Monday, September 30, 2013


Five things you should know about flood insurance

1) Your homeowners policy doesn't cover floods. Flood damage is not a covered peril on standard homeowners policies and most commercial policies, although many people assume that it is. That can be a costly assumption.

2) You can get an estimate of your property's flood risk online with a "one-step flood risk profile."

3) You may have to have flood coverage. Mortgage lenders often require flood coverage if a home is located in a flood-prone area (also known as a "special flood hazard area.")

4) Most people buy flood coverage through the government. Flood insurance is widely available through the National Flood Insurance Program, which is run by the Federal Emergency Management Agency, or FEMA. There are limits, however, on how much damage they'll cover. Many local agents sell NFIP policies.

5) Rates may be going up. In July 2012, Congress passed the Biggert-Waters Flood Insurance Reform Act, which will change the way the National Flood Insurance Program is run. Among those changes: premiums will increase for some policyholders. That's being done to make the program more financially stable.

Wednesday, September 25, 2013


We're looking for a communications and social media manager

Please help us spread the word - do you know a communications expert who's looking for a new challenge? We're currently recruiting for a Public Affairs Communications and Social Media Manager.

This position reports to the Deputy Commissioner for Public Affairs and manages select agency-wide public affairs strategies and communication projects. It also oversees the agency's social media efforts, represents the agency as senior writer and editor on legislatively required reports and high-profile projects for the commissioner and is primary spokesperson for news media and stakeholder groups on agency administrative, civil and criminal enforcement actions.

Here's the full job announcement. Please share with anyone you think might be interested.

We're taking applications through Oct.8.

Dismissal for Delay at Status Hearings

The Court of Appeal has answered a question that arises fairly frequently in civil litigation: under what circumstances should an action be dismissed by the court following a status hearing?

In Faris v. Eftimovski, 2013 ONCA 360 (C.A.), the action was commenced in 2007 alleging damages from real estate transactions in 2003 and 2005.  At the time of the status hearing in 2012, pleadings had not been finalized, no documentary productions had been exchanged, and no examinations for discovery had occurred.  Two of the defendants had died.  The status hearing judge dismissed the action, holding that there were unexplained delays in the action and there was non-compensable prejudice to the defendants since parties had died.

The Court of Appeal dismissed the appeal.  Justice Tulloch distinguished between r. 24, which permits a defendant to take a deliberate procedural step to have the action dismissed, and r. 48, which allows the court to control the pace of litigation. The onus is on the plaintiff to demonstrate there was an acceptable explanation for the delay and that, if the action was allowed to proceed, the defendant would suffer no non-compensable prejudice.

There has been much discussion recently about lengthy delays in trial lists.  Could the Court of Appeal be signalling an attempt to clear out cases that are slowing down the system?

How to contact Washington's Health Benefits Exchange


Earlier this month, the Washington Healthplanfinder (our state's health insurance exchange) opened its toll-free hotline to start answering questions about health coverage options, how to access financial help and what you need to know about the Exchange's enrollment process. The phone number is 1-855-923-4633 or TTY/TDD 1-855-627-9604. They're available from 7:30 a.m. to 8 p.m., Monday through Friday.

The Healthplanfinder can also help you find other people -- a broker in your local community, say, or a nearby in-person assister -- to help you through the process. Click on the link or image above to find out more.

Sunday, September 22, 2013


These Carbs Are Actually Good for You!

While carbs tend to get a lot of bad press (think the Atkins diet), they are an essential part of any diet if you expect to have energy and function at an optimal level. "Your body definitely needs carbs," says nutritionist Kelly Aronica, who believes that they should make up at least 50-60% of the calories you consume daily. Why? Because glucose, the simplest type of carbohydrate, is the only thing that can be used to meet the energy needs of the body, support the brain and nervous system, and maintain a well-functioning digestive system.

Though the body has a backup plan if no carbohydrates are eaten, it's not perfect (hence why it's meant as a backup plan). As Aronica explains it, if there's a lack of carbohydrates, the body essentially converts protein and fat into glucose, which is what the body converts into fuel so we have energy. The problem is that this system is less efficient and slower than just consuming carbohydrates and, depending on your sensitivity level, it often leads to low energy and light-headedness. But that's not the only reason to eat carbs.

