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

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

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

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

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

She was sentenced to three months in jail.

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

Common questions about Medicare and health care exchanges

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

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

Among the other questions we're hearing frequently:

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

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

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

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

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

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

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

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

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

Changes mean quicker responses to your insurance complaints

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

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

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

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

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

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

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

Insurance questions: Does my homeowners policy cover lightning?

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

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

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

Health care reform questions: Where can I get help?

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

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

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

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

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

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

From a press release we put out this morning:

FOR IMMEDIATE RELEASE – Sept. 4, 2013

Media contact: Public Affairs (360) 725-7055

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

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

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

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

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

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

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

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

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

####

Kreidler achieves settlement with health insurers - approves 10 more Exchange plans

Insurance Commissioner Mike Kreidler has reached settlements with Community Health Plan of Washington and Kaiser Foundation Health Plan of the Northwest and approved their 10 plans for sale in Washington’s Health Benefit Exchange, the Washington Healthplanfinder.

 Consumers in Washington will now have 41 choices in the Exchange when open enrollment begins Oct. 1. Community Health Plan of Washington (CHPW) will have three plans available in 26 counties.

 Kaiser will offer an additional seven plans in Clark and Cowlitz counties.

 Kreidler said the additional 10 plans meet the same high standards held for the other approved companies. They also ensure continuity of care for Medicaid enrollees and create more competition in the marketplace.

 The Exchange set an initial July 31 deadline for the Insurance Commissioner’s review and approval of plans for inclusion in the Exchange, where subsidies for health coverage will be offered as part of the federal Affordable Care Act.

“We had 31 health plans approved by the Exchange’s deadline. Washington consumers now have an additional 10 quality plans to choose from,” Kreidler said.  “We took the initial deadline seriously, but we also followed our own legal process and it worked. The Exchange cannot delay any further. It must take action and approve these plans by Sept. 5.”

Read the full release.

New online tool shows you what individual health insurance costs next year in WA

We've built a new online tool to help you find out what health care plans will cost next year. Simply click on the map -- premiums vary by where you live -- and it will tell you which insurance carriers are offering coverage in your area. You can click on each company to see its rates, which vary based on your age.

A couple of caveats: These rates are mainly for the individual market, meaning people who have to buy insurance for themselves, and don't get it through an employer, Medicare, etc.

Also, the rates do factor in the subsidies that will be available to some people. Those subsidies will reduce the cost of coverage substantially for many people. You can estimate how much you'll pay, with subsidies taken into account, by using this online calculator from the Washington HealthPlanFinder.

Lastly, the list of health plans is likely to grow over the next couple of months. We are still reviewing plans, for example, for multiple insurance carriers that have filed to sell coverage outside the state exchange. And some plans that were rejected for the Exchange have filed appeals. So stay tuned.

An open letter from Mike Kreidler about insurance plans filed for Washington's exchange

An open letter from Insurance Commissioner Mike Kreidler

In January, the biggest changes under health care reform – or “Obamacare” – will take effect. Many health plans, which now have to comply with federal standards, will be significantly better. And hundreds of thousands of low- and middle-income Washingtonians will qualify for subsidies to help pay for coverage.

This fall, Washington’s new Health Benefit Exchange will open for business, giving consumers an easy way to compare health plans, sign up, and see if they qualify for the subsidies.

Many kinds of insurance policies, before they can be sold, must be reviewed and approved by my office. This is a very important consumer protection, designed to ensure that prices are fair and that insurers can deliver on their promises.

I’m pleased to report that based on state and federal law, we were able to approve 31 health insurance plans, from four carriers, for the Exchange. People shopping on the Exchange will have broad choice and significantly better coverage, starting Jan. 1, 2014.

Unfortunately, we had to reject applications from five other insurance carriers. These were not decisions I made lightly. I am a strong supporter of competition and consumer choice, and a longtime supporter of health care reform.

As the state’s insurance regulator, however, I have a duty to protect consumers and to hold all insurers to the same standards. There were substantial problems in the plans we rejected.

Health insurers must have adequate networks of doctors and other health care providers. And there were major problems with the networks of most of the rejected plans. One didn’t offer any pediatric hospital.

Another had no approved retail pharmacy. Certain plans didn’t have adequate access to transplant surgeons, or to HIV/AIDS specialists.

One network would have required people to drive more than 45 miles to see a cardiologist, and more than 120 miles to see a gastroenterologist. That would be like living in Tacoma but having to see a doctor in Bellingham.

