Kreidler on Supreme Court case and the state health-care exchange

Commissioner Kreidler sat down with TVW's Christina Salerno yesterday for a Q&A on health care reform, including this week's three days of arguments in the U.S. Supreme Court and the shape of the state's upcoming Health Benefits Exchange.

From the discussion:

What would change if they overturned the act?

People are directly benefiting from parts of the act today. People can stay on their parents’ insurance until 26, they can get preventive care with no deductibles — all of that would go away. (Attorney General) Rob McKenna’s lawsuit would undo all of that. The entire law may go down. We’d be back to square one, which is a system that’s failing us as a country and as a state. For many individuals, it was making a difference between life or death decisions.

State website access.wa.gov among the top nationwide

Well-deserved kudos to the folks who run Access.wa.gov, a Washington state website that helps make much of what government is doing available on one easy-to-navigate site.

The Sunshine Review, a nonprofit group focused on government accountability, recently awarded the site with an A+ grade, meaning that it's one of the most accessible state government sites in the country. From the group's report card on the site:

Elected officials are listed with contact information
Budgets are posted
Audits are posted
Contracts are posted in a searchable database
The site includes information on requesting public records
Lobbyist lists and reports are posted in a searchable database
etc.

(And a hat tip to The HDC Advance for the heads up on this.)

How to appeal when your health insurer says no

Seattle's KING 5 TV recently did a story on the case of a Tacoma man diagnosed with stage 4 cancer. After trying other treatments, his apparent only remaining option is an experimental anti-cancer drug that his insurer refuses to cover.

He contacted our office, and we're helping him navigate the appeals process. Many people don't realize that a denial by your health insurer is not the final word on the matter. There are multiple rounds of appeals available, including to what's called an "independent review organization," which is a group that has the power to require your insurer to cover a treatment or procedure. And more than a quarter of the people who appeal to an independent review organization win.

How to appeal the decision? We've put together a detailed appeals guide with sample letters to send your insurer. Take a look -- and don't give up.

Here's the story from KING 5:

Hearing next week on Humana's request to acquire Arcadian Health Plan

From our public notices web page:

The Insurance Commissioner has scheduled a hearing for March 27, 2012 at 10:00 a.m. Pacific Time in his Tumwater, Washington office to consider whether he should approve or deny Humana Inc.’s request to acquire Washington-based Arcadian Health Plan, Inc.

Arcadian Health Plan, Inc. offers Medicare Advantage health products through the federal Centers for Medicare and Medicaid Services, and is wholly owned by its parent company, Arcadian Management Services, Inc. Arcadian Management Services, Inc. is currently owned by five venture capital investment funds affiliated with Morgan Stanley Dean Witter, and by Arcadian employees. Humana Inc. proposes to purchase the parent company and all of its subsidiaries including Arcadian Health Plan, Inc.

Humana Inc., which had $36.8 billion in revenue in 2011, and has 11.2 million covered individuals in its medical plans and another 7.3 million in its specialty plans nationwide, is proposing to acquire all outstanding stock of Arcadian Management Services, Inc.. If approved, Humana Inc. would wholly own Arcadian Management Services, Inc. and all six of its subsidiary health carriers including Arcadian Health Plan, Inc.; Arkansas Community Care, Inc.; Arcadian Health Plan of North Carolina, Inc.; Arcadian Health Plan of Georgia, Inc.; Arcadian Health Plan of Louisiana, Inc.; and Arcadian Health Plan of New York, Inc.

The public is notified that all interested parties may submit letters of support or objections and/or may participate in the hearing by appearing in person or by telephone. To view the Notice of Hearing, which includes advice on how to participate and other related documents, go to http://www.insurance.wa.gov/orders/hearings_proceedings.shtml

Our complaint- and rates Web applications will be down over the weekend

Two of our most popular Web applications will be off-line this weekend because of scheduled maintenance to our imaging software.

From 5 p.m. Friday until 8 a.m. Monday, these two systems will be down:

• Online complaint filing (where consumers can file complaints against their insurance company)
• Our health insurance rate request lookup (where you can see which insurers have filed proposals to increase health insurance premiums)

Thanks for your patience and understanding.

Health care reform: Two years later, what's changed?

From a press release we put out this morning:

The Affordable Care Act’s most controversial component – the mandate requiring everyone to have health insurance – is still two years away. But two years after the law’s enactment, many Washington consumers are quietly benefitting from many of the laws lesser-noticed provisions.

“The Affordable Care Act’s individual mandate gets most of the attention, but it shouldn’t overshadow the success stories of the early reforms,” said Insurance Commissioner Mike Kreidler. “By far the most popular benefit of health reform that we hear about is the ability for parents to keep their adult kids on their health plans – especially in today’s economy – and there are many more.”

Among the changes that have already taken effect here in Washington state:

■More than 2.4 million Washingtonians no longer face lifetime limits on their health benefits.

■More than 52,000 young adults up to age 26 have been able to stay on their parents’ health plans.

■More than 1.2 million Washingtonians now have coverage for preventive care with no co-pays or deductibles.

For much more information about what's changed and is changing, click on the link above.

