New report: What repeal of the Affordable Care Act would mean in WA

We've just posted a new report detailing the effects in Washington state of the federal health care reform law. Among them:

Numerous consumer protections built into the law have already taken effect. Among these: drug discounts for more than 1 million Washington seniors, tax breaks for small businesses, and parents can now keep their adult children on the parents' health policy until age 26.

We also estimate that more than 800,000 Washingtonians who today have no health coverage at all would qualify for free or subsidized coverage in 2014.

Turning 65 soon?

If you or someone you know will be turning age 65 in the next year or so, check out our new Medicare web pages. We launched a series of web pages called “What is Medicare?” to help people who will soon become eligible for Medicare. The information provides a basic overview of Medicare, explaining the different parts and options available to people.

For additional help with Medicare choices, we also offer our free, unbiased and confidential Statewide Health Insurance Benefits Advisors (SHIBA) service. We have more than 300 volunteer advisors around the state who we extensively train to help advise people on their Medicare options. SHIBA’s a great service. These folks can help you navigate the Medicare maze. Call 1-800-562-6900 and ask to speak with a SHIBA advisor in your area.

Insurance and broken windows

Q: Am I covered if my son breaks a neighbor's window while he's hitting rocks with his baseball bat or mowing our lawn?

A: Generally yes -- if it's an accident. Your homeowners policy will typically cover this type of accident at home or even away from home. But if it was a deliberate act, the damage may not be covered.

Also, consider your deductible. If the estimate to repair the window is small, it may be worth it to pay the damages out of pocket.

Note: This is one of a series of common -- or in some cases, particularly unusual -- questions received by our consumer advocacy staff, who answer questions from consumers.
Got a question or insurance problem of your own? If you live in Washington, feel free to give us a call, toll-free at 1-800-562-6900. We'll do our best to help. (And if you live in another state or territory, here's a handy map that lists the contact info for your local insurance regulatory office.)

WA to get at least $450,000 in MetLife settlement

From a press release our office issued this morning:

OLYMPIA, Wash. – Washington stands to receive at least $450,000 as part of a multi-state settlement with Metropolitan Life Insurance Company.

The $40 million settlement, which was announced in April and now involves at least 28 states, is based on concerns raised by insurance regulators over the extent of MetLife’s efforts to investigate and pay life insurance benefits. MetLife did not admit liability.

Under the terms of the settlement, MetLife agreed to regularly check the Social Security death master file or similar records to determine if its life insurance policyholders, annuity owners or retained asset account holders have died. The company will then make efforts to locate beneficiaries and pay claims.

“From what we’ve seen, I’m happy to report that there don’t appear to be major or widespread problems in Washington state with paying life insurance benefits in a timely manner,” said Insurance Commissioner Mike Kreidler. “But it’s important to hold companies accountable when they fail to pay benefits when due.”

Under Washington state law, insurers must pay interest on a life insurance policy from the date of death. Unclaimed policies are turned over to the state’s unclaimed property fund, which holds the money for any future claims.

Washington’s share of the settlement, to be determined in early July, depends on the number of states that sign on to the settlement. The money will go into the state’s general fund.

Spokane-area woman convicted of theft in insurance case

A Liberty Lake, Wash. woman pleaded guilty today in Spokane County Superior Court to theft for filing thousands of dollars in false insurance claims.

Sarah Shireee Walters was sentenced to 10 days in jail, which was converted to 80 hours of community service. She was also ordered to pay more than $4,000 in restitution and fees.

Walters and her husband, Jeremy Walters were both employees of Liberty Mutual/Safeco insurance company since early 2010. They had a renter's policy for their apartment in Liberty Lake.

Last April, Sarah Walters called Safeco and reported the loss of two Gateway laptops and computer games while the couple was on a day trip. The company processed the claim and issued a check for $1,524.

A few weeks later, Walters again called Safeco. This time, she reported the loss of two $500 iPod Touch devices, a set of $450 Dr. Dre headphones and a $580 camera. She said she'd left them in a Spokane park, and that they may have been stolen. The couple was sent a $2,030 check.

Less than three weeks after that, Walters again called Safeco to say that she'd lost two EVO phones and a BlackBerry. She said she'd had all three phones in her sweater pocket at the park.

