We're rolling out new consumer tools for the new year, including an easy way to look up past violations and complaints against insurers and agents.
The insurance commissioner’s website now includes a “consumer toolkit” that offers:
• Easy-to understand information on different types of insurance.
• Online filing – and tracking – of complaints against an insurance company.
• Online filing of complaints against an insurance agent or broker.
• And a new system to look up contact information, licensing history, past violations and consumer complaints against agents or companies.
The agency also continues to expand its website and its social media presence, including a new page on Facebook.
Thursday, December 30, 2010
Tuesday, December 28, 2010
Job opening: Financial examiner
We're looking for a person to fill a financial examiner 3 position in our company supervision division, which is located in Seattle. Applications must be received by 5 p.m. on Friday.
The successful applicant will plan, conduct, and lead in-the-field financial examinations of insurance companies and other entities that our agency regulates. Duties include:
For more details, please see the job announcement.
The successful applicant will plan, conduct, and lead in-the-field financial examinations of insurance companies and other entities that our agency regulates. Duties include:
Examines and analyzes annual financial statements, actuarial opinions, management discussions and analyses, audited financial statements, holding company statements, quarterly financial statements, financial ratios, and other sources of information to discern financial condition, difficulties, trends, statutory compliance, accuracy, and completeness.
For more details, please see the job announcement.
Monday, December 27, 2010
Stranded traveler? Here are some things to check
The weather on the East Coast has clearly scrambled plans for a lot of travelers this holiday; here are some tips that might help as you sort out your plans for getting home.
If you're wondering what your rights are, do an online search for the name of your airline and the words "contract of carriage." (Here, for example, is a summary of United's.) This is your contract with the carrier. If you feel they're violating it, you can file a complaint here. The bad news: Travel experts say that airlines generally aren't obligated to provide meals or a hotel if the problem is weather-related.
Also, if you used a credit card to buy the ticket, check with your credit card company. Cards come with a variety of perks, and you may have trip coverage without knowing it. Mastercard, for example, offers many cardholders reimbursement for lost or delayed baggage and trip cancellation insurance, as long as the tickets were paid for with an eligible MasterCard card.
For general information on travel insurance, see our page on this topic, which spells out the types of coverage and what they mean, in plain language. We're not trying to sell you anything; we're the state agency that regulates insurance in Washington state.
Lastly, here's the list of toll-free numbers for airlines.
Good luck.
If you're wondering what your rights are, do an online search for the name of your airline and the words "contract of carriage." (Here, for example, is a summary of United's.) This is your contract with the carrier. If you feel they're violating it, you can file a complaint here. The bad news: Travel experts say that airlines generally aren't obligated to provide meals or a hotel if the problem is weather-related.
Also, if you used a credit card to buy the ticket, check with your credit card company. Cards come with a variety of perks, and you may have trip coverage without knowing it. Mastercard, for example, offers many cardholders reimbursement for lost or delayed baggage and trip cancellation insurance, as long as the tickets were paid for with an eligible MasterCard card.
For general information on travel insurance, see our page on this topic, which spells out the types of coverage and what they mean, in plain language. We're not trying to sell you anything; we're the state agency that regulates insurance in Washington state.
Lastly, here's the list of toll-free numbers for airlines.
Good luck.
Tool to compare insurance companies by the number of complaints
One of the most-used features of our website is our "Complaint Comparison Tool," a free and simple online tool that lets you compare the number of complaints filed by consumers against different insurance companies.
The information's broken down by year and by type of insurance (health, life, homeowners, auto, etc.). It also compares the number of complaints to an insurer's market share, which makes for easy apples-to-apples comparisons with other companies.
Take a look. We've posted 5 years' worth of data, and should be posting more soon.
The information's broken down by year and by type of insurance (health, life, homeowners, auto, etc.). It also compares the number of complaints to an insurer's market share, which makes for easy apples-to-apples comparisons with other companies.
Take a look. We've posted 5 years' worth of data, and should be posting more soon.
Wednesday, December 22, 2010
Job opening: Chief market analyst
Our office is looking for a chief market analyst to fill an opening at our Tumwater office.
The person will manage staff performing market analysis, and help ensure that companies are acting within the scope of their license and are complying with laws and regulations.
Here's the job listing, which has much more detail about qualifications, salary, etc.
The critical part: Applications are due by 5 p.m. on Dec. 31, 2010.
Also, here's a handy online tool from careers.wa.gov that can e-mail you information about any job openings at state agencies, universities, etc.
The person will manage staff performing market analysis, and help ensure that companies are acting within the scope of their license and are complying with laws and regulations.
Here's the job listing, which has much more detail about qualifications, salary, etc.
The critical part: Applications are due by 5 p.m. on Dec. 31, 2010.
Also, here's a handy online tool from careers.wa.gov that can e-mail you information about any job openings at state agencies, universities, etc.
Tuesday, December 21, 2010
We're expanding our social media presence
As a small agency with a broad consumer-protection mission, one of our hardest jobs is simply getting the word out to consumers that we can help them. Increasingly, we're turning to social media tools to help spread the word.
In the summer of 2009, we launched this blog, which is getting thousands of visitors a month. Shortly thereafter, we set up a Twitter feed, which we believe is now the second-largest among state insurance departments nationwide. From what we can tell, the blog tends to attract consumers Googling around for information. Our Twitter followers tend to be industry folks: agents, brokers and insurers.
Now we've launched an agency Facebook page. We're hardly the first Washington state agency to do so (Here's the list, put together by the good people at access.wa.gov), but surprisingly few insurance departments are using this tool. We'll see how it goes.
In the summer of 2009, we launched this blog, which is getting thousands of visitors a month. Shortly thereafter, we set up a Twitter feed, which we believe is now the second-largest among state insurance departments nationwide. From what we can tell, the blog tends to attract consumers Googling around for information. Our Twitter followers tend to be industry folks: agents, brokers and insurers.
Now we've launched an agency Facebook page. We're hardly the first Washington state agency to do so (Here's the list, put together by the good people at access.wa.gov), but surprisingly few insurance departments are using this tool. We'll see how it goes.
Monday, December 20, 2010
Where to look if you can't afford health coverage
We've put together a list of resources, suggestions and alternatives for folks who cannot find affordable health coverage. Our "can't afford health care coverage" page includes links and information about:
- community clinics and local free clinics,
- state-offered health coverage,
- free cancer screenings
- hospital charity care
- dental exams and treatment
- and specific programs for certain diseases or disabilities.
Friday, December 17, 2010
High wind warning for eastern Puget Sound
The National Weather Service is forecasting gusts of up to 60 miles per hour tonight and Saturday in the east Puget Sound lowlands, which includes Bellevue, Gold Bar, Enumclaw, North Bend and Buckley. The good news is that those are the gusts; the wind will generally be 20-30 miles per hour in the area.
Wet soil and high winds often mean tree damage, so here's our ever-popular winter storm guide, with common questions about insurance and storm damage.
Wet soil and high winds often mean tree damage, so here's our ever-popular winter storm guide, with common questions about insurance and storm damage.
Insurance survey ranks Olympia as the safest mid-sized U.S. city in America; a dozen other Washington cities also score well
Farmers Insurance Group has released its seventh annual list of the safest cities in America.
Scoring highest among mid-sized cities: Olympia, Wash. Also doing well: Seattle/Bellevue/Everett, Bellingham, Yakima, the Tri-Cities, Spokane, Bremerton-Silverdale, Wenatchee, and Mount Vernon-Anacortes. (Some areas are grouped into single statistical areas.)
How do they decide? Here's what their press release says:
Scoring highest among mid-sized cities: Olympia, Wash. Also doing well: Seattle/Bellevue/Everett, Bellingham, Yakima, the Tri-Cities, Spokane, Bremerton-Silverdale, Wenatchee, and Mount Vernon-Anacortes. (Some areas are grouped into single statistical areas.)
How do they decide? Here's what their press release says:
The rankings, compiled by database experts at www.bestplaces.net, took into consideration crime statistics, extreme weather, risk of natural disasters, housing depreciation, foreclosures, air quality, terrorist threats, environmental hazards, life expectancy and job loss numbers in 379 U.S. municipalities.
Case closed: Man who claimed $33k tie collection had been stolen pays the money back, pleads guilty
A Lynnwood man who claimed that thieves had repeatedly made off with his collection of more than 200 silk neckties has paid back more than $33,000 and pleaded guilty to two counts of making a false insurance claim.
Under a diversion agreement, the felony charges will be dropped from his record if he complies with the agreement.
Carlton H. Wopperer, 50, was charged with two counts of insurance fraud in Snohomish County Superior Court in July. Last week, he paid restitution of $33,370.67 and signed the diversion agreement.
Three times in 9 years, Wopperer claimed, thieves had stolen his collection of 212 silk neckties from his vehicle. But an investigation by the state insurance commissioner's office revealed that Wopperer had returned many of those ties within minutes of buying them.
On Jan. 5, 2009, Wopperer told the Mill Creek Police Department that his vehicle had been broken into while parked at a greeting card store. He said that four plastic containers containing 212 of his silk neckties had been stolen. He said that he’d taken the ties to a quilt shop to see about having them sewn onto a quilt for display.
Wopperer purchased replacement ties from Nordstrom, Butch Blum, Barneys New York and Mario’s of Seattle, submitting the receipts to his insurer. His insurer, PEMCO Insurance, paid him $33,370 under the terms of a provision allowing for replacement cost of stolen items.
Six months later, on June 9, 2009, Wopperer reported a very similar crime. He told the Everett Police Department that his vehicle had been broken into while he was moving. The 212 replacement ties that he’d purchased following the January theft had been stolen, he said. He subsequently filed an insurance claim for approximately $35,000.
But a PEMCO adjuster, checking with the retailers, learned that most of the ties purchased in January had been returned almost immediately. PEMCO denied Wopperer’s claim and reported the case to Insurance Commissioner Mike Kreidler’s Special Investigations Unit. State investigators interviewed store employees, documented the paper trail and referred the case to the Snohomish County Prosecutor’s Office.
(The investigation also revealed that there had been a third claim. Nine years earlier, on June 19, 2000, Wopperer told the Lynnwood Police Department that his collection of 212 silk ties had been stolen from his vehicle while parked at a mall. His insurer at the time paid his $16,900 claim.)
Under a diversion agreement, the felony charges will be dropped from his record if he complies with the agreement.
Carlton H. Wopperer, 50, was charged with two counts of insurance fraud in Snohomish County Superior Court in July. Last week, he paid restitution of $33,370.67 and signed the diversion agreement.
Three times in 9 years, Wopperer claimed, thieves had stolen his collection of 212 silk neckties from his vehicle. But an investigation by the state insurance commissioner's office revealed that Wopperer had returned many of those ties within minutes of buying them.
On Jan. 5, 2009, Wopperer told the Mill Creek Police Department that his vehicle had been broken into while parked at a greeting card store. He said that four plastic containers containing 212 of his silk neckties had been stolen. He said that he’d taken the ties to a quilt shop to see about having them sewn onto a quilt for display.
Wopperer purchased replacement ties from Nordstrom, Butch Blum, Barneys New York and Mario’s of Seattle, submitting the receipts to his insurer. His insurer, PEMCO Insurance, paid him $33,370 under the terms of a provision allowing for replacement cost of stolen items.
Six months later, on June 9, 2009, Wopperer reported a very similar crime. He told the Everett Police Department that his vehicle had been broken into while he was moving. The 212 replacement ties that he’d purchased following the January theft had been stolen, he said. He subsequently filed an insurance claim for approximately $35,000.
But a PEMCO adjuster, checking with the retailers, learned that most of the ties purchased in January had been returned almost immediately. PEMCO denied Wopperer’s claim and reported the case to Insurance Commissioner Mike Kreidler’s Special Investigations Unit. State investigators interviewed store employees, documented the paper trail and referred the case to the Snohomish County Prosecutor’s Office.
(The investigation also revealed that there had been a third claim. Nine years earlier, on June 19, 2000, Wopperer told the Lynnwood Police Department that his collection of 212 silk ties had been stolen from his vehicle while parked at a mall. His insurer at the time paid his $16,900 claim.)
Wednesday, December 15, 2010
Individual plan open enrollment for kids ends Dec. 15
If you want to buy an individual health plan for your child this year, or add your child to your individual plan, or if you’re an emancipated minor looking for an individual health plan, the 2010 open enrollment ends today. Kids still can get coverage through the Washington Health Insurance Pool and, if they qualify, from the Pre-existing Condition Insurance Plan.
We'll announce enrollment options for 2011 in the next few weeks.
New consumer protections under the Affordable Care Act prevent all health plans from discriminating against children because of a pre-existing condition. However, special enrollment periods are allowed. Washington state’s 2010 individual plan open-enrollment period was Nov. 1-Dec.15. During this time, children under age 19 could enroll in an individual health plan without having to take a health screen.