Where -- and why -- to find flood coverage

Another post for National Flood Safety Awareness Week: Here in the rainy Northwest, we can't say this often enough: a standard homeowners insurance policy does NOT cover flooding.

The good news is that flood insurance is widely available through the National Flood Insurance Program. It's a federally run insurance program, but sold by local agents and brokers. For most homeowners, the NFIP is the first stop for flood coverage.

If you live in an area with a high chance of flooding (a "Special Flood Hazard Area"), your lender will generally require you to have flood insurance. Even if you live in a minimal or moderate flood hazard area, you may still want to buy it.

There are, however, limits to federal flood insurance. For commercial structures, for example, the NFIP maximum is $500,000 for the building and $500,000 for the contents. Businesses also may need additional coverage that isn't available through the NFIP, such as business interruption coverage.

Insurance company claims representative pleads guilty to fraud on her own car

A Puyallup woman has pleaded guilty to attempted forgery and attempted insurance fraud after submitting a bogus receipt for a $1,609 windshield repair to her insurance company.

Candice Leigh Chapman, 31, was sentenced last week to 45 hours of community service and a deferred sentence.

In June of 2010, Chapman filed a claim saying that she'd had a damaged windshield replaced in her Volkswagen Touareg and had paid for the repair herself. She emailed a copy of a quote from a Seattle auto glass company, with "paid" stamped on the  bottom.

But when her insurer, Farmers, called the glass shop to confirm the bill, the shop said it had never repaired or replaced the windshield. Nor do they use a "paid" stamp. At that point, Farmers turned the investigation over to the state insurance commissioner's Special Investigations Unit.

The unusual wrinkle in this case is what Chapman did for a living: She was an insurance company claims representative at a different insurance company. And her primary job responsibility was handling auto glass claims.

Flood awareness week: How to spot a flood-damaged car

In honor of National Flood Safety Awareness Week, here are some pointers on spotting a flood-damaged car:

-Smell. Particularly here in the rainy Pacific Northwest, it's very hard to dry out a flooded car quickly enough to prevent mold and mildew in the carpets, padding below the carpets, and the upholstery.

-Moisture in odd places inside the car. For example, look for moisture or condensation behind the gauges on the dashboard, a clock, and the display panel of a stereo. (Note: It's fairly common in the Northwest to see water or condensation in exterior lights, like taillights, turn signal lights, etc. in older vehicles. That's not necessarily a sign of flooding. Rain may have just seeped in through the gaskets that are supposed to seal the lights.)

-Check the car's unique Vehicle Identification Number to see if it has been reported as a salvage vehicle. These numbers are typically found on a small metal plate visible through the front windshield at the front of the dashboard. The National Insurance Crime Bureau runs a website where you can check VIN numbers -- up to 5 a day -- for free. (Hint: it's case-sensitive.)

-Dampness, mold, silt, mud or rust in low spots on the vehicle, such as under the spare tire in the trunk, the interior crevices of the trunk behind the wheels or in the glove compartment.

-Interior rust, such as springs under the seats.

-Check the car's oil. Engine oil contaminated with water will often look like chocolate milk.

NAIC survey: Most homeowners have no home inventory (and how to easily make one)

The National Association of Insurance Commissioners today released the results of a survey indicating that most Americans don't have a home inventory of their possessions.

The February survey indicated that 59 percent of consumers haven't made a list of what they own. Of those that had, nearly half didn't have receipts. More than a quarter didn't have photos of their property.

Home inventories are a key tool for recovering from a tornado, flood, earthquake or other disaster. They can speed up and dramatically simplify the insurance claims process. They can also help you and your agent decide if you have enough coverage if you have a rare collection or other high-value items. (On average, home contents are reimbursed only up to 50 percent of the home's insured value. In other words, if you're house is insured for $200,000, the maximum contents reimbursement would typically be $100,000.)

Last year, severe weather disasters inflicted more than $43 billion in the United States, according to the NAIC.

How to prepare a home inventory? There are smartphone applications to help. The myHOME Scr.APP.book app lets users capture images, descriptions, bar codes and serial numbers of personal possessions and stores the information electronically for safekeeping. The app organizes information by room and creates a back-up file for email sharing. There's a version for the iPhone and another version for Android phones.

For those without a smart phone, the NAIC offers a downloadable home inventory checklist and tips for effectively cataloguing your possessions.

More consumer tips: Company lookup, agent lookup, and where to look up financials

More tips for National Consumer Protection Week:

How to look up an insurer, including complaint history and disciplinary actions

How to look up an agent, insurance agency, or broker, including complaints and discipline

And how to find the company financial statements that show how your insurance company is doing.

We're the insurance regulator for the state of Washington. Not in Washington? Here's a map with links and contact info for every state's insurance regulator.

Consumer tips: How to look up complaints, available health plans and rate hikes

More tips for National Consumer Protection Week:

-Look up the number of consumer complaints against specific insurance companies

-Buying health coverage on your own? Here's how to find a health plan in your area

-And see if your health plan wants a rate increase.

(We're the state insurance regulator in Washington state. Don't live in Washington? Here's a handy map with links and contact info for your state's insurance regulator.)