As Aronica puts it, carbs are also needed because their presence lets the body know to release insulin, which is necessary to use the glucose to build muscle, energy storage, and even fat (if you have excess glucose). Now if the mention of fat made you start to believe all those anti-carb rants, then you need to remember that there's a big difference between carbs that provide fiber, nutrients, and vitamins and ones that only supply sugar. Don't believe us? Aronica points out that a recent study from the New England Journal of Medicine "showed that eating refined potato products, sweetened drinks, sweets and desserts, fruit juice, and other refined grains were linked to weight gain where high-fiber carbs were linked to long term weight loss." So instead of banishing carbs from your diet, be more particular about the ones you eat.

Avoid refined carbohydrates (like white bread) and opt for the carbs that have high-fiber levels and a bounty of nutrients and vitamins, like folate and heart healthy omega-3's. While most of the fibers in food aren't actually digestible, they provide a lot of other important health benefits to keep you operating at your best and are a necessary part of any diet. To help you make better choices, we put together a list of the carbs that are best for your body.

Carbs with Lots of Folate

Lentils, 1 cup Cooked: 1 cup, 358 milligrams Folate

Beets, Cooked, 1 cup: 136 milligrams Folate

Brussels Sprouts, Cooked: 1 cup, 157 milligrams Folate

Black-eyed Peas: 1 cup, canned, 358 milligrams Folate

Chickpeas, Cooked: 1 cup, 282 milligrams Folate

Okra, Cooked: 1 cup, 269 milligrams Folate


Carbs High in Protein

Buckwheat Flour: 1 cup, 15.14 grams protein

Rice, Long-Grain, Dry: 1 cup, 15.00 grams protein

Soybeans, Boiled: 1 cup, 28.62 grams protein

Couscous, Dry: 1 cup, 22.07 grams protein

White Beans, Canned: 1 cup, 19.02 grams protein

Black Beans, Cooked: 1 cup, 15.24 grams protein


Carbs High in Vitamin C

Peaches: 1 cup, 235.5 milligrams Vitamin C

Red Peppers, Cooked: 1 cup, 232.6 milligrams Vitamin C

1 Papaya: 187.9 milligrams Vitamin C

Grape Juice, 6-fluid-ounce can: 179.5 milligrams Vitamin C

Brussels Sprouts: 1 cup, 96.7 milligrams Vitamin C

Peas, Cooked: 1 cup, 76.6 milligrams Vitamin C


Carbs High in Iron


Soybeans: 1 cup, 8.84 milligrams Iron

Cream of Wheat Cereal: 1 packet cooked, 8.09 milligrams Iron

Lentils, Cooked: 1 cup, 6.59 milligrams Iron

Spinach, Cooked: 1 cup, 6.43 milligrams Iron


Carbs High in Potassium


Tomatoes, Canned: 1 cup, 2657 milligrams Potassium

Beet Geens, Cooked: 1 cup, 1309 milligrams Potassium

White Beans, Canned: 1 cup, 1189 milligrams Potassium

Dates: 1 cup, 1168 milligrams Potassium

Raisins, Seedless: 1 cup, 1086 milligrams Potassium

Potatoes: 1 potato baked, with skin, 1081 milligrams Potassium

Lima Beans, Cooked: 1 cup, 955 milligrams Potassium

Plantain, Raw: 1 medium plantain, 893 milligrams Potassium

Friday, September 20, 2013


"I'm on Medicare Part A and B. I want to drop Part B and buy a health plan through the Exchange so that I can get a subsidy"

Don't do it.

That's worth saying again: Do Not Do This.

Here's why: Most health insurance plans have language in their policies that lets them drop anyone who is eligible for Medicare. As a result, even if you manage to sign up for the plan, the company will likely eventually figure out that you're eligible for Medicare and will drop you.

Then, if you go back onto Medicare Part B, you'll have to pay a penalty for as long as you continue to have Medicare. The penalty is 10 percent for each full 12-month period that you could have had Part B.