These were not minor technicalities. They were major problems.

Some people have pointed out that three of the carriers whose plans were rejected are currently serving people on Medicaid. They worry that people whose incomes rise, making them ineligible for Medicaid, will have difficulty moving to a regular commercial plan, or would lose important continuity of care offered by the community clinics. Many of these community clinics offer important services, such as language assistance or transportation.

Rest assured: The plans I approved for the Exchange include a substantial number of community clinics throughout the state. In many cases, Medicaid patients who want to remain with the same clinic will be able to.

The Affordable Care Act requires all carriers participating in the Exchange to contract with an adequate number of “Essential Community Providers,” or ECPs. These are defined as health care providers that serve high-risk, special needs and underserved individuals. Many Sea Mar clinics, for example, have contracts with the commercial carriers who were approved for the Exchange.

My staff and I worked very hard to try to get all carriers and all plans across the finish line in time. We had dozens of meetings, and 14 webinars to try to walk them through the process. I called one CEO after another, laying out the key issues and timelines. On the final night, July 31, we had staff waiting at their desks until midnight, in order to give the companies every possible minute to succeed.

But some carriers – particularly those new to the commercial insurance market -- simply couldn’t meet the standards this time.

We knew this first big year of health reform implementation would be a bumpy ride, and it has been. But I remain optimistic about the future. We will continue to work with all carriers to help them get ready for the next year, when I fully expect more insurers to succeed.

In the meantime, consumers have a broad number of choices. The insurance is meaningful, the networks robust, the subsidies significant. Again, the process has been bumpy. But it’s a very promising start.

Mike Kreidler

Insurance Commissioner

Auto insurance and pizza delivery

We get a lot of calls from parents -- and usually those calls are after the fact, unfortunately -- about whether their child delivering pizzas needs additional auto coverage.

Sorry, but the answer's usually yes. Most personal auto insurance policies won't cover you if you're getting paid to use your own car to transport people or property for business purposes.

In general, you'll need to buy a business or commercial auto insurance policy if you are a health care worker who occasionally uses your own car to take clients to appointments. The same is true if you use your own car to deliver flowers, newspapers, pizzas, etc.

If you have questions about your coverage -- and policies do differ -- contact your agent or insurance company directly.

Health insurance questions: Preventive colonoscopies and polyps

Until fairly recently, when consumers had routine preventive colonoscopies, they often faced a substantial bill for surgery if a polyp was discovered and removed during the procedure. But current guidelines from the U.S. Department of Labor, under the Affordable Care Act, protect consumers from these extra charges for polyp removal.

Q5: If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost-sharing for the cost of a polyp removal during the colonoscopy? 

No. Based on clinical practice and comments received from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and the Society for Gastroenterology Nurses and Associates, polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure. On the other hand, a plan or issuer may impose cost-sharing for a treatment that is not a recommended preventive service, even if the treatment results from a recommended preventive service.

In addition, the federal guidelines help people with a family history that put them in a high risk group for certain diseases. They will now be able to get more frequent preventive care without additional costs.

Q7: Some USPSTF recommendations apply to certain populations identified as high-risk. Some individuals, for example, are at increased risk for certain diseases because they have a family or personal history of the disease. It is not clear, however, how a plan or issuer would identify individuals who belong to a high-risk population. How can a plan or issuer determine when a service should or should not be covered without cost-sharing? 

Identification of "high-risk" individuals is determined by clinical expertise. Decisions regarding whether an individual is part of a high-risk population, and should therefore receive a specific preventive item or service identified for those at high-risk, should be made by the attending provider. Therefore, if the attending provider determines that a patient belongs to a high-risk population and a USPSTF recommendation applies to that high-risk population, that service is required to be covered in accordance with the requirements of the interim final regulations (that is, without cost-sharing, subject to reasonable medical management).

If you're having problems with your health insurer over these sorts of issues and you live in Washington state, feel free to contact our consumer hotline at 1-800-562-6900 or email us. 

WA Supreme Court: Insurer can be held liable for agent's actions

In a case that’s been closely watched by the insurance industry, Washington’s State Supreme Court on Thursday affirmedthat insurers are liable for the illegal actions of their agents.

“The ruling is a big win for consumers,” said Insurance Commissioner Mike Kreidler, whose decision the case was challenging. “If you allow someone to do business on your behalf, it only stands to reason that you can be held responsible for what they do.”