Direct Buy Auto Warranty ordered to stop unauthorized insurance sales in WA

For the second time in less than a week, our office is ordering a New York-based company to stop selling unauthorized insurance in Washington state.

This time it's a company called Direct Buy Associates, Inc., although it also does business under several similar names, including Direct Buy Auto Warranty, Direct Buy Warranty, and DirectBuy Warranty. The order also includes AHMT Corp.

Direct Buy Associates and AHMT -- with have adjacent offices on a street in Brooklyn -- do business through websites like directbuyautowarranty.com, directbuywarranty.com and directbuyautowarranty.net. The companies have also listed mailing addresses that include a mailstop in New Jersey, a virtual office in New Jersey, and a European headquarters in Cyprus.

In 2011, we began getting complaints from Washington consumers who had bought plans from these companies. The plans, sold since at least 2009, purported to cover vehicle repairs. The companies sold at least 57 such plans to Washingtonians. At least one Washington consumer who paid the fees monthly was charged international transaction fees from Cyprus.

None of companies or principals named in the order are authorized to transact insurance in Washington. Nor are they registered here as service contract providers.

Our order requires the companies to send copies of the order to all their Washington customers, and to report to us all premiums they've collected for business here.

The order also names a number of individuals, including Albert V. Hakim, Michael A Hakim, R.D. Frazier, Jon Braidsworth and Robert Harrington.

How to file a complaint against an insurance company

Having trouble getting an insurance claim paid? Waiting months?

We can often help. We're the insurance regulator for the state of Washington state, and we field thousands of calls a year from folks having trouble with claims. Last year, we got consumers $8 million in previously-denied or delayed claims.

There are two ways to reach us:

• Our toll-free hotline: 1-800-562-6900.
• Or file a complaint 24/7 with our online filing application.

Important note: If you don't live in Washington state, contact your state's insurance regulator. Here's a handy map with contact info.

It's National Consumer Protection Week - March 4-10

Have you ever had your insurance claim denied or maybe you filed a claim and received less than you thought you deserved. Ever have trouble reading an insurance policy? If you're reading this now, you know about the Office of the Insurance Commissioner and the services we provide. But you probably know a handful of people who've never heard of us.

This week (March 4-10) is National Consumer Protection Week. Tell a friend about our consumer services and follow us on Facebook.

More than 500 people a month file complaints with us. Last year alone, we recovered more than $8.5 million for Washington state insurance consumers who had their claims denied or delayed.

Just in last few months we helped:

• A Redmond consumer get a $29,000 health insurance claim paid


• A Lake Stevens consumer collect an additional $2,553 on an auto claim


• A Rochester consumer get a $7,574 refund on their auto warranty


• A Sammamish consumer get their homeowners policy reinstated

Maybe we can help you! If you or someone you know has an insurance question or complaint, visit http://www.insurance.wa.gov/. We take complaints online and you can track our progress 24 hours a day, seven days a week. Or call our Insurance Consumer Hotline at 1-800-562-6900, Monday-Friday, 8 a.m. -5 p.m.

New York company ordered to stop selling unauthorized insurance in Washington

Our office today ordered the United Consumer Awareness Association to stop selling unauthorized health insurance in Washington state.

The company, a not-for-profit entity incorporated in Missouri, appears to have its home office in Syosset, New York.

The company, which is not licensed to solicit and sell limited-benefit medical insurance in Washington, nonetheless sold policies to 44 Washingtonians.

The order takes effect immediately. The company has the right to demand a hearing.

Landslides and mud-slides: NOT covered by a standard homeowners policy

The New York Times has an interesting story today about a significant hazard here in the rainy Pacific Northwest: mudslides.

Mudslides and landslides, the article notes, are "a topographical drama less spectacular but far more common than the potentially deadly earthquakes, avalanches and tsunamis that loom in anxious minds across the Pacific Northwest."

And here's what many homeowners don't know: mudslides and landslides aren't covered by a standard homeowners policy. So it can be very difficult to collect for losses caused by any form of land movement unless you bought specific additional riders or policies, like these:

Landslide coverage: You may be able to buy a special rider for your homeowners policy that includes coverage for contents for all perils, including earth movement. But this type of rider only covers contents, not the structure, and some insurers don't offer this option at all. For the structure, you may be able to buy separate earth-movement coverage from what's known as the "surplus lines" market, meaning insurers who specialize in risks that the traditional insurance industry doesn't cover. But if your home is on a hillside, it may be difficult to get this kind of coverage.

Flood insurance: Flood insurance may apply to some kinds of earth movement, such as water-related erosion, mudflows or flash floods. Most homeowners seeking flood coverage start with the National Flood Insurance Program, which is federally run but sold by local agents and brokers.

Earthquakes: Quake damage is another category of risk not covered in a standard homeowners policy, but you can buy this coverage to protect against losses from an earthquake -- or quake-triggered landslides.

Job opening: Actuary

We have a job opening for a full-time, permanent actuary at our main office in Tumwater.

The person will be reviewing health and disablity insurance rate filings, as well as helping our company supervision divisions financial analysis work. For a full description of the job, salary range, benefits, etc., please see the job listing.