And that's not all. If you are Medicare-eligible and you purchase a plan offered on the Exchange, you are not eligible for an Exchange plan subsidy. (If you are on Medicare, you are already getting a subsidy, because the federal government pays far more in Medicare costs that current Medicare recipients paid into the program.)

Wednesday, September 18, 2013


"I just got a letter from my insurer saying that I have to switch health plans because of Obamacare. What can I do?"

Tens of thousands of Washingtonians are -- or will be soon -- getting letters from their health insurers telling them that their plans are going away and that they'll need to pick a new one.
"In order to comply with the new health care law, your current health plan will be discontinued on Dec. 31, 2013," reads one of the letters, which are being sent out by about half a dozen insurers. "But don't worry. You have lots of options."
What's going on? Under health care reform, each health plan has to cover 10 essential benefits. Some of those benefits -- such as prescription drug coverage -- aren't included in many health individual health plans today. The new plans also have to include numerous preventive services, and meet standards for what they'll cover.

In some cases, those benefits mean that the premiums for the new plans will cost more, or that deductibles will be higher.

So what can you do?

1) Remember that as part of health care reform, many consumers will now qualify for subsidies to help offset costs. If your household income is less than 400 percent of the federal poverty level (e.g. $62,040 for a family of two, or $94,200 for a family of four), you may qualify for those subsidies. Also, expanded Medicaid coverage will be available -- for free -- for households that are at less than 138 percent of the federal poverty level ($21,404 for a family of two).

In other to get the subsidy, which is technically a tax credit, you would need to buy your health coverage through the Washington Health Benefit Exchange. Enrollment begins Oct. 1, with coverage starting Jan. 1, 2014. Here's a map with links to the rates for health insurance in the Exchange.

2) Shop around for a better deal. You do not need to stay with the insurance company you're with now, although that fact isn't necessarily trumpeted by the insurers in the letters they're sending out. So go on the Exchange -- you can still shop there, even if you don't qualify for a subsidy -- or check with a broker to see what else is available, and what it costs.

What if you have a pre-existing condition and have been turned down for health coverage in the past? It no longer matters. As part of health care reform, insurers must take all applicants. No more health screenings or questionnaires.

3) Remember that the premium is only part of the cost of insurance, particularly if you use the coverage. Your actual out of pocket costs are determined by how much of a deductible you have to meet, how much the co-pays or coinsurance charges are, what drugs are covered, etc. We calculate, for example, that the preventive care included in these policies without any copays, etc. is worth about $500.

Timing of Summary Judgment Motions

At what point in a lawsuit is it appropriate to bring a summary judgment motion?

In Stever v. Rainbow International Carpet Dyeing & Cleaning Inc., 2013 ONSC 4054 (S.C.J.), the defendant brought a summary judgment motion prior to discoveries, alleging there was no issue requiring a trial as the limitation period had expired.  Justice Morgan held that summary judgment motions typically proceed after discoveries are complete, or with affidavit evidence and cross-examinations that "go a long way to replicating what will be produced at discoveries."  Justice Morgan adjourned the summary judgment until after discoveries had been completed.

Stever is in line with the Court of Appeal's decision in Combined Air, which held:

58     Moreover, the record built through affidavits and cross-examinations at an early stage may offer a less complete picture of the case than the responding party could present at trial. As we point out below, at para. 68, counsel have an obligation to ensure that they are adopting an appropriate litigation strategy. A party faced with a premature or inappropriate summary judgment motion should have the option of moving to stay or dismiss the motion where the most efficient means of developing a record capable of satisfying the full appreciation test is to proceed through the normal route of discovery. This option is available by way of a motion for directions pursuant to rules 1.04(1), (1.1), (2) and 1.05.

In many cases, especially where there is an issue of discoverability, summary judgment is likely not appropriate until discoveries are complete.

"I was turned down for life insurance due to my health. Does this mean I can't get life insurance at all?"

Not necessarily. Different life insurers have different underwriting standards, so another company might insure someone with your health condition.

So try a different company, or try going through a broker, who might know more about which companies might be the best match for your individual situation.