The case involved violations of the state’s insurance laws in 2006 and 2007 by an insurance agency appointed by Chicago Title Insurance Company. That agency, Land Title Co. of Kitsap County, Inc. repeatedly offered illegal inducements to get business. The violations included illegally “wining and dining” real estate agents, builders and mortgage lenders with free meals, donations for a golf tournament, monthly advertising, and Seattle Seahawks playoff game tickets.

Although Land Title was Chicago Title’s exclusive agent in the Washington counties at issue in the case, Chicago Title argued that it was not responsible for its agent’s actions. In a consent order signed in 2009, the company agreed to pay a $48,334 fine if it did not prevail in court.

“Chicago Title’s arguments were contrary to a century of insurance law,” said Kreidler. “In order to effectively regulate insurers and protect consumers, it’s important to hold insurers responsible for the actions of their agents.”

Title insurance practices have long been a concern to Kreidler, whose office in 2005 scrutinized 18 months of employee expense reports and ledgers for the largest title companies in King, Pierce and Snohomish counties. The examination found many cases in which the companies were providing gifts, golf tournament sponsorships, parties, ski trips, sports tickets, meals and other inducements to get business.

“Few people shop for title insurance, although they certainly can,” said Kreidler. “It tends to be included in the large stack of documents that homeowners are handed to sign. So title companies and others in the industry are positioned to steer business to particular insurers.”

New rules took effect in March 2009, clearly outlining what can be given. There are limits on advertising, donations to trade associations, meals, training, leasing workspace and gifts.

Agent charged with theft and forgery; collected commissions for fictitious customers

A former Vancouver insurance agent has been charged with theft and forgery for allegedly collecting about $15,000 in commissions by creating fictitious applicants for insurance policies.

Julie Anne Goss, 43, an independent agent for AFLAC, was arraigned last week in Clark County Superior Court.

The scam came to light after the owner of a restaurant in Battle Ground, Wash. told AFLAC that she’d received premium bills for two “employees” that had never worked there. 

AFLAC investigated, and it turned out that Goss wrote dozens of policies for 15 people that either weren’t employees at the named businesses or apparently didn’t exist. In other cases, she wrote policies for real employees, but they said they hadn't applied for the coverage.

In each case, Goss stood to get a commission for the policy. All told, the investigator found, between August 2010 and January 2011, Goss wrote 91 fraudulent insurance policies and collected more than $15,000 in commissions for them.

The company canceled its contract with Goss in March 2011 and reported the matter to our Special Investigations Unit. After investigating further, we revoked Goss’ insurance license in January 2012. The charges against her were filed in late June.
If you suspect insurance fraud and you live in Washington state, please report it.

How to find an old life insurance policy (and other unclaimed property)

We get a lot of queries from people looking for old life insurance policies that they think might have named them as a beneficiary.

Here are some quick tips. For more specifics and links, please see our brand-new "how to find an old life insurance policy" web page.

• Try to track down as much information as possible. You'll presumably know the name of the policyholder (any name changes?), and it also helps to know the state or states that the person lived in.

• Ideally, you'll be able to locate a copy of the policy itself, which will have a number on it. But sometimes there's a wrinkle: the insurance company or its name may have changed, especially for older policies. That can be a challenge, but your state's insurance department can probably help you track down the current company information. If you live in Washington state -- we're the state insurance regulator there -- feel free to call us at 1-800-562-6900 and talk to our consumer advocacy staff.

• If you can't find the policy, try going through the person's financial records, looking for payments made to an insurer. Also, look through old mail: the company may have sent periodic statements or billing reminders. It's also worth checking with the person's auto- or homeowners insurers, since people sometimes buy life insurance from the same company.

• You could opt to pay a search company to run a check for the person's name through industry databases or send queries to a large number of insurers.

• If a policy goes unclaimed for a long time, insurers are supposed to turn the money over to state-run unclaimed property programs. They hold the money, often forever, in case someone files a claim. You can easily run the person's name through these free, state-run online search sites. Washington state's is at http://ucp.dor.wa.gov, and you can easily find other state's unclaimed property programs at www.unclaimed.org.

• One other important tip: Many life insurance policies automatically end at a certain age.  

COBRA and Medicare: How to avoid a common (and costly) mistake

If you're continuing your employer health coverage through COBRA and you become eligible for Medicare, it's important for you to sign up for Medicare during your Medicare eligibility period.

Here's why: Health insurers generally include language in their policies that says they can refuse to pay bills if they find out that you stayed on COBRA coverage after you were eligible for Medicare.