Insurance companies and agents fined

We'll be posting a news release on this shortly, but we've issued the following fines and other enforcement actions:

• Fidelity National Title Insurance Co. and Chicago Title Insurance Co.: Fined $100,000 for wrongfully offering discount club memberships to people who were in a position to send title business to the companies.
• Aetna Life Insurance Co.: Fined $20,000 for failing to promptly handle appeals from consumers.
• Charter Warranty Services, Inc., Mechanical Breakdown Protection, Inc., and Paul Pawlusiak, of Detroit, Mich.: Ordered to stop selling unauthorized motor vehicle service contacts.
• Scott L. Stevens and RV Protection.net, of Mill Creek: Ordered to stop acting as an agent for a service contract provider not authorized to do business in Washington state.
• Cynthia L. Rushing, of Spokane: License revoked for misappropriating funds.
• Trevor D’Jon Losse, of Cle Elum: Fined $1,000 for multiple violations, including failing to disclose other state disciplinary actions against him.
• Robert Tychsen, of El Cajon, Calif.: Fined $1,750 for selling insurance in Washington without a license.
• Douglas D. Wellsandt, of Hayden, Idaho: Fined $5,000 for violations including falsely stating that Washington policies had been sold in Idaho.
• Ross S. Wolf, of Sammamish: Fined $2,000 for violations including acting as an insurance company’s agent without having been appointed by the company.

Orders and details about these cases are posted online at www.insurance.wa.gov/orders/enforcement.asp.

The fines collected do not go to the agency. They are deposited in the state's general fund to pay for other state services.

Washington consumers with questions, problems or complaints can call us at 1-800-562-6900 or e-mail AskMike@oic.wa.gov. (Not in Washington? Here's how to reach your state's insurance regulator.)

A company that insured the Titanic goes under, leaving behind maritime relics

The Wall Street Journal's Leslie Scism has a story today about Atlantic Mutual, the company that insurered the Titanic and many other ships for more than a century, before the company was ordered into liquidation two years ago.

The story details the maritime artifacts and records amassed by the company. Many of the items -- model ships, paintings, old maps, gold coins, barometers, etc. -- may be sold soon.

Tacoma man sentenced to prison for insurance fraud, forgery

A Tacoma man has been sentenced to more than two years in prison for insurance fraud and forgery after filing a false auto insurance claim.

Cash B. Knott, 46, was sentenced Friday in Pierce County Superior Court to 29 months in prison and must pay $1,200 in costs and assessments. He pleaded guilty in January to two counts of forgery and one count of felony insurance fraud.

On Nov. 6th, less than a month after getting coverage from Progressive Direct Insurance Co. for his 1992 Ford Ranger pickup, Knott filed a $5,674 insurance claim with Progressive. He said someone had scratched the paint, stolen his chrome wheels and tires, and stolen his navigation and entertainment system, 1,000 watt amplifier and other electronic components.

He provided Progressive with a Sept. 2 stereo shop invoice for $4,547.84 worth of stereo equipment, a copy of his check, and a bank statement showing the withdrawal from his checking account.

The problem: When contacted by an insurance adjuster, the stereo shop said it had no record of such a purchase. All they could find was that Knott had bought an amplifier -- for $109 -- on Sept. 2.

Insurance Commissioner Mike Kreidler's Special Investigations Unit obtained a search warrant for Knott's bank records. The bank found no checks written to the stereo shop, and none whatsoever for $4,547.84.

Homeowners insurance: What's NOT covered

People often assume that homeowners insurance is a catch-all, covering virtually any event.

Not true, unfortunately. There are many things that a typical homeowners policy does NOT cover. Among them:

• floods
• earthquakes
• breaks in a water line leading to your home
• termites
• stolen pets
• damaged or stolen cars, boats and motorcycles (these would typically be covered, however, by your car/boat/etc. insurance)

Also, here's a list of what IS covered by a typical homeowners policy, as well as add-ons you might want to consider.

Cease and desist order issued for "Prolong Plus" auto warranties

A New Jersey-based company selling vehicle warranties paired with engine additives has been ordered to stop selling unauthorized vehicle warranties in Washington state. The order takes effect immediately.
The Choice Manufacturing Company, Inc., also known as The Choice Warranty, Inc., is not authorized to sell vehicle service contracts in Washington. Their application was denied in 2008 because they didn't meet several requirements of the state's insurance law.

Despite that denial, however, the company continued to sell its "Prolong Plus" vehicle warranty in Washington. When state officials investigated, the company and principal Peter Masi refused to provide information or cooperate.

Our office has received several complaints from people who bought the warranties. Each said that the company had wrongly denied claims.

The Prolong Plus warranty requires consumers to put additives in their car radiators, engine oil, air conditioning or batteries. The additives are manufactured by Choice Manufacturing.

What if you live in Washington and bought one of these warranties? Even though the warranty was not legally sold here, the company is still required to honor the terms of the contract.

Most and least expensive cars to insure

Insure.com is out with its annual list of the most- and least-expensive cars to insure. (Scroll down after clicking that link to reach the table listing the cars.)