Insurance Commissioner Mike Kreidler created the special open enrollment period through a rule. After today, children under age 19 can get coverage through the Washington State Health Insurance Pool (WSHIP), or if they qualify, through the new Pre-existing Condition Insurance Plan (PCIP-WA). To enroll in PCIP-WA, you must have been uninsured for at least six months and have a pre-existing medical condition. There are some exceptions where parents can apply for coverage anytime in the individual market, such as the birth or adoption of a child or if a child or the parent:
■is no longer eligible for a state program.
■loses coverage due to a divorce.
■loses employer-sponsored coverage.
■moves and their plan is not available in where they live.
If you have questions about how to find health insurance or if you need help understanding your rights, call us at 1-800-562-6900 or read our health insurance page.
We'll announce enrollment options for 2011 in the next few weeks.
New consumer protections under the Affordable Care Act prevent all health plans from discriminating against children because of a pre-existing condition. However, special enrollment periods are allowed. Washington state’s 2010 individual plan open-enrollment period was Nov. 1-Dec.15. During this time, children under age 19 could enroll in an individual health plan without having to take a health screen.
Insurance Commissioner Mike Kreidler created the special open enrollment period through a rule. After today, children under age 19 can get coverage through the Washington State Health Insurance Pool (WSHIP), or if they qualify, through the new Pre-existing Condition Insurance Plan (PCIP-WA). To enroll in PCIP-WA, you must have been uninsured for at least six months and have a pre-existing medical condition. There are some exceptions where parents can apply for coverage anytime in the individual market, such as the birth or adoption of a child or if a child or the parent:
■is no longer eligible for a state program.
■loses coverage due to a divorce.
■loses employer-sponsored coverage.
■moves and their plan is not available in where they live.
If you have questions about how to find health insurance or if you need help understanding your rights, call us at 1-800-562-6900 or read our health insurance page.
Tuesday, December 14, 2010
Wind damage and insurance
High winds swept through western Washington last night, with peaks of 70 mph in Hoquiam, 62 at Alki Point, 54 at McChord Field and 43 in Puyallup. (Here's a National Weather Service map of the winds and list of other cities' wind speeds.)
Power was knocked out for thousands of people, according to the Seattle Times, and there were downed trees throughout the area: 3 trees fell on one brick home in Seattle, a falling tree killed a woman in her mobile home in Kitsap County, and firefighters in Snohomish County freed a man trapped in his home by a fallen tree.
All of which brings us back to a frequent topic this time of year: winter storms and insurance. We've posted a long list of questions and answers online, including things like:
-Is your car covered if tree limbs fall on it?
-Will insurance pay to clean up all that tree debris in your yard? (Sorry; no.)
-What if your boat in the marina sank in the high winds?
-What if the power surge killed your TV?
...and much, much more. Take a look, and if you have questions or are having trouble getting a claim paid -- and you're a Washingtonian -- call us at 1-800-562-6900. We're the state agency that regulates insurance in Washington state; we'll try our best to help you.
Power was knocked out for thousands of people, according to the Seattle Times, and there were downed trees throughout the area: 3 trees fell on one brick home in Seattle, a falling tree killed a woman in her mobile home in Kitsap County, and firefighters in Snohomish County freed a man trapped in his home by a fallen tree.
All of which brings us back to a frequent topic this time of year: winter storms and insurance. We've posted a long list of questions and answers online, including things like:
-Is your car covered if tree limbs fall on it?
-Will insurance pay to clean up all that tree debris in your yard? (Sorry; no.)
-What if your boat in the marina sank in the high winds?
-What if the power surge killed your TV?
...and much, much more. Take a look, and if you have questions or are having trouble getting a claim paid -- and you're a Washingtonian -- call us at 1-800-562-6900. We're the state agency that regulates insurance in Washington state; we'll try our best to help you.
Monday, December 13, 2010
Flooding and insurance: What to do
-Document the loss. Take photos, notes, video, etc.
-Contact your insurer as soon as possible. Be aware that standard homeowners coverage does not cover flood damage. But you may have flood coverage without knowing it -- in flood-prone areas, it's often required in order to qualify for a mortgage.
-Mitigate the damage as best you can. Get furniture and belongings up out of the water if possible. Shovel or squeegee mud and water out. Start drying things out.
-Create a paper trail. If you rent a pump, save the receipts. If your electrical system's damaged and you have to move to a motel temporarily, save those receipts.
-Where practical, avoid throwing out damaged items. The adjuster may want to see them.
Also: Standard flood coverage generally doesn't cover basement improvements, like finished walls or floors, or furniture or personal belongings in a basement. It does, however, cover essential equipment like your furnace and water heater.
Winter storm update: Flood insurance
Heavy rains over the weekend raised rivers high throughout the region, but the storms this morning began moving to the southeast. Many rivers in the region, according to FEMA, crested Sunday night, with longer rivers cresting Tuesday or Wednesday.
Our agency's particularly interested in south King County's Green River Valley, where we've set up what's called a "market assistance plan" to help businesses find flood insurance coverage. According to FEMA, the amount of rain falling in that area "is not expected to be of concern for Howard Hanson Dam operations or for flooding on the lower Green River Basin."
Still, this is probably a good time for a reminder: Contrary to what many people think, standard homeowners coverage and business insurance policies do not cover damage from floods. For flood protection, you generally have to buy a separate flood insurance policy. If your property is in a flood hazard area, you'll probably be required by your lender to have this coverage.
Fortunately, flood coverage is widely available through the National Flood Insurance Program. For more on that, and a link to an easy site to check your property's flood-risk profile, see our flood page.
Our agency's particularly interested in south King County's Green River Valley, where we've set up what's called a "market assistance plan" to help businesses find flood insurance coverage. According to FEMA, the amount of rain falling in that area "is not expected to be of concern for Howard Hanson Dam operations or for flooding on the lower Green River Basin."
Still, this is probably a good time for a reminder: Contrary to what many people think, standard homeowners coverage and business insurance policies do not cover damage from floods. For flood protection, you generally have to buy a separate flood insurance policy. If your property is in a flood hazard area, you'll probably be required by your lender to have this coverage.
Fortunately, flood coverage is widely available through the National Flood Insurance Program. For more on that, and a link to an easy site to check your property's flood-risk profile, see our flood page.
Friday, December 10, 2010
A plain-language guide to Washington state insurance law
For quite a while, one of our staffers has been periodically maintaining two plain-language guides to Washington's lengthy insurance laws. One's for life and health plans, the other's for property and casualty policies.
We've used these as a staff resource for years, and figured it might be helpful to post it online for anyone to use. Trying to find the insurance laws about emergency medical services? Think you've been unfairly discriminated against? Have detailed questions about life insurance or long term care policies?
Take a look, and feel free to bookmark them.
(Of course, we'd also be happy to sell you a printed copy of the state's insurance laws, for $20-$25 each. But the web versions are so much easier to search. And free.)
We've used these as a staff resource for years, and figured it might be helpful to post it online for anyone to use. Trying to find the insurance laws about emergency medical services? Think you've been unfairly discriminated against? Have detailed questions about life insurance or long term care policies?
Take a look, and feel free to bookmark them.
(Of course, we'd also be happy to sell you a printed copy of the state's insurance laws, for $20-$25 each. But the web versions are so much easier to search. And free.)
Thursday, December 9, 2010
Distinct Advantage Administrative Services ordered to stop selling illegal vehicle service contracts in Washington state
Our office has ordered a Federal Way, Wash.-based company to stop selling unauthorized vehicle service contracts in Washington state.
The order names Distinct Advantage Administrative Services, LLC, company principal Michael Phelps and former insurance agent Thomas L. Ross. Ross is a former Washington insurance agent whose license was revoked in March 2003. Nonetheless, he began marketing Distinct Advantage service contracts around October 2009 as an "agent" for the company.
None of the three are registered with Washington as a service contract provider.
Distinct Advantage sold at least 37 vehicle service contracts, totalling $26,468, through 6 car dealers. The contracts were not approved for sale in Washington. The forms state that Distinct Advantage is insured by Colonial American Casualty and Surety Co., but Colonial American has no record of any affiliation with Phelps or his company.
Here's a link to the full order.
The order names Distinct Advantage Administrative Services, LLC, company principal Michael Phelps and former insurance agent Thomas L. Ross. Ross is a former Washington insurance agent whose license was revoked in March 2003. Nonetheless, he began marketing Distinct Advantage service contracts around October 2009 as an "agent" for the company.
None of the three are registered with Washington as a service contract provider.
Distinct Advantage sold at least 37 vehicle service contracts, totalling $26,468, through 6 car dealers. The contracts were not approved for sale in Washington. The forms state that Distinct Advantage is insured by Colonial American Casualty and Surety Co., but Colonial American has no record of any affiliation with Phelps or his company.
Here's a link to the full order.
Wednesday, December 8, 2010
Des Moines insurance agent charged with multiple counts of first-degree theft
Brenda MacLaren-Beattie, a longtime insurance agent in Des Moines, Wash., has been charged with first-degree theft for allegedly selling fake insurance to oral surgeons in Washington and Oregon.
An investigation by Insurance Commissioner Mike Kreidler’s office found that MacLaren-Beattie, 67, sold thousands of dollars in fake business-insurance policies, often issuing counterfeit certificates of insurance to doctors and clinics.
She was arraigned last week in King County Superior Court. She faces 14 counts of first-degree theft, totaling $41,729 in payments from 11 clinics for non-existent coverage.
The fictitious policies were for business owners’ general liability insurance, rather than professional liability/medical malpractice. General liability insurance typically covers things like slip-and-fall accidents, employee theft, and damage to rented property.
An investigation by Insurance Commissioner Mike Kreidler’s office found that MacLaren-Beattie, 67, sold thousands of dollars in fake business-insurance policies, often issuing counterfeit certificates of insurance to doctors and clinics.
She was arraigned last week in King County Superior Court. She faces 14 counts of first-degree theft, totaling $41,729 in payments from 11 clinics for non-existent coverage.
The fictitious policies were for business owners’ general liability insurance, rather than professional liability/medical malpractice. General liability insurance typically covers things like slip-and-fall accidents, employee theft, and damage to rented property.
Tuesday, December 7, 2010
Health insurance rates, by state
Update: (6/20/2013): Here's information on the latest state-by-state breakdown of health insurance premiums and deductibles. And here's information on the rate filings we're getting for 2014.
Here's the original post:
The Commonwealth Fund has put together an interesting state-by-state breakdown of private-employer health insurance premiums and deductibles over the past 6 years.
The upshot: premiums for businesses and their employees rose 41 percent, while per-person deductibles jumped 77 percent. (Continue those trends out to 2020, and an average premium for family coverage will be more than $23,000.) The report also looks at the potential for federal health reform to reduce that cost growth.
This chart shows employer premiums as a percentage of median household income for people under age 65:
In Washington state, the cost of premiums rose 38 percent between 2003 and 2009, with family coverage costing an average of $12,758 here last year.
How's that compare to everyone else? About in the middle. In a list of the 50 states plus Washington, D.C., from highest family premiums to lowest, we come in 28th. (The U.S. average premium for family coverage: $13,027.) Arkansas ($10,969) came in with the lowest rates; Massachusetts ($14,723) with the highest. Oregon's ($12,783) are slightly higher than Washington's.
Here's the original post:
The Commonwealth Fund has put together an interesting state-by-state breakdown of private-employer health insurance premiums and deductibles over the past 6 years.
The upshot: premiums for businesses and their employees rose 41 percent, while per-person deductibles jumped 77 percent. (Continue those trends out to 2020, and an average premium for family coverage will be more than $23,000.) The report also looks at the potential for federal health reform to reduce that cost growth.
This chart shows employer premiums as a percentage of median household income for people under age 65:
In Washington state, the cost of premiums rose 38 percent between 2003 and 2009, with family coverage costing an average of $12,758 here last year.
How's that compare to everyone else? About in the middle. In a list of the 50 states plus Washington, D.C., from highest family premiums to lowest, we come in 28th. (The U.S. average premium for family coverage: $13,027.) Arkansas ($10,969) came in with the lowest rates; Massachusetts ($14,723) with the highest. Oregon's ($12,783) are slightly higher than Washington's.
WA insurance commissioner rejects new Regence rate increase
From a news release our office issued this morning:
After several requests for additional information, Insurance Commissioner Mike Kreidler has formally rejected requests to change the rates of individual health plans offered by Regence BlueShield, Regence BlueShield of Oregon and Asuris NW Health (Regence).
The proposed rates were scheduled to take effect Jan. 1, 2011. Regence has the right to appeal the decision.
Regence BlueShield and Asuris requested 3.7 percent and Regence BlueShield of Oregon requested 4.9 percent.