A lot of consumers get caught in this trap. Many people who are on COBRA don't know that they should sign up for Medicare when they become eligible. Instead, they assume that COBRA will continue to pay their medical bills, so they delaying signing up for Medicare until their COBRA coverage ends.

Then, months after becoming eligible for Medicare, they find out that their COBRA plan is refusing to pay for medical care that the consumer already received. They can't backdate their Medicare enrollment, so they're stuck with those medical bills. Yikes.

Don't get caught in this trap. If you're on COBRA and become eligible for Medicare, sign up.

"My doctor says I need a treatment, but my insurer won't cover it. What can I do?"

Q: "My doctor says that I need a particular medical treatment, but my health insurance company won't cover the cost. Is there anything I can do?"

A: Yes, there definitely is. Contact your health insurer, tell them you want to file an appeal, and ask what you need to do to start the process.

Then collect materials to support your argument, such as letters from your doctors describing why this is the best treatment for you, any medical journal articles or studies showing the treatment's effectiveness, etc.

You may also want to point out the health problems that will or can arise if the company doesn't pay for the treatment. Be sure to provide and estimate of the costs of treating those problems, especially if those costs would be significantly higher than paying for the treatment.

After you send in your appeal to your insurer, don't give up. Most people don't win the first round, but the odds of winning increase as you reach higher levels of appeals. The change of winning is highest when your appeal reaches the final level, called an "independent review organization."

For more tips on appeals, including templates, sample letters and detailed pointers, please see the appeals section of our website or call our consumer advocates at 1-800-562-6900. (If you live in a state other than Washington, please contact your own state's insurance department.)

Statement on U.S. House vote re: delaying the individual mandate

Note: The U.S. House of Representatives is scheduled to vote today on a bill that would delay for a year the individual mandate requiring most Americans to have health coverage starting in 2014. The penalty for not having coverage next year would be $95 or 1 percent of income, whichever is greater.

Statement from Washington Insurance Commissioner Mike Kreidler:

“Delaying the mandate would be unwise. This is an issue of personal responsibility. It’s unfair for people who can afford coverage to not have it, and to expect the rest of us to cover the cost of their care if they become seriously sick or injured. ”
“A critical part of the Affordable Care Act was the provision requiring that insurers take all applicants. No more screening out people because they have pre-existing medical conditions. But to make that work, you have to have as many people as possible in the insurance pool.
“Without an individual mandate to have coverage, people would likely just buy insurance when they knew they needed it. That’s like letting people get homeowners insurance only when their house catches fire.”

More states asking insurers if they're ready for climate change

From a press release we just sent out:

Insurance companies are facing growing scrutiny over their preparedness for climate change, an issue that could potentially affect insurance affordability and availability.

“I’m very pleased to see more states joining this effort,” said Washington Gov. Jay Inslee. “Being prepared is clearly in the best interests of both insurers and the families and businesses they insure.”

Last year, insurance regulators in Washington, California and New York surveyed major insurers about what steps they’re taking to address risks to their underwriting and investment portfolios.

This year, regulators in Connecticut and Minnesota have also joined the survey.

“Climate change is a potential game-changer for insurers,” said Washington Insurance Commissioner Mike Kreidler. “We want to make sure that this issue is on their radar.”

Climate change poses a double challenge to insurers. Extreme weather events and droughts, for example, can sharply increase claims. Climate-related issues could also have a significant effect on insurers’ investments, potentially affecting their long-term ability to pay claims.

“Unprepared insurers are much more likely to simply pull out of markets, leaving homeowners and businesses struggling to find alternative coverage,” said Kreidler, who chairs the National Association of Insurance Commissioners’ working group on climate change. “And when insurers abandon a market, government tends to end up as the insurer of last resort.”

Kreidler’s office has been surveying insurers on this issue since 2008.

“I wish some companies were further along,” said Kreidler, “but I’m encouraged to see that a growing number of companies are taking steps to incorporate climate change into their risk modeling and investment considerations.”

For a look at past surveys and responses for Washington, California and New York, please see California’s Climate Risk Disclosure Survey web page.

"I have two health insurance plans. Why do I still have to pay for some things?"

Q: "Why do I have to pay anything out of pocket? I have two health insurance plans. Between them, shouldn't they cover all the costs?"

A: Unfortunately, most insurers changed the rules under which they coordinate benefits within the past 10-15 years. Under the new rules, there's less economic advantage to have two (or more) health insurance plans.