Among the cheapest to insure: minivans, small SUVs, and some large pickup trucks. The lowest-cost vehicle to insure is the Toyota Sienna.

The most expensive will come as no surprise. The list, topped by the Audi R8 Spyder Quattro convertible, is dominated by expensive European sports cars.

The folks at PropertyCasualty360.com, an industry news site, put together a short slideshow with the top cars in each category.

Give us your feedback

We're tuning up our agency website (not this blog; we've already done that part) and would love to get your feedback.

Our survey takes less than a minute. Please take a quick look at the site and give us your thoughts.

Thank you!

Surpluses of nonprofit health insurers in WA at $2.4 billion

The Seattle Times had a story today about a change in the law we've proposed.

The background: Washington's three major health insurers -- all of whom are non-profit companies -- have amassed surpluses totalling more than $2.4 billion.

Commissioner Kreidler is asking lawmakers to let him consider those surpluses when the companies propose increases in health insurance premiums. The That, hopefully, could ease future premium hikes. In the individual and small group markets, insurance premiums, on average, have more than doubled since 2005.

The bill is SB 5247. It has cleared a key committee and is currently in the Senate's Rules Committee.

How to look up the number of complaints against an insurance company

We've created an easy online tool to look up the number of complaints against insurance companies.

We're the insurance regulator in Washington state, so the data's only for our state. But it can provide some insight into who we hear a lot of complaints about, and who we don't.

Since the market share of these companies varies widely, we also calculate what we call the "complaint index." That's simply the ratio of complaints divided by market share, to make the results easy to compare.

Survey: 57 percent of people in low-income families have no health insurance

The Commonwealth Fund today released the results of a new survey on the uninsured. Among the group's findings:

• 57 percent of people in low-income families (those earning less than about $30,000 for a family of 4) had no health insurance at some point last year.
• 35 percent have been uninsured for two years or more.
• Among moderate-income adults (about $30,000 to $56,000 for a family of 4), some 36 percent of adults in those families were uninsured during the past year.

None of this should come as a surprise. We do our own report on the uninsured in Washington state, and income is by far the largest factor correlated to being uninsured. The less you make, the more likely it is that you don't have health insurance.

We've also found that in most income brackets, the younger you are, the more likely that you're uninsured. See the report link above for more data and details.

Car sharing and usage-based insurance bills move forward

Everyone in Washington state is required to have basic liability insurance if you own a car. Well, here's two bills that could impact how you get insurance and how much you pay for coverage.

The first, House Bill 2384, creates an insurance framework for peer-to-peer car sharing programs. Several other western states (OR, CA) have passed similar bills. Here's how it would work: You sign-up with a program to share your car when you're not using it. Your financial liability for the car transfers to the program during the time it's in use. Of course you still need insurance coverage for when you're driving your car, but the program is responsible for having insurance coverage for any car in its use. The bill report has all of the details if you want to know more.

Next is an issue we've seen before: Usage-based insurance (House Bill 2361). Nothing prevents an insurance company from creating a usage-based insurance product today, but under our state law, all auto insurance products and why they cost what they do is public once the premiums are approved by our office.

Certain information is considered confidential (ie. those pesky credit scoring models) but only if they've been carved out in state law. This bill would allow insurers who want to offer a usage-base product the ability to keep their products confidential. Also, there would be limits on how the insurance company could use your information and they couldn't sell it to anyone.

So why should you care? Well, you could get your rates reduced depending on how you drive. This means: the amount of miles, where you drive, the time of the day you drive, your speed, etc. Of course it goes both ways - if you have a lead foot or tend to brake hard, you could see your rates go up. Here's the full details.

Both bills must pass a February 14 deadline to stay alive.

Job openings: Actuary, investigator, HR consultant, etc.

We have four job openings, although some of the application deadlines are coming up soon. (Check each listing for the deadline, some may have closed by the time you're reading this.) We're looking for:

• Human resource consultant 3
• Actuary 2 or Actuary 3
• Investigator 3
• Health insurance advisor 2

We're a small agency, but we do have job openings periodically. Most are due to retirements or resignations, rather than new positions. When we have job openings, we post them on our jobs page, as well as on the state's careers.wa.gov site.

Insurers and agents fined more than $1.3 million in 2011

Insurance Commissioner Mike Kreidler fined insurance companies, agents and brokers more than $1.3 million in 2011.

Violations included wrongly denying medical claims, overcharging customers, misappropriating clients’ money, charging unapproved rates and submitting false documents.

“These cases are the exception, not the rule,” said Kreidler, who’s been the state’s insurance regulator since 2001. “The vast majority of insurers, agents and brokers comply with the law.”

The largest fine, issued in January 2011, was against six Chubb & Son subsidiaries, which were ordered to pay $534,000 for violations including a long-running pattern of failing to properly document why the companies were charging higher or lower rates for certain policyholders.

Other major fines included $100,000 from American Bankers Insurance Co. of Florida (June 2011) and $100,000 from Regence BlueShield (August 2011).

Over the past 11 years, Kreidler has issued more than $13 million in fines against insurers, agents and brokers who violated the law. The agency’s disciplinary orders are posted online at http://www.insurance.wa.gov/orders/enforcement.asp.