Also, it's a good idea to check with your employer. Some employers offer some life insurance coverage (say $25,000 or $50,000) to their employees without requiring employees to answer health questions.

Tuesday, September 17, 2013


Pierce County man charged with insurance fraud and attempted theft

A University Place man, Leandre Garner, has been charged by the attorney general's office with felony insurance fraud and second-degree attempted theft for filing a bogus claim with State Farm.

On Nov. 8, 2012, Garner got coverage online with the company for his 2007 Chrysler 300. Prior to that date, the vehicle was uninsured.

On Nov. 9, 2012, Garner said, he returned home from an appointment and discovered that his car had been hit by an unknown vehicle. The damage was estimated at $4,339. Garner filed a claim.

The problem: half a dozen people subsequently told investigators from State Farm and our Special Investigations Unit that Garner's car was damaged well before November. His ex-girlfriend said it happened around September, not November. A nearby tenant, an apartment office worker and an apartment groundskeeper also said the accident happened well before Nov. 8. So did the body shop that did the estimate.

Asked if he'd taken photos of the damage, Garner showed a State Farm investigator cell phone images he'd taken. He was surprised when the investigator pointed out that the metadata embedded in the images showed that they'd been taken Sept. 19, 2012.

When asked about this, Garner said that the must be a problem with the phone.

Arraignment is scheduled for Pierce County Superior Court on Sept. 24, 2013.

Monday, September 16, 2013


"I heard I can keep my adult child on my health insurance until age 26. But do I have to?"

Q: I heard I can keep my adult children on my health insurance until they turn 26. But what if I don't want to?

A: Then don't. Health care reform permits -- but doesn't require -- parents to keep their adult children on the parent's health plan up to age 26, unless the children have coverage through their own employer.

That said, you may want to provide coverage if you can afford it. No one is immune from bad luck, and rates for medical care when a person has no insurance can be very high indeed.

Also: if your child doesn't have a job or has a job that doesn't offer health coverage, you may be able to extend your coverage to him/her more cheaply than they could buy an individual policy on their own.

Sunday, September 15, 2013


Treadmill instantly sheds 80% of your weight

 

 
Lose the weight instantly!!!” “Erase pounds in seconds!!”
 
Sound too good to be true? Not if you have an anti-gravity treadmill. The high-tech machine literally “unweights” users, allowing very overweight people to walk or run without pain. The technology started with astronauts, but now it’s making a huge difference in lives across the country.

Anti-gravity and treadmills … How does that work?

The technology was originally conceived in the '90s by two inventors to design effective exercise regimens for NASA’s astronauts. Then it was adapted by AlterG, a company based in Fremont, Calif., for use in training and rehabilitation.

An anti-gravity treadmill looks like your typical gym machine, except for one difference: an air-filled bag that fits around a person’s torso and lower extremities. And that’s where the magic happens.

 Users wear shorts that zipper into the air chamber. Then an airtight seal is formed and the chamber inflates. The user then gets lifted slightly, reducing the amount of body weight the legs have to carry, thus allowing users to walk or run at less than their actual weight.

How much less? As low as 20 percent of their body weight, effectively giving them the weightlessness they would have on the moon.

From the moon … to Metairie, La.

Physical therapist Robbie Porche started out with one anti-gravity treadmill in his southern Louisiana physical therapy clinic. Now he has three. Porche says anti-gravity treadmills have given very overweight patients, who are struggling to slim down, a new outlook on breaking a sweat.

“If they are overweight, it has taken a very long time to get in the condition they are in. It actually brings back that feeling of how it was before they gained the weight. That’s motivation.” He adds, “Patients were actually increasing their time on the AlterG, and then they would start fussing when we would have to kick them off it.”

Barbara Wheat, who has had a full and partial knee replacement, is one of those patients. Unable to exert herself without pain, she struggled with any form of exercise.

“I just felt like I can’t do it. It’s going to hurt. I’m too tired. I don’t want to be bothered.”

But after trying out the anti-gravity treadmill, Wheat says, “Little by little, I gained confidence. I stayed longer and started burning more calories. It just started working for me. I was a linebacker. In the AlterG, I was only a half a linebacker.”