After three claims in three months, the company referred the claim to one of its investors. Confronted with discrepancies in the claims, Sarah Walters admitted that the laptops, camera and other items were never really missing.

She pleaded guilty today to two counts of second-degree theft.

Insurance: When a driver admits liability

Q: I was in a car accident and the other driver admitted that it was his fault. But his insurance company won't pay 100 percent. Why not?

A: Determining who is at fault for an accident depends on the facts as discovered during the investigation, not on just one driver's opinion. Even though one driver might be cited by police or admit fault, the issue of liability can only be determined after all the accident facts, weather, visibility, and all other driver actions and factors at the scene are taken into account.

It may sound hard to believe, but even if someone runs a stop sign and gets a ticket, the other driver could be found partially at fault for contributing to the accident by speeding, for example.

Note: This is one of a series of common -- or in some cases, particularly unusual -- questions received by our consumer advocacy staff, who answer questions from consumers.
Got a question or insurance problem of your own? If you live in Washington, feel free to give us a call, toll-free at 1-800-562-6900. We'll do our best to help. (And if you live in another state or territory, here's a handy map that lists the contact info for your local insurance regulatory office.)

Insurance company turned down your claim? We may be able to help.

Often when consumers call us with insurance problems, we suggest that they file a complaint with our office. And it's not uncommon for people to say something like “Why should I bother? I already called the insurance company, and they gave me their answer.”

First off, don't give up. Filing a complaint with our office can still help.

Here's why: When we receive complaints, we send the paperwork to our contact people at each insurance company. These are usually higher up in the insurance company than the front-line staff who answer customer service questions. Because of their position in the company, the insurance workers we deal with often have more discretion to consider all the factors and make a decision on your claim.

Also, state law says that when an insurance company receives a complaint from our office, the company needs to investigate the issue and respond to us in a timely manner. Sometimes, just the process of having another person from the insurance company take a closer look can lead to a resolution.

Finally, these complaints give our office a window into what’s going on within an insurance company, so the time that you spend filing the complaint can help us see a bigger picture. In the long run, that can help a lot of consumers in addition to you. In some cases, complaints by just a few individuals have led to investigations that resulted in refunds to hundreds of people. (Here's an example of that.)

So if you need help -- and live in Washington -- give us a call at 1-800-562-6900 or send an e-mail to AskMike@oic.wa.gov. (If you live elsewhere, here's how to find your area's insurance regulator.) Our services are free and we won't try to sell you anything. We're the government agency that regulates the insurance industry in Washington state.

Prestige Administration ordered to stop selling insurance products in WA

An Arizona company that has sold at least 82 vehicle service contracts illegally in Washington state has been ordered to stop.

Our office has issued a cease-and-desist order against Phoenix-based Prestige Administration Inc.

Our legal affairs investigators found that the company issued at least 82 motor vehicle service contracts or similar products to Washington consumers. (Under Washington law, these contracts are considered a form of insurance.)

The problem is that the company is not authorized to conduct insurance transactions here in Washington. Nor have they registered with our office as a service contract provider.

Here's a key part for consumers who bought those contracts: Nothing in our order prevents the company from fullfilling the terms of the existing contracts.

The company has the right to demand a hearing.

Agent charged with theft and forgery

An insurance agent in Pierce County has been charged with theft and forgery for allegedly collecting tens of thousands of dollars in payments from clients but not issuing them insurance.

Nancy M. Bishop, who did business as the Nancy Bishop Agency in Puyallup, Wash., was charged Thursday in Pierce County Superior Court with one count of first-degree theft and five counts of forgery.

In late 2009, our office received a complaint from the owner of a construction company. The owner said that she'd made multiple payments to Bishop, but that the company's policy had been cancelled for nonpayment. We launched an audit of Bishop -- which she twice tried to postpone. We found that she owed policyholders more than $131,000.

Our investigation found dozens of instances in which Bishop collected premiums but provided no insurance coverage. She continued to bill clients anyway. She overcharged some customers, according to the records. We found numerous instances in which she received refunds from a finance company but apparently failed to forward those refunds back to her customers.

We also found numerous cases in which forged certificates of insurance, with Nancy Bishop's name at the bottom, were sent to state regulators. Of the 24 such instances we found, there was no actual insurance.

Arraignment is scheduled for May 18.