Fines collected by the insurance commissioner’s office do not go to the agency. The money is deposited in the state’s general fund to pay for other state services.

Non-profit health insurer surplus legislation advances in WA legislature

A bill we requested, Senate Bill 5247, was approved by a key state Senate committee last night.

The bill would allow us, when considering premium rates proposed by non-profit health insurers, to take into account the large surpluses that the companies have built up in recent years. (Surpluses are not the same thing as reserves. Theres' been some confusion out there on this point.)

These surpluses have grown dramatically over the past decade. The state's three major nonprofit health insurers together now have more than $2.4 billion in surplus.

Meanwhile, the cost of individual health policies more than doubled from 2005 to 2011.

At least 11 other states, including neighboring Oregon, have the authority to consider surpluses when reviewing rates. We think it's time Washington did the same.

What's a health care exchange?

Stateline, a news service that covers state government, put together a story summarizing the new health care exchanges scheduled to launch in 2014, how they work, and the status of the efforts to create them at the state level. From the article:

Considered the engines of the national health law, state exchanges are online marketplaces designed to make it easier for individuals and small businesses to shop for insurance policies. They will also be one-stop enrollment centers for low-income people who qualify for Medicaid and moderate income individuals who qualify for federal tax credits.

There's a tremendous amount of behind-the-scenes work taking place in Olympia in preparation for these exchanges. Again, from Stateline's article:

One small group of states — led by Maryland, Washington, Oregon, Rhode Island and California — is running significantly ahead of the rest. Statutes have been enacted to create the exchanges and the basic decisions about how to run them have already been made.

Our office and Gov. Chris Gregoire have also requested additional exchange legislation in Washington this year.

Tacoma insurance agent sentenced for stealing from clients

An insurance agent in Tacoma has pleaded guilty to second-degree theft for misappropriating checks from dozens of policyholders.

Michel Anthony James, an independent contractor who was working for State Farm, is believed to have deposited checks from more than 40 policyholders into his own business bank account. State Farm discovered the problems when it audited James' accounts. It subsequently terminated its contract with James.

Based on a subsequent iinvestigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit, James:
• failed to apply premiums to policies,

•wrongly withdrew cash from his premium fund account (which is where those policyholder checks were supposed to go),

•failed to refund overpayments to policyholders,

•and violated contractual agreements with State Farm.

The theft added up to $23,926.87.

On Jan. 13 in Pierce County Superior Court, he pleaded guilty to second-degree theft. He was sentenced to community service, electronic home monitoring and $1,800 in costs and assessments. He has also paid back the misappropriated money.

(Updated Feb. 1 to note that James no longer works for State Farm.)

Tacoma man pleads guilty to forgery and insurance fraud

A Tacoma man has pleaded guilty to two counts of forgery and one count of felony insurance fraud for filing a false auto insurance claim.
Cash B. Knott, 46, pleaded guilty Jan. 13 in Pierce County Superior Court.
On Nov. 6th, less than a month after getting coverage from Progressive Direct Insurance Co. for his 1992 Ford Ranger pickup, Knott filed a $5,674 insurance claim with Progressive. He said someone had scratched the paint, stolen his chrome wheels and tires, and stolen his navigation and entertainment system, 1,000 watt amplifier and other electronic components.

He provided Progressive with a Sept. 2 stereo shop invoice for $4,547.84 worth of stereo equipment, a copy of his check, and a bank statement showing the withdrawal from his checking account.
The problem: When contacted by an insurance adjuster, the stereo shop said it had no record of such a purchase. All they could find was that Knott had bought an amplifier -- for $109 -- on Sept. 2.
Insurance Commissioner Mike Kreidler's Special Investigations Unit obtained a search warrant for Knott's bank records. The bank found no checks written to the stereo shop, and none whatsoever for $4,547.84.
He's slated for sentencing on Feb. 17th. The standard range for the charges are 22 to 29 months in prison.

What are my odds of dying from...?

The Insurance Information Institute has released some interesting data about the odds of dying in a wide variety of accidental (or sometimes not-so-accidental) injuries.

According to the III, your odds of dying from:

• A car accident: 1 in 303.
• Being shot: 1 in 306.
• Falling down the stairs: 1 in 2,018.
• An airplane crash: 1 in 7,032.
• Falling off a ladder: 1 in 8,912
• A lightning strike: 1 in 84,079.

See the link above for more examples.

Anti-fraud group releases its "Hall of Shame" for 2011

The Coalition Against Insurance Fraud has compiled its annual "Insurance Fraud Hall of Shame" list. And this batch is pretty horrifying:

• A debt-plagued Arizona homeowner torched his home for $440,000 in insurance money -- and killed a witness and the witness' family. He got 14 years in prison for the insurance fraud, and the death sentence for the murders.

• A Rhode Island radio DJ who wanted to upgrade her home and pool had several friends simulate storm damage to her home -- smashing a hole in her roof with a tree limb, messing up the pool, etc. The problem: The weather was fair and in the 70s that day. And one of the DJ's accomplices was caught on an unrelated federal wiretap bragging about the job.