“I’m disappointed and frustrated that I’ve had to take this step, but Regence’s policyholders are my top priority, said Kreidler. “They’re counting on me to review the rates and make sure they’re justified. Regence failed to make its case.”
See the link above for more information, including links to Regence's rates.
After several requests for additional information, Insurance Commissioner Mike Kreidler has formally rejected requests to change the rates of individual health plans offered by Regence BlueShield, Regence BlueShield of Oregon and Asuris NW Health (Regence).
The proposed rates were scheduled to take effect Jan. 1, 2011. Regence has the right to appeal the decision.
Regence BlueShield and Asuris requested 3.7 percent and Regence BlueShield of Oregon requested 4.9 percent.
“I’m disappointed and frustrated that I’ve had to take this step, but Regence’s policyholders are my top priority, said Kreidler. “They’re counting on me to review the rates and make sure they’re justified. Regence failed to make its case.”
See the link above for more information, including links to Regence's rates.
Our North American Dealer Co-Op order -- and what it means if you're a customer
In October, many consumers across Washington received notices from the North American Dealer Co-op (NADC). Our office ordered NADC to send out those notices.
Here’s the background: Washington car dealers would sell people vehicle service contracts, offering a money back guarantee as an incentive to buy them. If you didn’t use the vehicle service contract after a certain period of time and met other conditions, you were promised your money back.
NADC, in essence, insured that money-back guarantee. (The service contracts themselves are a separate product, and are NOT affected by our order. More on that below.) In 2007, Insurance Commissioner Mike Kreidler told the company that they were acting as an unauthorized insurer in Washington state. The company disputed that; a hearing was held and the commissioner’s decision was upheld.
In October 2010, Thurston County Superior Court Judge Thomas McPhee affirmed the order, which requires NADC to do the following things:
-Stop offering the program to any Washington auto dealers.
-Send a copy of the order to all member dealers.
-Send a copy to all Washington consumers who’d bought an NADC auto dealer extended service contract reimbursement guarantee.
-Tell consumers that should they file a valid claim against that guarantee when their extended service contract expires, it will be honored.
Here’s the critical thing to know: The underlying vehicle service contract should still be in effect. Those service contracts are a different product, covering repairs to the car. Those contracts are not affected by this order.
Our order does, however, require NADC to honor all valid money-back guarantee claims made for unused service contracts under NADC’s money-back guarantee offer.
If you’re a Washingtonian and have questions or concerns that NADC’s improperly denying your money-back claim, contact us at 1-800-562-6900.
Consumers can also contact:
North American Dealer Co-Op
1-800-637-2277
ATTN: Claims Department
1661 Wadsworth Blvd.
Lakewood, CO 80214
Here’s the background: Washington car dealers would sell people vehicle service contracts, offering a money back guarantee as an incentive to buy them. If you didn’t use the vehicle service contract after a certain period of time and met other conditions, you were promised your money back.
NADC, in essence, insured that money-back guarantee. (The service contracts themselves are a separate product, and are NOT affected by our order. More on that below.) In 2007, Insurance Commissioner Mike Kreidler told the company that they were acting as an unauthorized insurer in Washington state. The company disputed that; a hearing was held and the commissioner’s decision was upheld.
In October 2010, Thurston County Superior Court Judge Thomas McPhee affirmed the order, which requires NADC to do the following things:
-Stop offering the program to any Washington auto dealers.
-Send a copy of the order to all member dealers.
-Send a copy to all Washington consumers who’d bought an NADC auto dealer extended service contract reimbursement guarantee.
-Tell consumers that should they file a valid claim against that guarantee when their extended service contract expires, it will be honored.
Here’s the critical thing to know: The underlying vehicle service contract should still be in effect. Those service contracts are a different product, covering repairs to the car. Those contracts are not affected by this order.
Our order does, however, require NADC to honor all valid money-back guarantee claims made for unused service contracts under NADC’s money-back guarantee offer.
If you’re a Washingtonian and have questions or concerns that NADC’s improperly denying your money-back claim, contact us at 1-800-562-6900.
Consumers can also contact:
North American Dealer Co-Op
1-800-637-2277
ATTN: Claims Department
1661 Wadsworth Blvd.
Lakewood, CO 80214
Monday, December 6, 2010
Tacoma woman pleads guilty to first-degree theft charges in insurance scam
A Tacoma woman whom repeatedly claimed to have slipped and fallen in grocery stores has pleaded guilty to first-degree theft.
Brenda J. Johnson, 50, claimed to have fallen in two different stores within about 15 minutes. She said she was near a check stand at a Tacoma Safeway store on Sept. 18, 2009 when she slipped on some liquid and fell, injuring her wrist and ribs.
On the same day at about noon, she said, the same thing happened to her in the frozen food aisle of a Tacoma Fred Meyer store. She filed claims with both stores, showing medical care and prescription drug receipts totalling more than $5,500.
A subsequent investigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit found that she had submitted virtually identical medical receipts to each store, including an emergency room report missing some pages. Documents obtained through a search warrant indicated that the treatment was unrelated to a fall at either store.
The investigation also found that Johnson had filed at least five auto-accident medical claims and at least half a dozen slip-and-fall injury claims.
On Nov. 22, Johnson pleaded guilty in Pierce County Superior Court to: $6,017 in restitution, 40 hours community service, and $1,000 in court fees and costs.
Brenda J. Johnson, 50, claimed to have fallen in two different stores within about 15 minutes. She said she was near a check stand at a Tacoma Safeway store on Sept. 18, 2009 when she slipped on some liquid and fell, injuring her wrist and ribs.
On the same day at about noon, she said, the same thing happened to her in the frozen food aisle of a Tacoma Fred Meyer store. She filed claims with both stores, showing medical care and prescription drug receipts totalling more than $5,500.
A subsequent investigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit found that she had submitted virtually identical medical receipts to each store, including an emergency room report missing some pages. Documents obtained through a search warrant indicated that the treatment was unrelated to a fall at either store.
The investigation also found that Johnson had filed at least five auto-accident medical claims and at least half a dozen slip-and-fall injury claims.
On Nov. 22, Johnson pleaded guilty in Pierce County Superior Court to: $6,017 in restitution, 40 hours community service, and $1,000 in court fees and costs.
Thursday, December 2, 2010
Give us your opinion on our website...
We're looking for feedback on our official website, http://www.insurance.wa.gov/. We're trying to make the site easier to understand and easier to use.
If you can spare a couple of minutes to give us your input, we'd much appreciate it. Just click on the link above and look for the "feedback" tab on the left. It's orange, and hard to miss.
Tuesday, November 30, 2010
Self-employed and looking for a small group health plan?
We've heard from a lot of self-employed or sole-proprietors who want to take advantage of the new group of one law but are having trouble finding a health plan.
(The new law took effect in Oct. and allows qualified self-employed people buy health insurance in the less expensive small group market.)
We think we have something that can help: We've added a direct link to the federal government's Healthcare.gov site. Just type in your zipcode and you'll get a list of health plans available in your county. Of course you can also contact an agent or broker directly, but this gives you another option. Here's the link to information we've posted on our site.
If you want to bypass our website and go straight to the place that let's you enter your zipcode - here you go
(The new law took effect in Oct. and allows qualified self-employed people buy health insurance in the less expensive small group market.)
We think we have something that can help: We've added a direct link to the federal government's Healthcare.gov site. Just type in your zipcode and you'll get a list of health plans available in your county. Of course you can also contact an agent or broker directly, but this gives you another option. Here's the link to information we've posted on our site.
If you want to bypass our website and go straight to the place that let's you enter your zipcode - here you go
Monday, November 29, 2010
Kreidler proposes health insurance rate reforms
News release issued by Washington State Insurance Commissioner today:
Insurance Commissioner Mike Kreidler is asking state lawmakers to preserve his authority to scrutinize health insurance rates, boost transparency, and to let him—for the first time—consider some insurers’ surpluses when reviewing rates.
“Some non-profit insurers have built up hundreds of millions of dollars in surpluses in recent years, while still seeking double-digit rate hikes,” said Kreidler. “I want the law changed so we can take a closer look at that, while still maintaining a vital insurance market.”
Under current law, surpluses—including investment income—cannot be taken into account when considering a company’s rate request.
Kreidler also will seek more transparency, so consumers can have a full picture on rate proposals by insurers. Today, most information included in a rate filing is not releasable to the public.
“Tens of thousands of Washingtonians who have to buy insurance on their own struggle to find and keep coverage,” said Kreidler. “We can help protect them by continuing to review rate hikes carefully. They also deserve to see how much of their insurance premium is spent on direct medical care versus administrative overhead and profit.”
Rate review: Kreidler gained the authority to review rates in the individual market in 2008, but it’s scheduled to expire after 2011. He’s proposing legislation to do away with that deadline.
Surpluses: The surplus proposal would only apply to non-profit health insurers, which account for most of the health insurance market in Washington. Also:
• Once a company amasses a surplus equal to 3 months of claims expenses, rate hikes would not be approved.
• The insurance commissioner could grant exceptions, however, if limiting the surplus or rates would pose a threat to the financial health of an insurer.
Transparency: The legislation would allow the public to see:
• What percentage of a specific rate request goes to profit, medical costs and administrative costs.
• How much, overall, a health carrier collected in premiums, how much money it made, and how much it paid out in direct medical claims.
• The medical trends the health carrier is using to project future rates.
“It’s simple: We need oversight of the health insurance industry,” said Kreidler. “And families deserve to see where their money’s going and how their rates are set.”
Insurance Commissioner Mike Kreidler is asking state lawmakers to preserve his authority to scrutinize health insurance rates, boost transparency, and to let him—for the first time—consider some insurers’ surpluses when reviewing rates.
“Some non-profit insurers have built up hundreds of millions of dollars in surpluses in recent years, while still seeking double-digit rate hikes,” said Kreidler. “I want the law changed so we can take a closer look at that, while still maintaining a vital insurance market.”
Under current law, surpluses—including investment income—cannot be taken into account when considering a company’s rate request.
Kreidler also will seek more transparency, so consumers can have a full picture on rate proposals by insurers. Today, most information included in a rate filing is not releasable to the public.
“Tens of thousands of Washingtonians who have to buy insurance on their own struggle to find and keep coverage,” said Kreidler. “We can help protect them by continuing to review rate hikes carefully. They also deserve to see how much of their insurance premium is spent on direct medical care versus administrative overhead and profit.”
Rate review: Kreidler gained the authority to review rates in the individual market in 2008, but it’s scheduled to expire after 2011. He’s proposing legislation to do away with that deadline.
Surpluses: The surplus proposal would only apply to non-profit health insurers, which account for most of the health insurance market in Washington. Also:
• Once a company amasses a surplus equal to 3 months of claims expenses, rate hikes would not be approved.
• The insurance commissioner could grant exceptions, however, if limiting the surplus or rates would pose a threat to the financial health of an insurer.
Transparency: The legislation would allow the public to see:
• What percentage of a specific rate request goes to profit, medical costs and administrative costs.
• How much, overall, a health carrier collected in premiums, how much money it made, and how much it paid out in direct medical claims.
• The medical trends the health carrier is using to project future rates.
“It’s simple: We need oversight of the health insurance industry,” said Kreidler. “And families deserve to see where their money’s going and how their rates are set.”
Tuesday, November 23, 2010
Ice, snow and cars: Filing an insurance claim
First: Unless you signed a contract with an insurance company requiring you to take your car only to a specified shop, you can choose where to take it for repair. But the shop still needs to work with the insurer to come to an agreed-upon price. If not, and they still fix the car, you may be responsible for whatever the insurer doesn't pay.
For more details on "diminished value", non-OEM parts, getting a rental car, etc., please see our "How the auto insurance claims process works" page.
If you're in a wreck and it's more than a fender-bender, you might want to see our "What happens if my car gets totaled?" page. From it:
You have the right to payment of the actual cash value of your auto, and to expect a prompt and fair settlement. Don’t be surprised if your “value amount” and the insurer’s “value amount” do not match. Be ready to negotiate with the insurer when this happens.
The page has a lot more information on how insurers establish the cash value of the totaled vehicle, what happens if you can't find a comparable vehicle, and -- we get this question a lot -- what happens if you want to keep your damaged car.
If you have questions or problems with an insurer -- we're the state agency that regulates the insurance industry in Washington state -- give us a call at 1-800-562-6900 or e-mail us at AskMike@oic.wa.gov.
Friday, November 19, 2010
Issaquah woman sentenced to $300,000 in restitution in insurance fraud case
A King County Superior Court judge today ordered Issaquah's Linda Ann Rose, 67, to pay and forfeit a total of $300,000 in restitution to insurance companies for fraudulent injury claims after a minor accident in a parking lot.
On Nov. 13, 2004, Rose was involved in a parking lot collision in Issaquah. An SUV backed out of a parking stall and struck Rose's rented Ford Mustang. Photos of both vehicles show minimal damage, but Rose claimed that she suffered severe back injuries as a result of the collision.