Experts say one of the treadmill's biggest benefits is reducing stress on weakened or injured joints.
Henry Knoll, who suffers from osteoarthritis in both knees, has rekindled a dream of running again. “In 2004 I stopped exercising and I got up to 306 pounds. As a kid I could run distances, and it would never ever bother me. I’d like to be able to get back to that.”

The anti-gravity treadmill may be one small step in the journey of weight loss, but it’s a huge step in helping people lead healthier lives.

5 Myths that Are Destroying Your Diet

Metabolism myths, debunked"But I heard it at the gym!" Stop falling for these common metabolism myths.

1. "Eating after 7 P.M. slows your metabolism."
Calories consumed after dark are no more sinister than any others. But at nighttime, we're often exhausted, starving, or bored, so it's much easier to overdo it.

2. "The more slowly you lose weight, the easier it is to drop a lot."
Actually, in an 18-month study, obese women who dropped pounds faster were five times more likely to lose 10% of their body weight than the "slow-and-steady" losers.

3. "To tone muscle, do more reps with lighter weights." Nope. The best way to build muscle is to work it to fatigue; 20 lifts with a too-light weight won't be as effective. Use a weight light enough to lift at least eight times, but heavy enough that lifting it more than 12 times is difficult.

4. "I just earned a brownie!"
Depends on your workout. A 40-minute spin class will earn you a 410-calorie Starbucks Double Chocolate Brownie, but you'd need to walk for two hours on a treadmill.

5. "If you stop lifting weights, your muscle turns to fat."
That's just not possible. Your muscles might atrophy, and you might gain weight, but one type of tissue can't transform into another.

Wednesday, September 11, 2013


Woman who pretended to be employer in lost-wage claim pleads guilty to insurance fraud

A woman who pretended to be an employer to help her son allegedly file a fake lost-wages insurance claim has pleaded guilty to insurance fraud.

Sherryl Rose Brongil pleaded guilty on Monday in King County Superior Court to one count of insurance fraud.

According to an investigation by State Farm and our Special Investigations Unit, Brongil's son, Larry Kwant, was accelerating out of a parking lot in her Cadillac when he lost control of the car and caused $26,000 in damage to it. He filed a claim, including 23 days of lost wages at $25 an hour. The form was signed by a "Linda Lee."

Linda Lee turned out to be Sherryl Brongil. Not only did she sign the form, purportedly showing that her son had worked at a company where he'd never worked. She'd also pretended to be administrative assistant "Linda Lee" when contacted by a claims adjuster.

She was sentenced to three months in jail.

As for Kwant, he's been charged with insurance fraud and identity theft.

Discount Rate

The new discount rates have been posted on the Attorney General's website.  They can be found at:

http://www.attorneygeneral.jus.gov.on.ca/english/courts/civil/pecuniary_damages.asp

For 2014, the discount rate is 0.3% for the first 15 years and 2.5% thereafter.

Tuesday, September 10, 2013


Common questions about Medicare and health care exchanges


We've been getting a lot of questions about whether the new health care exchanges affect people on Medicare.

The short answer is no. If you have health coverage through Medicare, you don't need to do anything. It will not affect your coverage.

Among the other questions we're hearing frequently:

Do I need to re-enroll in my Medicare plan through the new health insurance Exchange?

Nope. Medicare's open enrollment is not part of the Exchange. If you are on Medicare, do not sign up for a plan in the Exchange.

Will I lose my Medicare coverage due to health reform and the Exchange?

No. Health care reform and the Exchange do not affect your Medicare coverage. You still have the same benefits and security you have now with Medicare.

Will people on Medicare be fined for not buying a health insurance Exchange plan?

No. In fact, it's against the law for someone who knows you have Medicare to sell you an Exchange plan.

Can I go to the Exchange and get a subsidy to help pay for my Medicare coverage?

Sorry, but no. If you're on Medicare, you're not eligible for the subsidies, which are for people buying coverage through the Exchanges.

For more questions -- including how the Exchange and Medicare work for recent immigrants, for those about to turn 65, etc. -- please see our new "popular questions about Medicare and the Exchange" web page.

