pretty much all of my life, and I was sick of hating myself. It was now or never.”

To start, he trashed nearly all the contents of his kitchen. “I cleared everything out of my fridge that was going to get in the way of me losing weight—cookies, candy, sodas,” he says. “I was only going to drink water or unsweetened iced tea, and no more fast food.

At that point, I’d been drinking a two-liter bottle of Mountain Dew every day, and if I went through any local drive-thru, they knew my name—that’s how often I used to eat that stuff.”

But he had a roadblock to contend with—at the time, he was broke. Aviance, who was then pursuing music and clothing design on the side, had recently been laid off work.

“I was unemployed and couldn’t afford a gym membership or fancy diets,”says Aviance. “I realized that walking was the easiest exercise I could do and it cost nothing.

So I grabbed my dance music and tennis shoes, and started walking.”
(Walk off the weight with these 14 walking workouts to burn fat and boost energy!)

At first, his walks were short—to the end of his block and back to grab the daily Billboard. “The first time around the block—I couldn’t even do it, it was just mounds of sweat,” he says. But he kept at it.

 One trip around the block became two, and soon he was walking a few miles every day.

Only $50 Per Week for Food

While he was determined to eat better, Aviance had to find a way to do it on a shoestring budget. “A friend told me I should check out the 99-Cent Store. Since I couldn’t afford Whole Foods or Trader Joe's, I decided to see what they had.”

Aviance was pleasantly surprised to find that the 99-Cent Store in his neighborhood had plenty of healthy foods to choose from. “Oatmeal, raisins, nuts, bananas, apples, oranges, bell peppers, spinach, salad dressing, tuna fish, eggs… I was shocked.

 I was blown away,” recalls Aviance. “It was a huge savings. I literally spent no more than $50 a week on food.” (Feeding a family? You can still do it on the (healthy) cheap—here are 20 ways to feed your family for $100 a week.)

Within three to four weeks, Aviance started to see changes. “And within 3 months, I was like ‘Hey, this is working!” he laughs. “I started to take all of my clothes to a seamstress so she could take everything in. I was still too broke to go out and buy new clothes, but I didn’t care. I was on a mission.”

Aviance’s morning walks become so regular, that people in his neighborhood started to take notice. “Since I walk every morning, people have started giving me high fives. I felt like a mini rock star in my community. I’ve even had people stop me and tell them I motivated and inspired them to start walking.”

Low-Cost Healthy Meals

Papa Joe was able to prepare a variety of healthy meals using ingredients he purchased at the 99-Cent Store. Here are a several examples of what he ate on his diet.

Breakfasts
1. 3 egg omelette with spinach, green pepper, tomatoes, and 2 slices of wheat toast
2. Cottage cheese with fresh fruit (oranges, blueberries, raspberries, strawberries, or apples)

Snacks (1 or 2 items)
1. Trail Mix
2. Peanut Butter and Jelly on Whole Wheat
3. Raisins
4. Snack Size Peanut M&M’s (For cheat day only) – Keeping it real!

Lunches
1. Yogurt with fresh fruit (Cantaloupe, Mango, Banana, or Honeydew)
2. Salad with tuna or salmon and balsamic dressing

Dinners
1. Chicken Pot Pie with a side of potatoes, squash, or mixed vegetables (broccoli, string beans, cauliflower, carrots)
2. Quiche (eggs, spinach, mixed vegetables) with beans and rice

Health Risks Disappeared

Within 18 months, Aviance lost 250 pounds, and a visit to his doctor confirmed that he was no longer at risk for diabetes, elevated cholesterol, or high blood pressure.“I’ve always been a very happy guy who would kid around with anyone, but when I was heavy, I felt like I had to be that way because I thought people were judging me based on my size.

But now it’s a happiness that is really shining from the inside out.” To speed along his transformation, he started to incorporate breaks for pushups and other strength moves during his walks. “I do pushups right in the street—the city is my gym,” he says. (Try these simple strength-training moves you can do anywhere, anytime.)

Today, Aviance is a health and wellness expert touring the country to inspire obese children and adults to start moving. “I want people to be as happy as I am, and part of that is being healthy. The sidewalk is my treadmill. Every morning I walk right outside my door and go. They can do it, too.”