In 2007, her attorney demanded $656,874 from the SUV owner's insurer, and subsequently filed a personal injury lawsuit in the case.
Investigators from the Washington Insurance Commissioner Mike Kreidler's Special Investigations Unit subsequently concluded that Rose knowingly provided altered medical records to her attorney, and that she had had an injured back "well before" the accident.
Rose entered a modified guilty plea to 3 felony counts of using false claims or proof in an insurance claim.
She was ordered to pay $250,000 to Progressive, $25,000 to Metlife, and to forfeit another $25,000 in a structured settlement from Metlife that had not yet been paid.
On Nov. 13, 2004, Rose was involved in a parking lot collision in Issaquah. An SUV backed out of a parking stall and struck Rose's rented Ford Mustang. Photos of both vehicles show minimal damage, but Rose claimed that she suffered severe back injuries as a result of the collision.
In 2007, her attorney demanded $656,874 from the SUV owner's insurer, and subsequently filed a personal injury lawsuit in the case.
Investigators from the Washington Insurance Commissioner Mike Kreidler's Special Investigations Unit subsequently concluded that Rose knowingly provided altered medical records to her attorney, and that she had had an injured back "well before" the accident.
Rose entered a modified guilty plea to 3 felony counts of using false claims or proof in an insurance claim.
She was ordered to pay $250,000 to Progressive, $25,000 to Metlife, and to forfeit another $25,000 in a structured settlement from Metlife that had not yet been paid.
Thursday, November 18, 2010
Flood coverage: Where to find it -- and what if you can't?
November in the Pacific Northwest generally means rain, and lots of it. (See also December, February, March, April and sometimes May.)
As the rivers swell, we tend to get nervous queries from consumers and businesses about flood insurance. Here are the basics, as well as some special information for businesses in Washington state's Green River Valley.
Does a standard homeowners' insurance cover flooding? No. Many people think it does. It does not.
Where do I get flood coverage? For most consumers and many businesses, the first stop is the National Flood Insurance Program, a federally run program that's been around for decades. But the business coverage maxes out at $500,000 per building and $500,000 for contents, so businesses may need extra coverage as well.
What's it cost? The average federal flood insurance policy costs less than $570 per year.
Am I in a flood zone? Here's a page to search flood maps. You can also get a quick risk estimate by typing your address into the feds' "one-step flood risk profile."
I heard that the federal flood insurance program was suspended. It was, but isn't anymore. The program lapsed several times this year, but Congress in late September reauthorized the program for another year.
Who sells it? Although it's a federally run program, it's sold by many insurance agents. To find a local one who sells it, see the program's agent locator.
And here's the special information for businesses in Washington's Green River Valley, which is in south King County. Last year, businesses in the area reported problems finding additional coverage. To help, we set up a "market assistance plan" that acts as a matchmaker between businesses and insurers. If you live in that area and can't find coverage for your business, the odds are good that the market assistance plan can help you.
For more, please see our flood information page.
As the rivers swell, we tend to get nervous queries from consumers and businesses about flood insurance. Here are the basics, as well as some special information for businesses in Washington state's Green River Valley.
Does a standard homeowners' insurance cover flooding? No. Many people think it does. It does not.
Where do I get flood coverage? For most consumers and many businesses, the first stop is the National Flood Insurance Program, a federally run program that's been around for decades. But the business coverage maxes out at $500,000 per building and $500,000 for contents, so businesses may need extra coverage as well.
What's it cost? The average federal flood insurance policy costs less than $570 per year.
Am I in a flood zone? Here's a page to search flood maps. You can also get a quick risk estimate by typing your address into the feds' "one-step flood risk profile."
I heard that the federal flood insurance program was suspended. It was, but isn't anymore. The program lapsed several times this year, but Congress in late September reauthorized the program for another year.
Who sells it? Although it's a federally run program, it's sold by many insurance agents. To find a local one who sells it, see the program's agent locator.
And here's the special information for businesses in Washington's Green River Valley, which is in south King County. Last year, businesses in the area reported problems finding additional coverage. To help, we set up a "market assistance plan" that acts as a matchmaker between businesses and insurers. If you live in that area and can't find coverage for your business, the odds are good that the market assistance plan can help you.
For more, please see our flood information page.
More from our case files...
Having trouble with an insurance company, agent or broker? Give us a call; we can often help. We're the government agency that regulates the insurance industry in Washington state. (If you don't live in Washington, here's an easy map with contact info for our counterparts in your own state.)
In Washington state, we're at 1-800-562-6900 or AskMike@oic.wa.gov. You can now also file a complaint easily online.
Here's a sampling of the sorts of things we help with virtually every day:
In Washington state, we're at 1-800-562-6900 or AskMike@oic.wa.gov. You can now also file a complaint easily online.
Here's a sampling of the sorts of things we help with virtually every day:
- A woman contacted us on behalf of her 75-year-old mother, who had forgotten to pay her long-term care insurance premium due to health issues. The company had cancelled the policy for non-payment. After multiple attempts to have the policy reinstated, the daughter sought our help. The policy was reinstated.
- A company that had sold an illegal discount health plan here agreed to pay a consumer $3,825.
- A widow whose annuity request had been delayed complained to us. We contacted the company, which honored the request, sending her a check for more than $250,000.
Wednesday, November 17, 2010
Job openings
We have a couple of job openings:
We're looking for an administrative assistant 4 for a limited-duration position funded by federal grant dollars related to health care reform. This person will perform "a wide range of complex administrative duties related to planning and implementation of organizational change, grant management and program support functions." The job duties include compiling statistical information and preparing written reports for executive managers and the grant funding agency. The position is funded by federal grants through November 2011.
Here's the link to the job posting, but if you want to apply, please do it quickly. Applications are due by 4:59 p.m. this Friday.
We're also looking for a financial examiner 2 to work in our Seattle office. This person will plan and conduct financial examinations of insurance companies and other regulated entities. From the job listing:
We're a small state agency -- we have a total of about 200 workers between our Tumwater, Olympia, Seattle and Spokane offices -- that regulates the insurance industry in Washington state. We have a pretty broad consumer-protection mission. We:
We're looking for an administrative assistant 4 for a limited-duration position funded by federal grant dollars related to health care reform. This person will perform "a wide range of complex administrative duties related to planning and implementation of organizational change, grant management and program support functions." The job duties include compiling statistical information and preparing written reports for executive managers and the grant funding agency. The position is funded by federal grants through November 2011.
Here's the link to the job posting, but if you want to apply, please do it quickly. Applications are due by 4:59 p.m. this Friday.
We're also looking for a financial examiner 2 to work in our Seattle office. This person will plan and conduct financial examinations of insurance companies and other regulated entities. From the job listing:
This position works with Financial Analysts (certified public accountants, certified financial examiners, and accredited financial examiners), attorneys, and other regulators on a state, national, and international level. This position examines, audits, and verifies specific groups of insurance companies, including bonds and stocks, mortgage loans, real estate, policy loans, premium notes, collateral loans, policy reserves, and capital stock.For qualifications, pay, and application information, please see this job posting. The deadline for applications is 5 p.m. on Dec. 3.
We're a small state agency -- we have a total of about 200 workers between our Tumwater, Olympia, Seattle and Spokane offices -- that regulates the insurance industry in Washington state. We have a pretty broad consumer-protection mission. We:
- monitor insurers' finances to make sure they can make good on their promises to policyholders.
- license tens of thousands of agents and brokers, and investigates complaints about them.
- scrutinize rate hike requests and makes sure that policies comply with the law.
- go after scams, both from unlicensed insurance companies and by people trying to defraud insurers.
How Washingtonians can file an insurance complaint online
We've launched a new "online consumer complaint center" this week, and we think we're the first state insurance department in the country to offer this kind of service.
The system lets Washington state consumers file complaints against insurers using a new interactive and password-protected web tool.
The idea is to make it more convenient and efficient for consumers to file a complaint with our office. We help with thousands of complaints, but until now, the process has relied on people mailing documents back and forth. We think this will be faster and easier.
What sorts of complaints? They often involve what insurers are covering -- or not covering . We often get calls from drivers whose cars are totalled, and who are unhappy about the payment offered for their vehicle. We try to help with complaints about delayed payments, policies being canceled, getting companies to reopen a claim or negotiate on payment, etc.
At our site, Washington state residents can file a secure complaint online, track its status 24/7, upload documents/photos/etc. related to the case, add comments, and view, print and save information about the case.
Not a Washington state resident? Here's a map with contact info for your own state's insurance department.
Request for proposals re: insurance rate review
We're looking for proposals from firms interesting in participating in a project to improve our review of health insurance rates and to increase public transparency for how health insurance premiums are determined.
Interested in bidding? The full request for proposals document is here.
The estimated time period for the contract is Feb. 16, 2011 to Sept. 30, 2011. We reserve the right to extend it for up to three one-year periods; see the RFP for details. It includs the scope of work, evaluation procedures, minimum qualifications, etc.
All proposals are due no later than 5 p.m. PST on Dec. 27, 2010.
For additional details, see also our general RFP page, and see this news release, which contains more information about the federal grant that's helping pay for the project.
Interested in bidding? The full request for proposals document is here.
The estimated time period for the contract is Feb. 16, 2011 to Sept. 30, 2011. We reserve the right to extend it for up to three one-year periods; see the RFP for details. It includs the scope of work, evaluation procedures, minimum qualifications, etc.
All proposals are due no later than 5 p.m. PST on Dec. 27, 2010.
For additional details, see also our general RFP page, and see this news release, which contains more information about the federal grant that's helping pay for the project.
Tuesday, November 16, 2010
High winds and storm damage -- what insurance covers and what it doesn't
Every time this happens, our office gets calls from people wanting to know what damage their homeowners/auto/business insurance covers. (We're the Washington state agency that regulates insurance.)
Here are a few common questions:
Am I covered if my car was damaged by falling limbs? If your car was damaged, that damage should be covered under the comprehensive coverage in your auto insurance policy. (If you opted for comprehensive coverage, that is. Some people, to save money, just get liability coverage.)
My yard is covered with branches from the storm. None of them hit the house or my fence, so there's no property damage. But would the cleanup costs be covered in this case? Sorry, probably not. Standard homeowner's policies typically only pay for such cleanup if your property was actually damaged. In other words, your home, garage, fence, etc. would probably have to first be damaged by the debris for the insurer to pay to remove it. Standard policies don't cover the loss of trees or shrubs because of wind.
My business has an awning over the sidewalk, and it's been damaged by the wind. Is it covered? Probably, but check with your agent or insurer to be sure, since business insurance can vary a lot. Also, many business policies have business interruption coverage, which can be very useful if a covered loss forces you to close the business. But there are often deductibles or other limits, so they may not apply if the business interruption is for just a few days.
Click here for our page with tips and storm-related Q&As re: insurance.
If you have damage and have questions or problems with your insurer (and live in Washington state), call our consumer affairs hotline at 1-800-562-6900. It's not a phone tree; it's staffed by live people.
Look for some more wind gusts tomorrow. Weather Underground is predicting a south wind 15-25 mph in Seattle and Olympia, and a lighter 10-15 mph in Tacoma.
If you've lost power, here are Puget Sound Energy's updates on progress restoring power, including a handy map of outages and progress.
And if you want the state version of a worst-case scenario survival guide, here's the link (it's a 5-meg pdf, sorry about that) to the Emergency Management Department's "Emergency Resources Guide." It tells you what to do in case of a pandemic, a terrorist bomb, biological weapons attack, or if you're trapped in debris (tap on a pipe). It's got questions to ask someone making a bomb threat, and what to avoid eating after a radioactive "dirty bomb" goes off, etc. etc. etc.
From our case files...
A sampling of recent cases our consumer advocacy staff has handled in the past few days (We get many consumer calls a day; these are very typical of the sorts of cases we deal with):
- A driver got into an accident with a business' truck in Seattle. The truck backed into his car. Yet the business' insurer initially offered to pay for only 70 percent of the nearly $2,400 in damage. The man complained to us. We contacted the insurer, which reviewed the case -- including photos provided by the car's owner -- and agreed to pay for all the damage.
- A Vancouver woman whose insurer wanted to cancel her policy due to a deteriorating roof asked for our help. We helped her get the company to renew the policy and keep her covered.
- An Issaquah man wanted to remove his daughter, who is a college student in another country, from his auto policy. The company refused. We asked them to review the decision. He got a $563 discount as a result.
Friday, November 12, 2010
One wrong denial for contraception coverage leads to company reprocessing nearly 1,000 other claims -- and paying $148,000
One consumer's call to our Insurance Consumer Hotline meant good news for nearly a 1,000 additional insurance consumers. A woman sought our help when coverage for her prescription contraceptive was denied by her insurance company. It turned out that the insurer had been violating a rule Insurance Commissioner Mike Kreidler enacted back in 2001. It had to pay her claim and reprocess 984 claims of other enrollees previously denied, making payments totaling more than $148,000.