Changes mean quicker responses to your insurance complaints

We've launched a new complaint response system that's speeding up the time between consumer insurance complaints and resolutions.

As Washington state's insurance regulatory agency and an advocate for consumers, we help with thousands of consumer complaints each year. Typical complaints involve wrongly denied claims, delayed payments and cancelled coverage.

The new online system, which is a secure link between our office and insurance companies we regulate, allows us to quickly get those complaints (along with our questions or concerns) to insurers. They'll look into the case and often reconsider their initial decision.

For years, largely in the interest of protecting complainants' private information, this process was handled by mail. Insurance companies were allowed 30 calendar days to respond to a complaint. 

The new online system is also secure -- and it's dramatically faster. Now insurers must respond electronically within 15 business days.

In other words, we've cut the time to process consumer complaints against insurers by more than 25 percent.

Got a complaint about your insurer? You can file a complaint online or call our Consumer Hotline 1-800-562-6900.

Saturday, September 7, 2013


Gangrene and your body health

Gangrene is a life threatening conditions that occurs when tissue of the body dies permanently. 

Gangrene and your body health

Causes of gangrene
Blood circulation is an important role in the body organism. In the circulation process of blood contains oxygen and nutrients which are delivered power sources of body. The gangrene is caused by loss of blood supply to a body part that can be external: skin, or Internal: organs, muscles. As a result, this area suffers tissue death so there is no longer outstanding. The area affected by gangrene is detected by bluish / black area, fishy smell of the wound and the loss of sensitivity.

Any kind of conditions which create obstacles of the blood flow to our body is increases the potential risks for gangrene, also included:

Atherosclerosis
Diabetes
Trauma or injury
Peripheral arterial disease
Reynaud’s phenomenon 

Types of gangrene

Primarily there are two types of gangrene are seen, those are dry gangrene and wet gangrene.

Dry gangrene:
It is common types of gangrene are seen to people who are suffered in autoimmune diseases & diabetes. Mostly affects to feet or hand.

Gangrene and your body health

Wet gangrene:
Wet gangrene is found in people who are injured or burns their body in accident. Not to proper blood circulation gangrene affects the injured parts. Wet gangrene is also seen three types: internal gangrene, gas gangrene & Fournier’s gangrene.

Treatments of gangrene

All treatment of gangrene is urgent because the more time of evolution persists, worse prognosis. Generally, you must remove the dead tissue to prevent infection and allow healing of the surrounding healthy tissue. Whatever the treatment, it will require hospital admission and, depending on its severity, a stay in an intensive care unit.
The surgery is very common for cases of gangrene. The goals of this treatment are: remove dead tissue and try to repair the vessel or improve blood flow.

Depending on the level of impact on the circulation and the ability to recover the bloodstream, they can exert two kinds of surgery: the amputation is the removal of the affected body part, this procedure is performed when there is no possibility of recovering the circulation, and the skin graft is the application of healthy skin from elsewhere on the body to the affected area and is applied in cases where surgery has been positive and there is possibility of blood flow.

The treatment antibiotic rarely needed forever. It is used preventively or curatively for cases of infected or gangrenous wounds with susceptibility of suffering. Antibiotics will be administered intravenously.

As we know gangrene is a serious condition of our body so we should take immediate treatments for it.

Friday, September 6, 2013


Insurance questions: Does my homeowners policy cover lightning?

In most cases, yes. Lightning is a covered peril in standard homeowners policies. Typically, both direct physical damage -- like burns, shattered windows, melted wiring -- would be covered. And if the lightning sets your home on fire, your fire coverage would also kick in.

How about lightning-caused damage to your electronics, like a TV or computer? Also typically covered.

And what about your car? If that gets hit by lightning, is the damage covered? Again, in most cases yes -- IF you have comprehensive coverage. (A man riding his motorcycle near Chehalis yesterday was struck by lightning, but is apparently doing well, other than a partly melted helmet. Really.)


Wednesday, September 4, 2013


Health care reform questions: Where can I get help?