• Another home-arson case involved a California couple who hired a man to burn down their home. The man used a lot of gasoline, leading to a blast that left him horribly burned. He died later that day. The couple went to prison.

• There are several others, but we'll end with what's probably the strangest case. A mortuary workers and medical worker faked the death of a man who'd never existed. There was even a grave. And a funeral service. Using forged documents, the workers and accomplices had taken out $950,000 in life insurance policies on the fictitious man.

When one company had doubts, the workers exhumed the coffin, filling it with a mannequin, cow meat, and bones before hauling it to a crematorium. But when they tried to bribe a doctor to forge medical records, he instead cooperated with investigators and recorded the conversations. One of the workers was sentenced to two years in prison, the other other is awaiting sentencing.

Long-term care insurance: Is it right for you?

Kaiser Health News and the Washington Post have an article today on the pros and cons of long term care insurance. From the article:

The question of whether to get long-term care insurance bedevils consumers and their advisers. Unlike medical insurance, it is intended primarily to cover people who need assistance with so-called activities of daily living -- for example, the care of a dementia patient or someone recovering from a broken hip. It can be expensive: Premiums range from $1,000 to $5,000 a year, depending on the age, sex and health of the purchaser as well as the extent of the coverage. And policy details can be confusing.

Even advocates acknowledge that it isn't for everyone. Jesse Slome, executive director of the American Association for Long-Term Care Insurance, an industry group, sums it up well: "Long-term care is a universal issue facing all Americans who are getting older. But long-term-care insurance is not a universal solution."

Many people think that their health insurance will cover long term care, but most don't. Nor do Medicare or Medicare supplemental policies. Medicaid will pay, but to qualify for Medicaid, your assets must dwindle away to almost nothing.

In recent years, we've received numerous complaints about the cost of the policies. 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.

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 is a problem across the country. Again, from the article:

"It's probably the most frequent complaint I hear," says (Kansas Insurance Commissioner Sandy) Praeger, who heads the National Association of Insurance Commissioners' health and managed care committee. "The problem is, the older policies weren't priced right to begin with. Companies expected about 8 percent of customers to stop paying their premiums, when, in fact the lapse rate is closer to 2 percent." That meant the insurers had to cover more beneficiaries than they expected at a time when the economic downturn has meant less returnon their investments.

Praeger acknowledges that rate increase requests have posed a dilemma for insurance commissioners. "If we don't give them the rate increase they need, the insurance carriers could become financially impaired, and that doesn't help people," she says. In fact, in recent years, a number of companies have stopped selling policies. As a result, she adds, it's hard to turn the increases down.

Insurer fined $100,000

A company that issued thousands of medical insurance policies to college students has been fined $100,000 for charging unapproved rates, as well as other violations.

Indiana-based Unicare Life and Health Insurance Co. has agreed to pay the fine.

Between mid-2004 and mid-2009, Unicare sold thousands of medical insurance policies to students at community colleges, technical schools, colleges and universities across Washington state. Insurance Commissioner Mike Kreidler’s office later determined that there were substantial problems with the coverage. Among them:

• For more than six years, the company used unapproved methods to set its rates.

• Unicare continued to wrongly cite a policy exclusion for 5 years after the law had changed to ban insurers from using the exclusion.

• Unicare allowed unlicensed insurance agents to market and sell the policies. The primary company marketing the policies was not licensed to do business in Washington until June 2009. At that point, it had been selling the policies for four years.

The company was unable to respond to Kreidler’s requests for supporting documentation on rates at specific colleges, saying that the documents were prepared by employees who no longer worked there.

Fines collected by the insurance commissioner’s office do not go to the agency. The money is deposited in the state’s general fund to pay for other state services.

The policies included international students at the University of Washington, Washington State University, Bellevue Community College, Seattle Pacific University, Shoreline Community College, Tacoma Community College and South Puget Sound Community College, among others.

Tips on winter storm-related insurance claims

As this week's snowstorm turns into an ice storm, we figured that it would be a good time for a Q&A re: winter storms and insurance claims. For more, please see our winter weather page.

My neighbor’s tree fell on my house. Who pays?

Usually your insurance, even if it was the neighbor's tree. And you’ll be responsible for the deductible.

Sometimes your insurer can prove the neighbor was at fault (diseased tree, etc.) and make their insurer pay. But that can be hard to prove.

If possible, take steps to prevent further damage. For example, you might try to cover holes in walls or the roof, but only if it's safe to do so. Beware of snow, ice, and falling limbs.

And save your receipts: Your insurer may reimburse you for those costs.

A tree fell on my car or carport. Am I covered?

Car: Yes, if you have comprehensive coverage.

Carport: Yes, usually your homeowners coverage will usually cover the damage. But unattached buildings – like a garden shed – are often not covered.

Lots of limbs fell in my yard. Will an insurance company pay for cleanup?

Usually not. Homeowners insurance is mainly for the home.

Lost power and freezer thawed. Am I covered?

Most homeowners policies cover this, but it may not be worth filing a claim, esp. if you have a high deductible.

I’m concerned about flooding. Will I be covered?