From Jan. 1, 2002 to May 25, 2010, the insurer had repeatedly denied payment, under a variety of different codes. Among them: "Condition not covered by this contract", "This service for this condition is not covered by your plan", and "Medical necessity for this service or supply has not been established." The contraceptives in question were IUDs, and the requested coverage was payment for removal of the devices.
Of the 985 claims, only 3 women appealed the decision -- and all the denials were upheld.
But one of those women decided to contact our office. And that led to getting those years' worth of claims, for hundreds of women, paid.
Here's the rule: In Washington, all state regulated health plans that have comprehensive prescription drug coverage must cover prescription contraceptives. Want to know more? Here's a page describing your rights under this state law.
If you've got an insurance question or problem and you live in Washington, don't be afraid to call us for free help. We're at 1-800-562-6900 or AskMike@oic.wa.gov.
Note: Post updated to reflect what kind of contraceptive and service was involved.
From Jan. 1, 2002 to May 25, 2010, the insurer had repeatedly denied payment, under a variety of different codes. Among them: "Condition not covered by this contract", "This service for this condition is not covered by your plan", and "Medical necessity for this service or supply has not been established." The contraceptives in question were IUDs, and the requested coverage was payment for removal of the devices.
Of the 985 claims, only 3 women appealed the decision -- and all the denials were upheld.
But one of those women decided to contact our office. And that led to getting those years' worth of claims, for hundreds of women, paid.
Here's the rule: In Washington, all state regulated health plans that have comprehensive prescription drug coverage must cover prescription contraceptives. Want to know more? Here's a page describing your rights under this state law.
If you've got an insurance question or problem and you live in Washington, don't be afraid to call us for free help. We're at 1-800-562-6900 or AskMike@oic.wa.gov.
Note: Post updated to reflect what kind of contraceptive and service was involved.
Wednesday, November 10, 2010
Update on Chubb fine and suspension: Suspension is stayed pending hearing
On Monday, we called for a $534,000 fine for Chubb & Son and a 9 month suspension of six of its subsidiaries (which would mean that they couldn't write new business; existing policies would remain in force, and renewals could still be done). The companies' attorneys yesterday demanded an adminstrative hearing on both matters. So the suspension, which was slated to take effect Nov. 18, is stayed for now.
In response to some media queries, here's a list of recent enforcement actions we've taken against these companies. All include the same sort of violations -- improper documentation of decisions about rates -- that led to these latest two orders. (All our disciplinary orders, including those for insurers, insurance agents, brokers, etc., are posted online here.)
2000: $67,000 fine for multiple violations, including failure to provide proper documentation for why credits and debits were applied to certain policies. The fine was actually $135,250, but about half ($67,625) was suspended so long as a compliance plan was followed to fix the problems.
2003: The balance of that fine -- $67,625 -- was imposed, after numerous violations continued, despite the compliance plan. From the 2003 order: "The company’s pattern of a continued high rate of filing and other violations are indicative of a systemic problem."
2007: We imposed a $250,000 fine for ongoing violations. Chubb & Son agreed to fully comply with a compliance plan, including multiple self audits, to fix the problems.
2010: We call for a $534,000 fine, based on hundreds of violations. The companies call for a hearing.
2010: Commissioner Kreidler orders a 9-month suspension of six Chubb subsidiaries' ability to sell new coverage. The companies call for a hearing.
Update: The case ended with a consent order that included a significant fine but no suspension. We posted the details here.
In response to some media queries, here's a list of recent enforcement actions we've taken against these companies. All include the same sort of violations -- improper documentation of decisions about rates -- that led to these latest two orders. (All our disciplinary orders, including those for insurers, insurance agents, brokers, etc., are posted online here.)
2000: $67,000 fine for multiple violations, including failure to provide proper documentation for why credits and debits were applied to certain policies. The fine was actually $135,250, but about half ($67,625) was suspended so long as a compliance plan was followed to fix the problems.
2003: The balance of that fine -- $67,625 -- was imposed, after numerous violations continued, despite the compliance plan. From the 2003 order: "The company’s pattern of a continued high rate of filing and other violations are indicative of a systemic problem."
2007: We imposed a $250,000 fine for ongoing violations. Chubb & Son agreed to fully comply with a compliance plan, including multiple self audits, to fix the problems.
2010: We call for a $534,000 fine, based on hundreds of violations. The companies call for a hearing.
2010: Commissioner Kreidler orders a 9-month suspension of six Chubb subsidiaries' ability to sell new coverage. The companies call for a hearing.
Update: The case ended with a consent order that included a significant fine but no suspension. We posted the details here.
Tuesday, November 9, 2010
Job openings
Due primarily to some federal health care reform grants (and one employee who left for a sunnier climate, think of that), the Washington state insurance commissioner's office has a few job openings. Most are limited-duration posititions based on grant money.
Here they are. Click on the position for details about requirements, salary, duties, application process, etc.
Functional Program Analyst 4: Deadline for applying is Nov. 12. These staff advocate on behalf of consumers to ensure that they're being fairly treated by their insurance carriers and by helping educate consumers about insurance. This person will help develop and test online tools to help consumers. This is a project position funded by federal grant dollars, and the grant period runs from Oct. 15, 2010 to Oct. 15, 2011.
Investigator 3: We're looking for a senior investigator to investigate suspected violations of state insurance law. From the job announcement: The Investigator 3 position is an advanced investigative position responsible for conducting complex investigations from the initial discovery of suspected violations, through the prosecution of those involved in illegal activity. Deadline for applying for this job is Nov. 16.
Communications Consultant 4: This is another project job, funded by a federal grant that runs from Oct. 15, 2010 to Oct. 15, 2011. This person will work with our Consumer Protection division to develop and manage communications strategies for consumer assistance and education. Deadline for applying is Nov. 19.
Management Analyst 5: Another project job, with the same grant timeline as those listed above. This would be a project manager position, leading a diverse project team. See the link for much more information on technical details, duties, etc. Deadline for applying: Nov. 19.
Here they are. Click on the position for details about requirements, salary, duties, application process, etc.
Functional Program Analyst 4: Deadline for applying is Nov. 12. These staff advocate on behalf of consumers to ensure that they're being fairly treated by their insurance carriers and by helping educate consumers about insurance. This person will help develop and test online tools to help consumers. This is a project position funded by federal grant dollars, and the grant period runs from Oct. 15, 2010 to Oct. 15, 2011.
Investigator 3: We're looking for a senior investigator to investigate suspected violations of state insurance law. From the job announcement: The Investigator 3 position is an advanced investigative position responsible for conducting complex investigations from the initial discovery of suspected violations, through the prosecution of those involved in illegal activity. Deadline for applying for this job is Nov. 16.
Communications Consultant 4: This is another project job, funded by a federal grant that runs from Oct. 15, 2010 to Oct. 15, 2011. This person will work with our Consumer Protection division to develop and manage communications strategies for consumer assistance and education. Deadline for applying is Nov. 19.
Management Analyst 5: Another project job, with the same grant timeline as those listed above. This would be a project manager position, leading a diverse project team. See the link for much more information on technical details, duties, etc. Deadline for applying: Nov. 19.
Monday, November 8, 2010
Kreidler calls for $534k fine against insurer, issues order to suspend six subsidiaries from writing new coverage for 9 months
Washington State Insurance Commissioner Mike Kreidler on Monday issued an order that would suspend the insurance certificates of six companies, effective Nov. 18. The move – which does not affect existing policies or renewals – would bar the companies from writing new coverage for 9 months.
Kreidler is also proposing a $534,000 fine, contingent on a hearing, against the parent company, Chubb & Son.
The suspension order includes Federal Insurance Company, Pacific Indemnity Company, Great Northern Insurance Company, Executive Risk Indemnity, Inc., Vigilant Insurance Company, and Northwestern Pacific Indemnity Company. All are property and casualty insurers. All are wholly owned subsidiaries of Chubb & Son. The policies affected are all commercial policies.
“It’s highly unusual for us to suspend a company’s certificate to sell insurance. But we’ve repeatedly tried to work with Chubb and its subsidiaries to fix a number of ongoing violations of state law,” Kreidler said in a press release. “Some of the problems that triggered this decision have been recurring for a decade.”
A key issue is Chubb’s repeated failure since 1998 to properly document the reasons for charging higher or lower rates on certain policies.
Repeated examinations and a series of company self-audits ordered by Kreidler since 2007 found hundreds of violations of state law, including numerous recent ones. In some cases, more than half the sample files checked had violations. The $534,000 fine amount was based on 534 violations of state insurance law, at $1,000 per violation.
Chubb can appeal the suspension. The suspension order does not affect the companies’ obligation to honor policies issued prior to the effective date of the suspension. Nor does it affect their authority to renew existing policies. But it would prohibit them from selling new policies during the nine-month period of the suspension.
Note: We'll add a link to the press release shortly. Done. And we added a link up above to the hearing notice re: the fine.
Update: Chubb has demanded a hearing on both the fine and the suspension. See our post re: that here.
Another update: In the end, Chubb's subsidiaries were fined, but there was no suspension. See here for details of the order.
Kreidler is also proposing a $534,000 fine, contingent on a hearing, against the parent company, Chubb & Son.
The suspension order includes Federal Insurance Company, Pacific Indemnity Company, Great Northern Insurance Company, Executive Risk Indemnity, Inc., Vigilant Insurance Company, and Northwestern Pacific Indemnity Company. All are property and casualty insurers. All are wholly owned subsidiaries of Chubb & Son. The policies affected are all commercial policies.
“It’s highly unusual for us to suspend a company’s certificate to sell insurance. But we’ve repeatedly tried to work with Chubb and its subsidiaries to fix a number of ongoing violations of state law,” Kreidler said in a press release. “Some of the problems that triggered this decision have been recurring for a decade.”
A key issue is Chubb’s repeated failure since 1998 to properly document the reasons for charging higher or lower rates on certain policies.
Repeated examinations and a series of company self-audits ordered by Kreidler since 2007 found hundreds of violations of state law, including numerous recent ones. In some cases, more than half the sample files checked had violations. The $534,000 fine amount was based on 534 violations of state insurance law, at $1,000 per violation.
Chubb can appeal the suspension. The suspension order does not affect the companies’ obligation to honor policies issued prior to the effective date of the suspension. Nor does it affect their authority to renew existing policies. But it would prohibit them from selling new policies during the nine-month period of the suspension.
Update: Chubb has demanded a hearing on both the fine and the suspension. See our post re: that here.
Another update: In the end, Chubb's subsidiaries were fined, but there was no suspension. See here for details of the order.
New health plans for small businesses
Small businesses in Washington state looking for health insurance for their employees should check out the new federally-funded Health Insurance Partnership (HIP). This is a new program administered by the state's Health Care Authority that provides small employers access to the same health insurance coverage available in the commercial market, but at significant savings.
The health plans available through the partnership include:
Kaiser Foundation Health Plan of the Northwest, Group Health Cooperative, Regence BlueShield, and Asuris Northwest Health and vary based on annual deductibles ($500-$5,000), co-pays, co-insurance, and prescription drug coverages.
Small employers (up to 50 employees) who don't currently offer health insurance qualify for the program if at least 50 percent of their employees are considered low-wage (their monthly wage doesn't exceed 200 percent of the Federal Poverty Level).
Also, premium subsidies of up to 90 percent are available to employees who qualify based on their family income. Get the details here.
The health plans available through the partnership include:
Kaiser Foundation Health Plan of the Northwest, Group Health Cooperative, Regence BlueShield, and Asuris Northwest Health and vary based on annual deductibles ($500-$5,000), co-pays, co-insurance, and prescription drug coverages.
Small employers (up to 50 employees) who don't currently offer health insurance qualify for the program if at least 50 percent of their employees are considered low-wage (their monthly wage doesn't exceed 200 percent of the Federal Poverty Level).
Also, premium subsidies of up to 90 percent are available to employees who qualify based on their family income. Get the details here.
Friday, November 5, 2010
Issaquah woman pleads to 3 felony charges in insurance fraud case
An Issaquah woman has entered a modified guilty plea to 3 felony counts of using false claims or proof in an insurance claim.
Linda Ann Rose, 67, is scheduled for sentencing in King Couny Superior Court November 19th.
On Nov. 13, 2004, Rose was involved in a parking lot collision. An SUV backed out of a parking stall and struck Rose's rented Ford Mustang. Photos of both vehicles show minimal damage, but Rose claimed that she suffered severe back injuries as a result of the collision. In 2007, her attorney demanded $656,874 from the SUV owner's insurer, and subsequently filed a personal injury lawsuit in the case.