Q: Will there be health care advocates for people who are not able to understand the complexities of the health care process? I have a family member who cannot work and is in dire medical need and struggling with doctor and drug costs. What help will they get from the health care reform?

A: Yes, there definitely will be advocates to help people navigate the complexities of finding the right health coverage. Health care reform includes a network of navigators and other people to help, and many insurance agents and brokers can help as well. Here's a list of the organizations that have received grants to provide in-person assistance here in Washington state.

Here in Washington state, you can sign up with the Washington HealthPlanFinder to be contacted by assistance staff within the first two weeks of October. They can answer your questions and help with enrollment in the exchange, if that's the best option for you. The coverage would start in January 2014.

In this particular situation, with your relative struggling today to pay for medical care and prescription drugs, feel free to give our consumer advocacy staff a call. They can walk you through the options, including free or low-cost medical, vision and dental clinics, help paying for drugs, and how to appeal when a health insurer won't pay for a treatment or prescription.

The hotline number is 1-800-562-6900. (Don't live in Washington state? Here's how to find your own state's insurance regulator.) You can also email us at AskMike@oic.wa.gov.



WA: Two more Exchange health plans approved for King, Pierce, Spokane counties

From a press release we put out this morning:

FOR IMMEDIATE RELEASE – Sept. 4, 2013
Media contact: Public Affairs (360) 725-7055

Kreidler settles with another health insurer – approves two more Exchange plans for King, Pierce, Spokane counties

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler has reached a settlement with Molina Healthcare of Washington, Inc. (Molina) and approved its two plans for sale in Washington’s Health Benefit Exchange, the Washington Healthplanfinder.

Consumers in Washington will now have 43 choices in the Exchange when open enrollment begins Oct. 1. Molina’s two plans will be available in three counties: King, Pierce and Spokane.

Previously, Molina only participated in the Medicaid market. Its approval to sell inside the new Washington Healthplanfinder guarantees Medicaid enrollees continuity of care and creates even more competition in the marketplace.

Molina was one of five companies Kreidler disapproved for sale in Washington’s new Exchange. Molina, Coordinated Care Corp., Kaiser, and Community Health Plan of Washington (CHPW) all appealed Kreidler’s decision. Molina later dropped its appeal, but reactivated it Aug. 29.

The reactivated appeal allowed a settlement. Specifically, Molina corrected information in its provider contracts to gain approval.

Kreidler began discussions with only those companies he believed could make the necessary fixes in time before the federal deadline of Sept. 5. Ten plans from Kaiser and Community Health Plan of Washington were approved Aug. 30.

The Executive Board of the Health Benefit Exchange is schedule to certify the final list of approved plans today at 1 p.m. It is scheduled to submit its final list to the federal government Sept. 5.

“I made the tough decision to disapprove some plans on July 31 because I didn’t believe they were good for consumers,” said Kreidler. “I’m pleased that we’ve reached a settlement with some of these companies to bring more quality plans to the Exchange and that consumers will be protected.”

####




Bifurcation

Rule 6.1.01 became effective on January 1, 2010.  It provides as follows:

With the consent of the parties, the court may order a separate hearing on one or more issues in a proceeding, including separate hearings on the issues of liability and damages. 

In Soulliere v. Robitaille Estate, 2013 ONSC 5073 (S.C.J.), the issue was whether a court may bifurcate a trial when one party does not consent.  The Court of Appeal held in Kovach (Litigation Guardian of) v. Linn 2010 ONCA 126 (C.A.) that a judge does not have the jurisdiction to bifurcate a jury trial when one party does not consent.  In Soulliere, however, the trial would be heard by judge alone.

Justice Smith held that r. 6.1.01 does not remove the Court's inherent jurisdiction to bifurcate a trial.  In keeping with the Court of Appeal's decision in Elcano Acceptance v. Richmond, Richmond, Stabler and Mills (1989), 55 O.R. (2d) 56 (C.A.), a Court may order bifurcation in the clearest of cases.  In the circumstances, Justice Smith declined to order bifurcation.  The case was not so exceptional as to warrant departure from the normal practice of hearing liability and damages together, and there was potential prejudice to the plaintiff if forced to wait.