As a general rule, if you have two health plans and you receive both of them on your own (i.e. you don't get either of the plans through your spouse), then generally the plan that you've had for the longest period of time should be the primary policy.

However, there are a lot of variables that can change the result. For example, if one of your plans is Medicare and you get the other plan through your employer, then having a Medicare plan can change the order of benefits, depending on the size of your employer.

Confusing? Yup. If you're having problems with an insurance issue and you live in Washington state, feel free to give us a call. We may be able to help. Our insurance consumer hotline is open from 8 a.m. to 5 p.m., Monday through Friday. The phone number if 1-800-562-6900. You can also reach us at AskMike@oic.wa.gov.

Insurance tips: Are my antiques and collectibles covered?

Q: "I have a number of rare antiques and collectible items of special value. Are they covered by my homeowners policy?"

A: Household goods usually are covered, but only to a limited value. If you have rare, valuable items, it's a good idea to talk to your agent or insurer about that, because you may need to insure them separately. This will likely cost more, but maybe not a lot more. And you'll know you're covered, rather than finding out after a fire, burglary, etc. that your policy was inadequate.

Also, you may need to get professional appraisals to establish the current, accurate value of the items.

For more tips, including inventorying your possessions, resolving claims, etc., please see our "insurance tips for homeowners" page.

Flood insurance changes run into resistance

From AP:

Just a year after Congress imposed significant changes in the government's oft-criticized flood insurance program, howls of protest from homeowners facing higher premiums have coastal lawmakers pressing for delays that would preserve below-cost rates for hundreds of thousands of people in flood-risk areas.

 Here's the full story, in case you missed it. Curious to see if  your community is scheduled for a rate update? Enter your zip code here.

What you need to know about boating and insurance

Summer is finally here! And it arrive before the Fourth of July - a rarity in the Northwest. Many of us like to go boating, especially with crab season now open. If you own a boat or rent a boat, you should consider boat insurance. Here's why:

Boating liability insurance in Washington state is not mandatory, but it's a good idea if you want to protect yourself and your passengers.  You can purchase boat insurance for a fairly reasonable price.  Coverage protects your boat from physical damage as well as your passengers if they're injured.  It also protects your boating equipment.

Check with the insurance company that covers your home and auto to see if it'll cover your boat, too. You could get a discount for having multiple policies with them.  If you're not sure what type of coverage you need, just ask your agent.  He or she can help make sure you're properly insured. Some small boats, like rowboats or dinghies may be covered under your homeowner policy - check your policy to be sure.

Here's more information about boating regulations in Washington state.

 

Our Insurance 5000 Bldg is closed today due to a malfunctioning cooling system

Effective immediately, our Insurance 5000 Bldg. in Tumwater is closed today due to a malfunctioning cooling system. All online services are still available and our other offices in Seattle, Olympia and Spokane are open. We expect the building to be back open tomorrow.

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

Commissioner Kreidler has been involved in climate change and insurance issues for years now. Currently, he chairs the National Association of Insurance Commissioner's Climate Change and Global Warming Working Group. Read his take in Climate Action on the unique opportunity the insurance industry has to prepare for the changes to our climate. 

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

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

Here's a couple more common questions we get:

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

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

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

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

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

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

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

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

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

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

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

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

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

To report insurance fraud or insurance scams here in Washington state, here's how to reach us.

Allianz Life Insurance fined $150,000

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

For more, please see the press release.

Spokane man sentenced for insurance fraud and attempted theft

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

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

The case stemmed from a claim filed in late July 2009 by Scribner's mother, Marilyn Warsinske. She said a patio roof at a home she'd purchased had collapsed due to the weight of snow some 6 months earlier. The policy covered "like kind and quality" replacement. Her son, she told the company, would handle the claim.

Scribner told the insurance company that patio cover was an extensive structure, spanning the entire length of the patio and wrapping around the home's chimney. Claims officials, inspecting the site, wondered why was there no flashing or holes in the masonry. Scribner said that house painters must have made repairs.

He sent the insurance company three bids to replace the cover based on his description. The bids ranged from $195,586 to $213,815.

Claims officials asked Scribner for any photos of the roof prior to the damage or after it collapsed. Perhaps some were taken during a home appraisal prior to the purchase, they suggested. Scribner said there were no photos and was no appraisal.

But a claims handler discovered an aerial photo of the home on a real estate website. It showed a much smaller patio cover than Scribner claimed.