Investigators from the Washington Insurance Commissioner Mike Kreidler's Special Investigations Unit subsequently concluded that Rose knowingly provided altered medical records to her attorney, and that she had had an injured back "well before" the accident.
Linda Ann Rose, 67, is scheduled for sentencing in King Couny Superior Court November 19th.
On Nov. 13, 2004, Rose was involved in a parking lot collision. An SUV backed out of a parking stall and struck Rose's rented Ford Mustang. Photos of both vehicles show minimal damage, but Rose claimed that she suffered severe back injuries as a result of the collision. In 2007, her attorney demanded $656,874 from the SUV owner's insurer, and subsequently filed a personal injury lawsuit in the case.
Investigators from the Washington Insurance Commissioner Mike Kreidler's Special Investigations Unit subsequently concluded that Rose knowingly provided altered medical records to her attorney, and that she had had an injured back "well before" the accident.
Thursday, November 4, 2010
Kreidler re: health insurance rates: "I share your frustration"
Our office continues to hear from people unhappy with health insurance rate hikes.
These can be particularly severe when you bump up into the next five-year "age band." Health insurance, which varies dramatically by age, is priced in 5-year groups. In other words, turning from 58 to 59 won't increase your rates more than usual, but turning from 59 to 60 will. These increases -- coming on top of annual rate hikes -- can be a very tough burden on folks who find themselves paying more and more for fewer and fewer benefits.
Washington state Insurance Commissioner Mike Kreider has issued an open letter to the state's health insurance consumers. From it:
Here's a link to the full text.
These can be particularly severe when you bump up into the next five-year "age band." Health insurance, which varies dramatically by age, is priced in 5-year groups. In other words, turning from 58 to 59 won't increase your rates more than usual, but turning from 59 to 60 will. These increases -- coming on top of annual rate hikes -- can be a very tough burden on folks who find themselves paying more and more for fewer and fewer benefits.
Washington state Insurance Commissioner Mike Kreider has issued an open letter to the state's health insurance consumers. From it:
Many of you have contacted me about your frustration at the rising costs of your health insurance. You’re tired of seeing your premium and out-of-pocket costs increase, at the same time you lose benefits. I don’t blame you for being mad. I share your frustration and take your concerns very seriously.Kreidler said that his authority remains too limited, and that he'll be asking state lawmakers for more power to protect consumers and new rules to increase transparency, so people can see the details of what actually goes into an insurer's rate request. From the letter:
You deserve to know how your premium dollars are being spent and what's driving the cost increases.The good news is that relief is coming; the bad news is that in many cases it won't be until 2014. That's when major provisions of the new federal health care reform law take effect, including a health insurance "exchange" where it's easy to comparison-shop, subsidies to help make insurance affordable, and rate caps based on a percentage of salary.
Here's a link to the full text.
Wednesday, November 3, 2010
Cease and desist order issued to ShieldStar Home Warranty
Washington state’s insurance commissioner on Tuesday ordered a New Jersey home warranty company to stop selling unauthorized service contracts in Washington.
ShieldStar, doing business as ShieldStar Home Warranty and http://www.shieldstar.com/, has sold at least 21 home warranty service contracts in Washington, according to a cease and desist order posted on Insurance Commissioner Mike Kreidler’s website.
This is the third cease and desist order that Kreidler has issued against a home warranty company in the past several months. (The other cases were unrelated to this one.)
In ShieldStar’s case, the contracts cover parts and labor necessary to fix major appliances and systems in the consumer’s home. But neither the company nor several affiliated individuals named in the report are registered in Washington as a service contract provider.
The company has been ordered to mail a copy of the Kreidler’s cease-and-desist order to all its customers in Washington and to report all premiums charged for Washington policies.
The company has the right to demand a hearing. The order is effective immediately.
Update: (12/8/2010) If you purchased a ShieldStar Home Warranty, we want you to know that the cease and desist order does not prevent the company from fulfilling the terms of your contract. Your current contract with ShieldStar is valid under its usual terms and conditions.
Similarly, the order does not prevent the company from providing a refund when requested by a Washington consumer.
If you have any questions or need any assistance with this or any other insurance-related matter, please feel free to call our consumer protection staff at (800) 562-6900
ShieldStar, doing business as ShieldStar Home Warranty and http://www.shieldstar.com/, has sold at least 21 home warranty service contracts in Washington, according to a cease and desist order posted on Insurance Commissioner Mike Kreidler’s website.
This is the third cease and desist order that Kreidler has issued against a home warranty company in the past several months. (The other cases were unrelated to this one.)
In ShieldStar’s case, the contracts cover parts and labor necessary to fix major appliances and systems in the consumer’s home. But neither the company nor several affiliated individuals named in the report are registered in Washington as a service contract provider.
The company has been ordered to mail a copy of the Kreidler’s cease-and-desist order to all its customers in Washington and to report all premiums charged for Washington policies.
The company has the right to demand a hearing. The order is effective immediately.
Update: (12/8/2010) If you purchased a ShieldStar Home Warranty, we want you to know that the cease and desist order does not prevent the company from fulfilling the terms of your contract. Your current contract with ShieldStar is valid under its usual terms and conditions.
Similarly, the order does not prevent the company from providing a refund when requested by a Washington consumer.
If you have any questions or need any assistance with this or any other insurance-related matter, please feel free to call our consumer protection staff at (800) 562-6900
Monday, October 25, 2010
Statistics from our consumer advocacy hotline...
We received nearly 13,000 calls last month to our free hotline for Washington residents with problems or questions involving insurance. Along the way, we helped consumers recover $776,937 in delayed/denied claims and similar problems.
We have experts in a wide variety of insurance matters, and we can often help resolve difficulties getting claims paid, help you find health coverage, etc.
We're not an insurer, agent or broker. We're the state agency that regulates the insurance industry in Washington state. We tend to get between 11,000 and 15,000 calls a month.
Got a problem or question? Give us a call: 1-800-562-6900 or e-mail us at AskMike@oic.wa.gov.
We have experts in a wide variety of insurance matters, and we can often help resolve difficulties getting claims paid, help you find health coverage, etc.
We're not an insurer, agent or broker. We're the state agency that regulates the insurance industry in Washington state. We tend to get between 11,000 and 15,000 calls a month.
Got a problem or question? Give us a call: 1-800-562-6900 or e-mail us at AskMike@oic.wa.gov.
Friday, October 22, 2010
Storm headed for western WA, rain and high winds Saturday night and Sunday
The National Weather Service has issued a "special weather statement" for much of western Washington late this weekend. From it:
Washington residents with insurance questions or problems can also call our consumer advocacy staff at 1-800-562-6900. We'll try to help.
A potent storm will slam into the region Saturday night and Sunday, resulting in locally heavy rain and strong winds, especially on the coast. Another blast of strong winds impacting a larger part of the area is possible on Monday.If you experience damage and have insurance questions, try our winter weather information, which covers common insurance questions about everything from sinking boats to fallen trees to power outages.
Washington residents with insurance questions or problems can also call our consumer advocacy staff at 1-800-562-6900. We'll try to help.
Thursday, October 21, 2010
Cease and desist order issued against Choice Home Warranty
Washington State Insurance Commissioner Mike Kreidler today issued a cease and desist order against CHW Group, Inc., doing business as Choice Home Warranty and http://www.choicehomewarranty.com/.
The company is believed to have sold at least 92 home warranty service contracts to Washington residents. The contracts cover repair or replacement on major systems and appliances in the person's home, and promise that Choice Home Warrant will pay for repair or replacement of those that fail.
The problem: the company isn't authorized to transact insurance in Washington state. Nor is it registered here as a service contract provider.
Kreidler ordered the company to mail a copy of the order to all Washington home warranty service contract customers. The company must also report to the state how much it's collected in premiums from Washington consumers.
The company has the right to demand a hearing. The order takes effect today.
We'll post a link to the order shortly.
Updated: As promised, here's the link.
The company is believed to have sold at least 92 home warranty service contracts to Washington residents. The contracts cover repair or replacement on major systems and appliances in the person's home, and promise that Choice Home Warrant will pay for repair or replacement of those that fail.
The problem: the company isn't authorized to transact insurance in Washington state. Nor is it registered here as a service contract provider.
Kreidler ordered the company to mail a copy of the order to all Washington home warranty service contract customers. The company must also report to the state how much it's collected in premiums from Washington consumers.
The company has the right to demand a hearing. The order takes effect today.
We'll post a link to the order shortly.
Updated: As promised, here's the link.
Friday, October 15, 2010
Which insurers sell individual insurance plans in Washington?
- Asuris Northwest Health
- Group Health Cooperative
- Group Health Options
- Kaiser Foundation Health Plan of the Northwest
- KPS Health Plans
- Lifewise Health Plan of Washington
- Premera BlueCross Individual Plans
- Regence BlueCross BlueShield of Oregon
- Regence BlueShield
- Time Insurance Company
Kreidler orders Regence to cover children
Washington State Insurance Commissioner Mike Kreidler this morning ordered Regence BlueShield this morning to stop illegally denying insurance to children, effective immediately.
“Regence is in clear violation of state law that prohibits insurers from denying insurance to people on the basis of age,” said Kreidler. “I was shocked and deeply disappointed when Regence announced its decision last week to stop selling insurance to kids.”
The Affordable Care Act requires all health plans to cover kids with pre-existing conditions. However, to accommodate the insurance industry’s concerns that people would only enroll their children when they became sick, the federal government let states create a special open enrollment period.
Kreidler issued an emergency rule creating a special enrollment period from Nov. 1-Dec. 15. During this time, anyone looking for an individual health plan for their families or just their children can enroll their kids without having to take a health screen.
But Regence Blue Shield, the largest health insurer in the individual market, notified Kreidler on Sept. 27 that, effective Oct. 1, it would no longer sell individual health insurance policies to kids.
Here's a link to the full press release.
Update: And here's the response from Regence, which says it was shocked and disappointed by the order. From their press release:
“Regence is in clear violation of state law that prohibits insurers from denying insurance to people on the basis of age,” said Kreidler. “I was shocked and deeply disappointed when Regence announced its decision last week to stop selling insurance to kids.”
The Affordable Care Act requires all health plans to cover kids with pre-existing conditions. However, to accommodate the insurance industry’s concerns that people would only enroll their children when they became sick, the federal government let states create a special open enrollment period.
Kreidler issued an emergency rule creating a special enrollment period from Nov. 1-Dec. 15. During this time, anyone looking for an individual health plan for their families or just their children can enroll their kids without having to take a health screen.
But Regence Blue Shield, the largest health insurer in the individual market, notified Kreidler on Sept. 27 that, effective Oct. 1, it would no longer sell individual health insurance policies to kids.
Here's a link to the full press release.
Update: And here's the response from Regence, which says it was shocked and disappointed by the order. From their press release:
It is important to stress that our eligibility changes do not apply to those insured members covered under small or large group policies. We've been very clear that we will insure kids during open enrollment periods when the child is not the sole subscriber -- and we will do so regardless of health status.
Tacoma woman with history of slip-and-fall claims charged with theft
A Tacoma woman who has repeatedly claimed to have slipped and fallen in grocery stores has been charged with theft and attempted theft after claiming to have fallen in two different stores within about 15 minutes.
Brenda J. Johnson, 50, is scheduled to be arraigned today in Pierce County Superior Court. She has been charged with first-degree theft and first-degree attempted theft.
Johnson said she was near check stand No. 2 at a Tacoma Safeway store on Sept. 18, 2009 at 11:46, buying peaches, when she slipped on some liquid and fell, injuring her wrist and ribs. Neither the cashier nor any other employee could recall any such incident.
On the same day at about noon, Johnson said the same thing happened in the frozen food aisle of a Tacoma Fred Meyer store.
In both cases, she said, she was embarrassed and quickly left. She filed claims with both stores, showing medical care and prescription drug receipts totalling more than $5,500.
A subsequent investigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit indicated that she apparently submitted virtually identical medical receipts to each store, including an 8-page emergency room report that was missing some pages.
Medical records obtained through a search warrant indicated that the treatment was unrelated to a fall at either store. The records also showed that there been no expense to Johnson for the care.
The investigation also revealed that Johnson has filed at least five auto-accident medical claims and at least half a dozen slip-and-fall injury claims.
Brenda J. Johnson, 50, is scheduled to be arraigned today in Pierce County Superior Court. She has been charged with first-degree theft and first-degree attempted theft.
Johnson said she was near check stand No. 2 at a Tacoma Safeway store on Sept. 18, 2009 at 11:46, buying peaches, when she slipped on some liquid and fell, injuring her wrist and ribs. Neither the cashier nor any other employee could recall any such incident.
On the same day at about noon, Johnson said the same thing happened in the frozen food aisle of a Tacoma Fred Meyer store.