Insurance commissioner's statement on Mackey v. McKenna

Insurance Commissioner Mike Kreidler on Thursday issued the following statement about the filing of a private lawsuit against Attorney General Rob McKenna over McKenna’s efforts to overturn federal health care reform:
“As this new lawsuit points out, Attorney General McKenna wants to have it both ways. Shortly after federal health reform passed, McKenna rushed to join fellow conservatives in challenging the law. Two years later, he seems to be trying hard to distance himself from the potential consequences of the case he signed his name to. Simply put, health care for hundreds of thousands of Washingtonians hangs in the balance.
“Mr. McKenna knows that many provisions of the law – such as letting parents keep adult children on their health coverage until age 26, expanding women's coverage, and barring insurers from denying coverage to sick children – are popular. He maintains that the challenge to the individual mandate will not overturn the entire law.
“The problem is that the case he joined seeks to do exactly that: throw out the entire law.
“About 700,000 Washingtonians stand to get free or subsidized health coverage through the health care reform law, starting in 2014. If the court challenge succeeds, those people will lose hope of coverage anytime soon.
"We cannot afford to play politics with people’s lives. History shows that as a nation, we summon the will to try to address health care reform only about once a generation. Hundreds of thousands of uninsured Washington families need meaningful, affordable coverage now. If the court challenge by Mr. McKenna and his conservative colleagues unravels the entire health care reform law, it will be a travesty. Washington's families cannot wait another 20 years.”

Insurance: Am I covered if I rent an RV?

Q: Does my auto insurance cover me if I rent a large RV for my vacation?

A: Maybe. Some policies will limit coverage to certain-sized vehicles that you may borrow or rent. So talk with your agent or insurer about your plans before you borrow or rent.

This can also be an important consideration if you're moving yourself or otherwise renting a large truck, by the way. Many auto policies exclude large trucks or other vehicles. It's a good idea to check first.



Note: This is one of a series of common -- or in some cases, particularly unusual -- questions received by our consumer advocacy staff, who answer questions from consumers.
Got a question or insurance problem of your own? If you live in Washington, feel free to give us a call, toll-free at 1-800-562-6900. We'll do our best to help. (And if you live in another state or territory, here's a handy map that lists the contact info for your local insurance regulatory office.)

Updated to correct typo in the question about renting a large TV. Whoops. We meant RV.

Insurance agent's license revoked: Submitted dozens of bogus life insurance applications

Insurance Commissioner Mike Kreidler has revoked the license of a Renton insurance agent who submitted dozens of bogus life insurance policies, apparently to collect the commissions.

Angela M. Scott, a former agent for Primerica Life Insurance Co., lost her license, effective April 9.

"By using fraudulent and dishonest practices and demonstrating incompetence, untrustworthiness and financial irresponsibility, Ms. Scott violated" state insurance law, says Kreidler's order.

From June 1, 2010 to May 2011, Scott submitted 88 term life insurance policies to the insurer. The premiums were to be paid through automatic withdrawals from the applicants' bank accounts.

But of the 88 applications submitted, 76 had invalid bank account numbers. Some 67 had invalid social security numbers. And 52 listed phone numbers that didn't work. When the banks didn't pay the premiums because of the incorrect account numbers, Scott submitted 60 money orders for policies' first payments.

An investigator for Kreidler's office reviewed 15 of the policies and could find no driver's licenses or other information indicating that the applicants were in fact real people. Nor could he find any trace of three people whom Scott claimed had introduced her to those applicants.

Scott has the right to demand a hearing to contest the revocation.

With dam repaired, program to help Green River Valley businesses find flood coverage ends

Two years after launching a special program to help business owners in Washington's Green River Valley find flood coverage, we're ending the program.

At the time, area businesses said they were having trouble finding insurance due to concerns about slumping in an earthen embankment adjacent to the Howard Hanson Dam. There were serious concerns among local business groups and lawmakers that without flood insurance, businesses in the heavily industrialized valley would start looking for locations elsewhere.

At our request, insurance companies agreed to

Fast forward two years: The U.S. Army Corps of Engineers has performed repairs on the dam, tested it, and the Corps says it is confident that the dam is again able to operate at full flood capacity. From all indications, businesses seeking flood insurance area again able to get it. That's why we're ending the program, which helped pair businesses seeking coverage with insurers willing to sell it.

Here's a news release we sent out about it, with links to the official letter ending the program.