The company launched a fraud investigation and notified Insurance Commissioner Mike Kreidler's anti-fraud Special Investigations Unit.

As it turned out, there had been a home appraisal, the investigators discovered. In fact, Keith Scribner met with the appraiser. And the appraisal included photos of the patio cover. A real estate agent interviewed by investigators described the cover as being "small and nothing special or significant."

The home's previous owner also provided photographs of the structure. It was originally canvas. When that because troublesome to remove each year, the homeowner bought a polycarbonate cover. Cost: About $300.

An architect told a state fraud investigator that he'd met with Scribner in 2008 -- months before the snow collapse -- to discuss plans to replace the deck cover with new, larger one.

A local company, provided with measurements and photographs of the original structure, drew up replacement bids at the request of a state fraud investigator. The bids: $3,913 and $4,782.

New report cites increased flood risk in coming decades

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

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

Mother Jones magazine summarized the report here.

Wildfires and homeowners insurance: Five things you need to know

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

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

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

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

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

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

Heads up: New travel insurance license rules in WA

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

• Under the new rules, any individual or business entity that will sell, solicit, or negotiate travel insurance must have the travel line of authority specifically listed on their Washington state insurance producer license.

• There is one exception to this new requirement. If a licensed business entity (agency) wants to transact travel insurance business, it must a) have a producer license with the travel line of authority and b) have a designated responsible licensed person for the agency who has a producer license with the travel line of authority.

Got questions? We've prepared an FAQ page on this topic, and if that doesn't help, you'll find contact info (email and phone) at the bottom of the FAQ page.

Average health insurance premiums, by state

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

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

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

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

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

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

Here are the state average premiums in our region:

• Washington: $5,144 single, $14,559 family
• Oregon: $5,055 single, $14,283 family
• Idaho: $4,553 single, $13,211 family
• California: $5,255 single, $15,837 family

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

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

Unfortunately, this is a national problem.

So what can you do if the increase is more than you can afford? You can choose to reduce your benefits under the policy, such as:

• Reduce your daily benefit
• Reduce the benefit period duration, such as from five years to two
• Reduce the amount of your optional inflation protections

 You can also choose what's called the contingent non-forfeiture option. Under this option, you keep your policy in force and stop paying premiums. Your coverage does not end, and the company provides benefits for qualified long-term care services covered under your policy -- here's the caveat -- equivalent to the premiums you've paid.

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

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

Long term care insurance is a fairly new product, with many companies not offering it until the early 1990s. As a result, they had little experience to base their prices on, and early policies were priced significantly lower than they should have been, based on how the cost of claims and the fact that -- unlike life insurance, for example -- few people cancel the policies. People get the policies, knowing they may well need them when they're older, and they tend to keep them.

 

As a result, most long-term care insurers have bumped up their premiums sharply in the past few years -- in some cases 40 percent or more -- angering customers who signed up for policies at relatively low cost years ago.   This puts insurance regulators in a bind. Consumers are understandably unhappy. But if regulators reject the rate increases, the insurance carriers could run into financial trouble, leaving them unable to pay claims. And nationally, a number of insurers have simply gotten out of the business of issuing new long-term care policies, which leaves consumers with even fewer choices. (In Washington, there are still a large number of companies approved to sell the coverage. Here's a list.)      

Stevens County woman convicted of insurance fraud over fake claims

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

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

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

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

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

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

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

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

The charge on which she was convicted is a felony.

Important notice to insurers re: new online complaint system

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

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

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

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

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

There are two training times available:

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

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

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

To learn more about the company Complaint Response System (CRS) project, visit our meetings page.

New report: Washington State Health Insurance Pool

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

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

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

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

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

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

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

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

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

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

Tools to help estimate the costs of medical procedures

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

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

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

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

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

• Many assistance programs, including those that cover children, veterans, pregnant women, those needing organ transplants, disabled workers, etc.
• Low-cost help for vision and hearing problems
• Free- and low-cost dental clinics
• Free breast-, cervical-, and colon-cancer screenings, HIV care help and support, etc.

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

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

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

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

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

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

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

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

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

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

Job opening: Human resources consultant

We're recruiting to fill a Human Resource Consultant 3 (Senior HR Generalist) position with our agency's operations division, based at our Tumwater, Wash. office.

 

The successful candidate, with guidance from the agency's human resources manager, will use a high degree of professional judgment to consult with assigned divisions on a variety of complex human resources issues.