In both cases, she said, she was embarrassed and quickly left. She filed claims with both stores, showing medical care and prescription drug receipts totalling more than $5,500.
A subsequent investigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit indicated that she apparently submitted virtually identical medical receipts to each store, including an 8-page emergency room report that was missing some pages.
Medical records obtained through a search warrant indicated that the treatment was unrelated to a fall at either store. The records also showed that there been no expense to Johnson for the care.
The investigation also revealed that Johnson has filed at least five auto-accident medical claims and at least half a dozen slip-and-fall injury claims.
Wednesday, October 13, 2010
Lewis County couple convicted of insurance fraud
A Lewis County couple have been sentenced to jail for filing a false insurance claim.
Jennifer Mau, 30, and David Eden, 47, were found guilty by a jury on Friday.
Their case began as a moving claim. They rented a U-Haul truck on March 30, 2007 to move their household goods and personal belongings from a Centralia storage facility to their new home. They claimed that the U-Haul truck leaked rainwater, destroying $16,789 worth of her property.
Mau reported the loss to U-Haul and filed a claim. The couple said they threw out the damaged property at a landfill.
The insurer had the U-Haul truck water tested for leaks. No leaks were found. The insurer, Republic Western Insurance, denied Mau's claim and turned the case over to state Insurance Commissioner Mike Kreidler's Special Investigations Unit. The SIU's investigation included checks with local weather stations, which reported little or no precipitation that night.
The court sentenced Mau to 60 days in jail, with the option of electronic home monitoring. Eden was sentenced to 15 days in jail. (Both sentences are stayed pending a possible appeal.)
Jennifer Mau, 30, and David Eden, 47, were found guilty by a jury on Friday.
Their case began as a moving claim. They rented a U-Haul truck on March 30, 2007 to move their household goods and personal belongings from a Centralia storage facility to their new home. They claimed that the U-Haul truck leaked rainwater, destroying $16,789 worth of her property.
Mau reported the loss to U-Haul and filed a claim. The couple said they threw out the damaged property at a landfill.
The insurer had the U-Haul truck water tested for leaks. No leaks were found. The insurer, Republic Western Insurance, denied Mau's claim and turned the case over to state Insurance Commissioner Mike Kreidler's Special Investigations Unit. The SIU's investigation included checks with local weather stations, which reported little or no precipitation that night.
The court sentenced Mau to 60 days in jail, with the option of electronic home monitoring. Eden was sentenced to 15 days in jail. (Both sentences are stayed pending a possible appeal.)
Cease-and-desist order issued against Capital HomeShield
Washington State Insurance Commissoiner Mike Kreidler has issued a cease-and-desist order against a Florida-based home warranty company doing business as Capital Home Shield.
The North Miami Beach company -- which was not registered as a service contract provider or insurer in Washington state -- nonetheless sold a contract to a Washington homeowner. He complained to us after he had difficulty getting them to pay for a repair to his stove. The company subsequently paid the claim.
Under the contract, Capital Home Shield, which is a doing-business-as name of MN Home Warranty Corp., promised to pay to repair or replace major systems and appliances that broke.
Kreidler ordered the company to to stop selling unauthorized contracts in Washington and to turn over a list of all its Washington clients, as well as reporting all premiums they've paid so far.
According to the local Better Business Bureau, the company has an "F" rating for repeatedly failing to respond to complaints.
The North Miami Beach company -- which was not registered as a service contract provider or insurer in Washington state -- nonetheless sold a contract to a Washington homeowner. He complained to us after he had difficulty getting them to pay for a repair to his stove. The company subsequently paid the claim.
Under the contract, Capital Home Shield, which is a doing-business-as name of MN Home Warranty Corp., promised to pay to repair or replace major systems and appliances that broke.
Kreidler ordered the company to to stop selling unauthorized contracts in Washington and to turn over a list of all its Washington clients, as well as reporting all premiums they've paid so far.
According to the local Better Business Bureau, the company has an "F" rating for repeatedly failing to respond to complaints.
Everett man who signed up for insurance AFTER crash pleads guilty
A 40-year-old Everett man who caused a three-car collision last fall has pleaded guilty to attempted insurance fraud, a gross misdemeanor.
On Oct. 8, 2009, Bieniek was driving his 1999 Ford F150 pickup. He'd owned it for about 5 years but didn't have insurance on it.
He claimed that just minutes before the collision, he'd picked up the truck from a friend in a parking lot, opened his laptop computer and bought insurance online from Geico Insurance.
But Geico, after pulling the company's online log, determined that Bieniek got the coverage after the wreck, not before. The company turned the case over to the Washington state insurance commissioner's Special Investigations Unit. Bieniek was charged with insurance fraud ("false claims or proof") in King County Superior Court in July.
On Friday, Bieniek pleaded guilty to attempted insurance fraud. He was sentenced to 6 months' probation, 120 hours of community service and a $500 victim penalty assesssment.
On Oct. 8, 2009, Bieniek was driving his 1999 Ford F150 pickup. He'd owned it for about 5 years but didn't have insurance on it.
He claimed that just minutes before the collision, he'd picked up the truck from a friend in a parking lot, opened his laptop computer and bought insurance online from Geico Insurance.
But Geico, after pulling the company's online log, determined that Bieniek got the coverage after the wreck, not before. The company turned the case over to the Washington state insurance commissioner's Special Investigations Unit. Bieniek was charged with insurance fraud ("false claims or proof") in King County Superior Court in July.
On Friday, Bieniek pleaded guilty to attempted insurance fraud. He was sentenced to 6 months' probation, 120 hours of community service and a $500 victim penalty assesssment.
Tuesday, October 12, 2010
Behind the scenes in our Consumer Advocacy program...
Not enough people know about it, but our consumer advocacy staff run a free phone hotline -- staffed by live people, not some endless phone tree -- to help you get answers to insurance questions and problems. It's 1-800-562-6900.
People call when they're unhappy with what their insurer's offering for their wrecked car, for example. They call, increasingly, because they cannot find affordable health coverage and are desperate to find coverage for loved ones. (We also have a special program, called Statewide Health Insurance Benefits Advisors, that trains hundreds of volunteers to help provide information on health insurance and Medicare options. They can be reached through the same number.)
One person called because he was unhappy with the value that an insurer put on his goat, which had met with an untimely end. (True. For what it's worth, we helped get him an extra $25 for his goat.)
Not everyone, however, speaks English-- or at least well enough to get into the details of an insurance claim and policy exclusions. So we have staff who can speak Spanish and Filipino/Tagalog, and others certified to interpret American Sign Language. We have a TTY machine. Some of our publications are available in Spanish, Chinese, Korean, Vietnamese and Russian.
And when that's not enough, we tap Language Line Services, a telephone interpreter service that can translate English into more than 150 languages (and vice versa) 24/7.
So if you know someone who's having trouble with an agent or insurer, needs help finding health coverage, etc., have them give us a call: 1-800-562-6900. We speak their language.
People call when they're unhappy with what their insurer's offering for their wrecked car, for example. They call, increasingly, because they cannot find affordable health coverage and are desperate to find coverage for loved ones. (We also have a special program, called Statewide Health Insurance Benefits Advisors, that trains hundreds of volunteers to help provide information on health insurance and Medicare options. They can be reached through the same number.)
One person called because he was unhappy with the value that an insurer put on his goat, which had met with an untimely end. (True. For what it's worth, we helped get him an extra $25 for his goat.)
Not everyone, however, speaks English-- or at least well enough to get into the details of an insurance claim and policy exclusions. So we have staff who can speak Spanish and Filipino/Tagalog, and others certified to interpret American Sign Language. We have a TTY machine. Some of our publications are available in Spanish, Chinese, Korean, Vietnamese and Russian.
And when that's not enough, we tap Language Line Services, a telephone interpreter service that can translate English into more than 150 languages (and vice versa) 24/7.
So if you know someone who's having trouble with an agent or insurer, needs help finding health coverage, etc., have them give us a call: 1-800-562-6900. We speak their language.
Seattle woman pleads guilty in insurance fraud case
A Seattle women has pleaded guilty to filing a false claim in an insurance case -- a class C felony -- after allegedly smashing her van into two parked cars and then filing an insurance claim saying the van had been stolen.
Luom Vo, 38, was sentenced in King County Superior Court to 30 days community service and more than $4,000 in restitution and other costs.
According to Insurance Commissioner Mike Kreidler's Special Investigations Unit, Vo was driving on Seattle's Beacon Avenue just before 2 a.m. on Nov. 27, 2009 when she hit two parked vehicles: a Volvo station wagon and a Pontiac Vibe. Her Honda van was disabled in the crash. Neighbors said they saw Vo then climb into a friend's car and leave.
Later that day, Vo filed a claim with her insurer, PEMCO, saying that the van had been stolen. She subsequently insisted to a PEMCO investigator that she was not driving it when the crash happened.
The SIU investigation found that the van had not been stolen, and that she was, in fact, behind the wheel.
Luom Vo, 38, was sentenced in King County Superior Court to 30 days community service and more than $4,000 in restitution and other costs.
According to Insurance Commissioner Mike Kreidler's Special Investigations Unit, Vo was driving on Seattle's Beacon Avenue just before 2 a.m. on Nov. 27, 2009 when she hit two parked vehicles: a Volvo station wagon and a Pontiac Vibe. Her Honda van was disabled in the crash. Neighbors said they saw Vo then climb into a friend's car and leave.
Later that day, Vo filed a claim with her insurer, PEMCO, saying that the van had been stolen. She subsequently insisted to a PEMCO investigator that she was not driving it when the crash happened.
The SIU investigation found that the van had not been stolen, and that she was, in fact, behind the wheel.
Monday, October 11, 2010
>129,000 in WA potentially affected in Farmers class-action settlement
At least 129,973 Washingtonians are potential members of the settlement class in a class-action case that Farmers Group and corporate parent Zurich Financial Services Group have agreed to settle for $455 million.
The companies say payments "may vary considerably", but will average $35 per policyholder, and that some 13 million policyholders may qualify for a distribution under the settlement.
Customers with questions can contact Farmers regarding the settlement at 1-888-538-5785.
Here's our original post on this, with more details about the case and a link to Zurich's press release.
The companies say payments "may vary considerably", but will average $35 per policyholder, and that some 13 million policyholders may qualify for a distribution under the settlement.
Customers with questions can contact Farmers regarding the settlement at 1-888-538-5785.
Here's our original post on this, with more details about the case and a link to Zurich's press release.
Friday, October 8, 2010
Tacoma couple sentenced in insurance-fraud case
A Tacoma couple who filed a falsified insurance claim, including a forged receipt for a 57-inch TV allegedly purchased from a stranger for $5,800 in cash, have been sentenced.
They also claimed that burglars had stolen a $3,000 Persian rug they'd purchased from their next-door neighbor. When investigators from the state insurance commissioner's Special Investigations Unit questioned the neighbor, he said he'd never sold them a Persian rug, and that the couple was looking for someone to pretend to be the seller so they could collect money from their insurance company.
The couple, Melissa and Anthony Mezias, brought $8,800 in restitution to their sentencing hearing in Pierce County Superior Court on Monday.
In addition to full restitution, Anthony Mezias will have to pay more than $1,000 in court fees and costs on one charge of first-degree theft. Melissa Mezias will pay $700 in fees and costs on one count of attempted false claims in an insurance case.
They also claimed that burglars had stolen a $3,000 Persian rug they'd purchased from their next-door neighbor. When investigators from the state insurance commissioner's Special Investigations Unit questioned the neighbor, he said he'd never sold them a Persian rug, and that the couple was looking for someone to pretend to be the seller so they could collect money from their insurance company.
The couple, Melissa and Anthony Mezias, brought $8,800 in restitution to their sentencing hearing in Pierce County Superior Court on Monday.
In addition to full restitution, Anthony Mezias will have to pay more than $1,000 in court fees and costs on one charge of first-degree theft. Melissa Mezias will pay $700 in fees and costs on one count of attempted false claims in an insurance case.
Thursday, October 7, 2010
$455 million Farmers settlement: Payments to up to 13 million policyholders
Zurich Financial Services Group said this morning that it and Farmers Group -- which it owns -- have "agreed in principle" to a $455 million settlement of a national class action lawsuit filed in California.
The settlement will affect up to 13 million people.
Here's a copy of Zurich's press release.
We're not sure yet how many of those 13 million people are in Washington state, although we're trying to find out. The settlement payments "may vary considerably," the company says, but will average $35 per policyholder.
What was the lawsuit about? Here's Zurich's summary:
(Note: And thanks to the eagle-eyed reader -- and you know who you are -- who noted that "our" was misspelled "ourt" in the last paragraph. Fixed.)
The settlement will affect up to 13 million people.
Here's a copy of Zurich's press release.
We're not sure yet how many of those 13 million people are in Washington state, although we're trying to find out. The settlement payments "may vary considerably," the company says, but will average $35 per policyholder.