Probably not. A standard homeowners insurance policy doesn't cover floods. You have to buy a separate policy, usually through the National Flood Insurance Program (NFIP).

My television set was ruined when the power came back on. Am I covered?

Most homeowner policies do cover appliances ruined by power surges. But consider your deductible -- in many cases, it may be more than the cost of simply replacing the damaged equipment.

Tips on auto insurance claims

After this week's record-setting snowstorm, it seemed like a good time to post some tips on auto- and homeowners claims. We'll start with auto, and then put up a second post specifically about homeowners claims. For more, please see our auto claims web page.


Claims process
• Get the name, contact info and insurance info of the other driver.
• Get the names and contact info of anyone in the other car. We've seen fraud cases in which friends of a car's sole occupant claim that they were in the car, too, so they can file claims.
• Call your agent or the company. They’ll walk you through the process.
• That said, if it’s just your car and the damage is minor, you may want to just pay for repair yourself., especially if you have a high deductible.

Repairs
• In Washington state, you can generally choose which shop to take your car to, but the shop and the insurer must agree on price. If they can't agree, you may be stuck paying the difference.

Who pays
• If you have collision coverage, the fastest thing may be to file a claim to your own insurer.
•      There’s often disagreement over who’s at fault. Unfortunately, these disputes fall outside our administrative authority. Work with the person processing the claim. In major disagreements, you may want to seek legal advice.
• But if you’re confident that another person was at fault, you may want to wait for their insurance to pay. That way you won’t have a claim on your record
• If the other person’s at fault, your insurer can also recover its costs from their insurer. This is called subrogation. If you file the claim against your insurer and they get the other driver's insurer to pay, you may get your deductible back.

Rental car?
• If other person was at fault, their insurer will negotiate with you to pay for a rental car.
• Or your policy might pay it for you.
• Pay attention to the limitations, though: Rental car coverage is often limited to a short period of time. We often get complaints from people about this.

Diminished value
• This is the difference in value between a repaired car and one that was never damaged. See if your policy covers this.
• If you're making claim to other driver’s insurance, you need to prove that the value is diminished. This can be tough to do.

Our offices will remain closed today

Our Thurston County and Seattle locations will remain closed today due to the the road conditions as the yesterday's snowstorm became today's ice storm. Sorry for the inconvenience; we just want to keep our staff safe today. 


All online services are still available at our website at http://www.insurance.wa.gov.


We expect to be fully operational during regular business hours starting tomorrow morning. We'll let you know here. Be safe!

OIC closes offices in Thurston County due to snow and ice

We've had to close our Thurston County offices this morning due to lots of snow and ice on the roads (and more coming down). This includes our office in the Insurance Building on the state capitol campus and our largest office, which is in Tumwater. We're sorry for the inconvenience, but conditions are pretty bad out there right now.

The good news: You can still:

• Ask us questions about insurance or file a complaint against an insurer or agent
• See rate requests by health insurers
• Look up the number of complaints against each insurer
• And look up disciplinary and contact information on agents, brokers and insurers.

Having some phone system problems this morning

Just fyi: We're having some trouble with our telephone network this morning. Callers may get just a steady busy signal or will hear the phone ringing but the call won't go to voicemail.

This affects many of our lines, including our consumer hotline (1-800-562-6900) and our main number (360-725-7000).

The folks who maintain the network are aware of the problem and are working to fix it now.

Update (11:30 a.m.) We believe everything's fixed and working now. Thanks for your patience.

Sensible Home Warranty ordered to stop selling insurance in WA

A New York-based home warranty company has been ordered to stop selling insurance in Washington state.

Sensible Home Warranty LLC, formerly known as CHW, LLC, sold Washington consumers approximately 142 home warranty service contracts since 2009. The contracts were for parts and labor necessary to fix major systems and appliances that failed in a consumer's home. The company solicits customers through telemarketing and through a website: http://www.sensiblehomewarranty.com/.

In Washington, service contracts like the ones sold by Sensible Home Warranty are considered insurance. But neither the company nor its principals, Harrison Gindi and Elliot Dabah, are authorized to transact insurance in Washington state. Nor are they registered as service contract providers.

Nothing in the order, which took effect immediately Jan. 6, 2012,  prevents the company from fulfilling the terms of its contracts or providing a refund to Washington consumers who ask for one.

The company has the right to demand a hearing.

Note: The company's registered office address is in Sparks, Nev., but its principal place of business and sales office is 1724 E. 12th St., Brooklyn, NY.

Kreidler on nonprofit health insurer surpluses: "How much is enough?"

Commissioner Kreidler recently had an op-ed in the Seattle Times, talking about the large surpluses that have been built up by non-profit health insurers in recent years. From it:

In Washington, the three major health insurers — Premera Blue Cross, Regence BlueShield and Group Health Cooperative — are sitting on a total of more than $2.4 billion above and beyond what they expect to ever pay out in claims. All of them are not-for-profits. And they continue to propose substantial rate increases.

He is proposing legislation that would give the insurance commissioner's office explicit authority to consider those surpluses when reviewing rate requests.

We're working on a web page that explains this issue in more detail, and includes charts of the major insurers' surpluses over the past decade. Stay tuned...