 

For more specifics, duties, salary, timeline, etc., please see the full job listing.

For other current job openings in our office, please see our "job opportunities" web page. At the current time, we have four positions we're recruiting for. The others include:

• Deputy insurance commissioner for company supervision
• Senior market analyst
• Information technology specialist

"My company's wellness program is asking me health questions. Is that legal?"

We often hear from consumers who ask whether it's legal for their employer to ask health questions in conjunction with employee wellness programs.

Last week, the federal government issued a final rule addressing this issue. The answer: Yes, employers can do that, as long as they meet certain non-discrimination criteria. Among them:

• The wellness program must be "reasonably designed to promote health or prevent disease,"
• must not be overly burdensome,
• and may not be "a subterfuge for discriminating based on a health factor."

Here’s a link to the rule where you'll find a lot more details, plus a link to an article that gives a good overview of the rule.

Insurance tips: Why are my life insurance premiums increasing?

Here's are some life insurance tips from our consumer advocacy department, which gets a lot of insurance questions:

With long-term products such as whole life insurance, annuities, or long-term care insurance, it can be difficult to know which product or company is the best. Companies often give an estimate of how they expect the products to perform, but realistically, only time will tell which company and product will perform the best. Don’t fall for high teaser interest rates or low-ball premiums that are adjustable.

Our agency receives a lot of complaints from people whose universal and other whole life policies are underfunded and become too expensive to maintain. It’s important to realize that when you buy a whole life product, you’re actually buying a schedule of mortality rates.

No matter how young you are when you buy the policy, as you age, your mortality charges will increase so you’ll need to pay more to keep the policy in effect. Review your annual statements and illustrations to stay on top of how your policy is performing so that you can make sure that you pay enough premiums to keep the policy in effect.

And then there's this issue: A lot of people who have life insurance policies don’t tell the beneficiaries that the policy exists. As a result, the beneficiaries don’t collect on the policies when the policyholder dies. (Partly as a result of this lack of communication, there’s an estimated $200 million in unclaimed life insurance benefits in the U.S.) Also, life insurance policies often lapse when a dying or disabled person quits paying the bills. Remember to keep your life insurance beneficiaries informed so that they can make a claim on the policy after you’re gone and so that they can make sure the policy doesn’t lapse beforehand.

The proposed health insurance rates for 2014: Where to find them and what they say

A lot of people are wondering how health care reform will affect premiums for health insurance, including those plans that will be sold through the new Washington Healthplanfinder, our state's health insurance exchange.

The insurers selling plans inside and outside the Exchange have filed their proposed rates with our office. These rates include those for small businesses and for individuals buying insurance coverage on their own.

Our actuaries are reviewing the proposed rates, which we've posted on our website.

From what we've seen so far, we're pleasantly surprised. Many people will see rates similar to what they're paying now, or in some cases, lower -- and with substantially better benefits. While we have a lot of work to do in reviewing these proposals, and the final rates could change, we're definitely not seeing the huge rate increases that some insurers had predicted.

In most cases, the benefits are substantially better, particularly for the individual market. Today, most individual health plans don't cover prescription drugs or maternity care. When the Affordable Care Act takes full effect in January, they'll have to cover those things.

Also, in many cases, deductibles in the new plans are much lower than today and the new plans include approximately $500 worth of free preventive services, such as a wellness visit, some immunizations, cancer screenings, etc.

Finally, federal subsidies will help with the costs. If you earn less than $45,960 (or $94,200 for a family of four) you may qualify for a federal subsidy -- in the form of tax credits -- to help you pay your premium. You can get an estimate of that subsidy at the Washington Healthplanfinder site.

Job opening: Deputy insurance commissioner for our Company Supervision division

We're recruiting to fill an exempt position for the deputy insurance commissioner in charge of our Company Supervision Division.

The successful applicant will manage a wide variety of situations and influences the course of insurance affairs at the state, national and international levels.

The position is responsible for the financial and market examination and supervision of all Washington-organized insuring entities and all other insuring entities licensed to do business in this state. The position’s mission is to protect insurance consumers, the public generally, and the state’s economy by ensuring the safety and soundness of insuring entities, and to ensure that they comply with applicable law.

In addition, the position has broad statutory discretion and specific statutory authority involving the registration/licensing, operation, supervision, receivership, liquidation, and merger of insuring entities.
For more specifics, duties, salary, and more please see the full job listing.