What was the lawsuit about? Here's Zurich's summary:
In the lawsuit, the plaintiff challenged the management services fees paid by the Farmers Exchanges (Exchanges) to FGI and certain of its affiliates, which under policyholder subscription agreements act as the attorney-in-fact for policyholder subscribers of the Exchanges.After our approval, policyholders entitled to participate in the settlement will be mailed notification, with more details. Customers can also contact Farmers regarding the settlement at 1-888-538-5785.
(Note: And thanks to the eagle-eyed reader -- and you know who you are -- who noted that "our" was misspelled "ourt" in the last paragraph. Fixed.)
Tuesday, October 5, 2010
New listserv for Washington state insurance agents and brokers
We've set up a listserv for Washington state insurance agents and brokers who would like to get occasional updates from our office. We're the office that regulates the insurance industry in Washington state.
We foresee periodically sending out updates about things affecting producers (which is the industry, regulatory and legal term for agents and brokers).
We received a lot of questions, for example, about the changes that started taking effect Sept. 23 under the new federal health care reform law. And a lot about the new "group of one" state law.
Click here to subscribe or unsubscribe.
We foresee periodically sending out updates about things affecting producers (which is the industry, regulatory and legal term for agents and brokers).
We received a lot of questions, for example, about the changes that started taking effect Sept. 23 under the new federal health care reform law. And a lot about the new "group of one" state law.
Click here to subscribe or unsubscribe.
Friday, October 1, 2010
Federal flood insurance program, after repeatedly lapsing this year, is reauthorized for another year
“This can be important and affordable coverage for property owners and renters in flood-prone areas,” said Washington State Insurance Commissioner Mike Kreidler. Many lenders require flood coverage in order to qualify for mortgages in flood zones.
The program lapsed several times this year, and was slated to lapse again at the end of September. During lapses, flood policies remain in force for those who have them, but new policies cannot be written or renewed.
“While the program needs changes to make it more financially sustainable, this move by the President and Congress gives property owners another year of stability and protection,” said Kreidler.
Standard homeowners policies do not cover flooding, Kreidler said. Property owners should strongly consider the federal flood coverage, he said, which is widely available.
This summer, Kreidler established a program, the Washington Flood Market Assistance Plan, to help businesses obtain additional private insurance in south King County’s Green River Valley.
Thursday, September 30, 2010
WA Insurance Commissioner describes health care changes
Wondering what health care reforms are coming down the pike? In this video by Comcast, Washington State Insurance Commissioner Mike Kreidler lays out the changes taking effect this fall and at the start of January, as well as some of the longer-term changes we can expect.
Tuesday, September 28, 2010
Regence to stop selling child-only policies in WA; Kreidler "appalled"
Here's a press release our office is putting out this morning:
Regence BlueShield, one of Washington state’s largest health insurers, intends to stop selling new policies for children in Washington under age 19 as of Oct. 1.
The decision followed days of discussions with Insurance Commissioner Mike Kreidler and his staff, who strongly objected to Regence’s decision.
“I’m appalled,” said Insurance Commissioner Mike Kreidler. “We’ve made regulatory concessions to limit Regence’s exposure. Their overreaction will seriously harm Washington families.”
As of Sept. 23, 2010, the federal Affordable Care Act requires many health plans to cover children’s pre-existing conditions. Kreidler’s office issued an emergency rule last week, allowing individual health plans to limit their risk by creating a special open-enrollment period from Nov. 1 – Dec. 15. During this time, parents can add their children to their individual plans without taking a health screen.
According to Kreidler, “A special enrollment period drastically limits the carriers’ risk and should more than address their concerns. By pulling out of this market, Regence just cut off vital coverage for working families.”
People still can buy individual plans from Regence for themselves and their families, but children only can be added between Nov. 1-Dec. 15. Anyone wanting to buy a health plan for just their child must choose a different health insurer.
Child-only policies are unusual in Washington state. Here, if you buy coverage for your family in the individual market, you’re issued one policy for the entire family. Family policies are not available in some states. There, people looking for family coverage must buy a policy for each member.
Regence Blueshield currently has 2,500 child-only policies in the state and they will remain in effect.
“So far, no other health carrier in Washington state has signaled its intent to leave this market,” added Kreidler. “I hope we can expect better from them.”
Parents looking for health insurance for their children can try the other health carriers in the individual market. Or, if they meet income qualifications, they might be eligible for Washington state’s Apple Health for Kids program. Coverage costs $30 a month per child for a family of four earning $66,150.
Monday, September 27, 2010
Congress gives federal flood-insurance program a one-year extension
The National Flood Insurance Program, which has repeatedly lapsed and been reauthorized by Congress this year, has gotten a one-year extension from Congress. The bill, S-3814, passed the House on Friday, and had earlier gotten the thumbs-up from the Senate. It now awaits the president's signature.
Thursday, September 23, 2010
New federal health reforms start today
Beginning today, most health plans sold after March 23, 2010 must include several new benefits when they renew. These provisions, outlined in the federal Affordable Care Act, are designed to increase access to health care. Under the new reforms, plans cannot:
Charge out-of-pocket costs, including co-pays, deductibles and co-insurance, for preventive services.
Cap lifetime benefits.
Cancel or rescind a policy, except in the case of fraud or misrepresentation.
Refuse to cover a child’s pre-existing condition.
If the health plan includes a cap on essential benefits, it can’t be less than $750,000.
And young adults can be covered on their parents’ plan until the age of 26, unless they get a job that offers health insurance.
However, there are some exceptions. Health plans sold before March 23, 2010, when the law was signed, are considered “grandfathered” and are exempt from some of these new protections.
For example, grandfathered individual health plans still can charge out-of-pocket costs for preventive services, cap lifetime benefits, and refuse to cover an enrolled child’s pre-existing condition. Grandfathered group plans (plans purchased by employers for their employees) still can charge out-of-pocket costs for preventive services.
Plans lose their grandfathered status if they significantly reduce benefits or increase deductibles, copayments, and/or an employee’s share of the premium.
Learn more about the fall reform here or see a general timeline of health reform.
Charge out-of-pocket costs, including co-pays, deductibles and co-insurance, for preventive services.
Cap lifetime benefits.
Cancel or rescind a policy, except in the case of fraud or misrepresentation.
Refuse to cover a child’s pre-existing condition.
If the health plan includes a cap on essential benefits, it can’t be less than $750,000.
And young adults can be covered on their parents’ plan until the age of 26, unless they get a job that offers health insurance.
However, there are some exceptions. Health plans sold before March 23, 2010, when the law was signed, are considered “grandfathered” and are exempt from some of these new protections.
For example, grandfathered individual health plans still can charge out-of-pocket costs for preventive services, cap lifetime benefits, and refuse to cover an enrolled child’s pre-existing condition. Grandfathered group plans (plans purchased by employers for their employees) still can charge out-of-pocket costs for preventive services.
Plans lose their grandfathered status if they significantly reduce benefits or increase deductibles, copayments, and/or an employee’s share of the premium.
Learn more about the fall reform here or see a general timeline of health reform.
Wednesday, September 22, 2010
U.S. Senate votes to re-authorize federal flood insurance program, insurers urging House to act quickly
The National Flood Insurance Program, which has repeatedly expired this year, only to be reauthorized by Congress for short stints, is slated to expire on Sept. 30. To prevent that, the U.S. Senate yesterday voted to extend the program through Sept. 30, 2011.
Insurers and insurance associations are now urging the House of Representatives to quickly do the same thing.
Congress created the program in 1968 as a way of getting a handle on the increasing public costs of providing aid to flood victims.
Many homeowners assume that flood damage is covered by standard homeowners coverage. It is not. The same is true for standard renters- and commercial property policies. If you want flood coverage, you have to specifically get flood coverage. (There's one exception to this general rule: comprehensive auto insurance coverage tends to cover flood damage to the vehicle.)
Flood insurance has been a major issue in south King County's Green River Valley, where the Army Corps of Engineers says there's a higher-than-normal risk of flooding due to weakness in an abutment to the Howard Hanson Dam. Work by the Corps and its contractors has dramatically reduced the risk of serious flooding (it was 1 in 3 last fall, now the Corps says its about 1 in 60), but we're still urging property owners and renters in the area to seriously consider getting at least the federal flood coverage.
For businesses, the federal coverage (capped at $500k/building and $500k contents) will not be enough. Many insurers stopped writing coverage in the area last fall. To help, our office has organized the Washington Flood Market Assistance Plan, which acts like a matchmaker between Green River Valley businesses needing coverage and insurers selling it.
The Insurance Information Institute has prepared a lot of flood-related information, including a list of major floods, how to prepare for a flood, what to do during a flood, and how to recover from a flood.
(Post modified 9/23 to add the info and a link for the state's flood Market Assistance Plan.)
Insurers and insurance associations are now urging the House of Representatives to quickly do the same thing.
Congress created the program in 1968 as a way of getting a handle on the increasing public costs of providing aid to flood victims.
Many homeowners assume that flood damage is covered by standard homeowners coverage. It is not. The same is true for standard renters- and commercial property policies. If you want flood coverage, you have to specifically get flood coverage. (There's one exception to this general rule: comprehensive auto insurance coverage tends to cover flood damage to the vehicle.)
Flood insurance has been a major issue in south King County's Green River Valley, where the Army Corps of Engineers says there's a higher-than-normal risk of flooding due to weakness in an abutment to the Howard Hanson Dam. Work by the Corps and its contractors has dramatically reduced the risk of serious flooding (it was 1 in 3 last fall, now the Corps says its about 1 in 60), but we're still urging property owners and renters in the area to seriously consider getting at least the federal flood coverage.
For businesses, the federal coverage (capped at $500k/building and $500k contents) will not be enough. Many insurers stopped writing coverage in the area last fall. To help, our office has organized the Washington Flood Market Assistance Plan, which acts like a matchmaker between Green River Valley businesses needing coverage and insurers selling it.
The Insurance Information Institute has prepared a lot of flood-related information, including a list of major floods, how to prepare for a flood, what to do during a flood, and how to recover from a flood.
(Post modified 9/23 to add the info and a link for the state's flood Market Assistance Plan.)
Tuesday, September 14, 2010
How -- and why -- to become a "group of one"
In a couple of weeks, changes to Washington state law will make it easier for sole proprietors and some self-employed individuals to get affordable health insurance coverage.
The change involves small group coverage, which under state law in recent years has meant entities (such as small businesses) of 2 to 50 employees. They could qualify for health coverage in the small group market, which doesn't require a health screening.
One-person businesses, however, have had to seek coverage in the individual insurance market, where health screening is the norm and coverage can be hard to find (and expensive) for folks with pre-existing medical conditions.
By Oct. 1, 2010, however, state law will consider 1 person a "group" for insurance purposes. This means that sole proprietors, for example, will be able to qualify for the group coverage.
There are some provisions to ensure that the business is bona fide, however. In general, the law requires people to show that:
-they've been employed by (or run) the same business for at least the last 12 months,
-they've made at least 75 percent of their income (or 51 percent for agricultural businesses) from the business or trade.
The bill changing the law was Senate Bill 6538, prime-sponsored by Sen. Karen Keiser and co-sponsored by Sen. Cheryl Pflug. Similar changes to federal law have been approved by Congress and signed by the president -- they're included in the federal health reform legislation passed this spring -- but don't take effect until 2014.
To find out more, talk to your insurance agent or broker, or call us -- the Washington state insurance commissioner's office -- at 1-800-562-6900.
Note: This post was corrected to indicate that the federal changes don't take effect until 2014.
The change involves small group coverage, which under state law in recent years has meant entities (such as small businesses) of 2 to 50 employees. They could qualify for health coverage in the small group market, which doesn't require a health screening.
One-person businesses, however, have had to seek coverage in the individual insurance market, where health screening is the norm and coverage can be hard to find (and expensive) for folks with pre-existing medical conditions.
By Oct. 1, 2010, however, state law will consider 1 person a "group" for insurance purposes. This means that sole proprietors, for example, will be able to qualify for the group coverage.
There are some provisions to ensure that the business is bona fide, however. In general, the law requires people to show that:
-they've been employed by (or run) the same business for at least the last 12 months,
-they've made at least 75 percent of their income (or 51 percent for agricultural businesses) from the business or trade.
The bill changing the law was Senate Bill 6538, prime-sponsored by Sen. Karen Keiser and co-sponsored by Sen. Cheryl Pflug. Similar changes to federal law have been approved by Congress and signed by the president -- they're included in the federal health reform legislation passed this spring -- but don't take effect until 2014.
To find out more, talk to your insurance agent or broker, or call us -- the Washington state insurance commissioner's office -- at 1-800-562-6900.
Note: This post was corrected to indicate that the federal changes don't take effect until 2014.
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