When an insurer forgets to bill you -- and then suddenly remembers

Q: "My insurer is supposed to take my monthly payment out of my checking account, but didn't do it for three months. Now they want me to pay for three months all at once. Can they do that?"

A: Sorry to tell you, but the short answer is yes, since they provided coverage for those three months. But since they erred by not taking the payments on time, it's worth asking if they'll allow you to pay in installments, so you don't get hit with a triple bill all at once.

When you know that a monthly insurance premium is supposed to come out of your bank account and you notice that it doesn't, don't wait and hope that that means you get free insurance. Call your agent or insurer and find out what's going on.

Job opening: Senior market analyst

We're recruiting for a senior market analyst position at our Tumwater, Wash. office.

This position is responsible for conducting market analysis of regulated entities under the direction of the Chief Market Analyst. This position protects consumer's interests and promotes a healthy business environment in this state by providing regulatory oversight of market interactions between consumers and insurance carriers.

For more specifics, duties, salary, timeline, etc., please see the full job listing.

May 9 hearing set to consider Washington Dental Service reorganization and merger plan

Insurance Commissioner Mike Kreidler has scheduled a hearing for 10 a.m. on May 9, 2013, in Olympia to consider whether he should approve or deny the request for the merger of Washington-based Washington Dental Services (WDS).


WDS has filed an application for its plan of reorganization and merger transaction that includes a proposed reverse merger of Washington Dental Service with and into a DD of Washington subsidiary to become a subsidiary of an existing holding company.

Here's a summary of the proposal, including background, history, and a brief explanation of the hearings process and what we look at. If the proposal is approved, WDS would become a subsidiary under a new holding company system. WDS would later change its corporate name to Delta Dental of Washington.


To view filed documents and information about the hearing process, go to Washington Dental Service #13-0115. (Scroll down a bit after clicking on that link.) Those documents include the notice of hearing, the reorganization plan, board resolutions, organizational charts, and other requests for transactions filed in this proceeding.

The hearing is open to the public. Any interested parties may submit letters of support or concerns or objections and/or may participate in the hearing by appearing in person or by telephone at no charge. For street address or directions on dialing in by phone (as well as more background on the proposal), please see the hearing order.

See if you'll save money on health insurance next year

Curious about what will happen to your health insurance rates after health reform? Our state Health Benefit Exchange, charged with creating a new online marketplace for health insurance, just launched a consumer-focused website, www.wahealthplanfinder.org and it includes a calculator for estimating your costs.

You can't choose a health plan until the site launches on Oct. 1, but you can use the calculator to see if you might qualify for a subsidy to help with your insurance costs. Keep in mind, it's only an estimate, but it should give you a sense of what to expect.

 

"Is there a grace period for a newly licensed driver to get insurance?"

Nope, not in Washington state. In order to operate a motor vehicle here, the driver must have the state minimum liability insurance. There is no grace period to obtain that insurance.

So parents, check with the insurance agent (or insurer) to see if your young driver is covered under your automobile insurance or if they need their own insurance policy.

New report on health insurance: 84 million in U.S. are uninsured/underinsured

The Commonwealth Fund this morning issued its latest report on uninsured and underinsured adults. Among the key points, in 2012:

• 84 million Americans were uninsured or underinsured.
• Due largely to the ACA, the share of young adults w/o insurance dropped by 1.9 million between 2010 and 2012
• 41 percent of adults ages 19-64 are having difficulty paying medical bills
• Costs prevent many Americans from getting needed health care
• Of the 55 million uninsured for all or part of 2012, 87 percent had incomes that would qualify them for subsidized health insurance under the ACA
• Of the 30 million underinsured, 85 percent would qualify for subsidies

Among the remaining challenges noted in the report:

 "...the law does not provide subsidized coverage to people who are not in the U.S. legally. Jonathan Gruber, an economist at the Massachusetts Institute of Technology, has estimated that of people who will remain uninsured in 2016, about 5 million will be undocumented immigrants. Second, both the Congressional Budget Office and Gruber predict that many Americans will not be insured, even though they are eligible for the new coverage options, whether because they are not aware of their eligibility, they are unable to find an affordable premium, or they elect not to enroll."

 

"I filed an insurance claim. How long will it take for the company to investigate?"

Here in Washington state, insurers should generally complete their claims investigations within 30 days unless there are good reasons why that cannot be done.

That said, all people involved in the investigation of a claim must provide reasonable assistance -- usually meaning providing information as requested -- so the insurer can process the claim.

The law that includes the 30 day standard is WAC 284-30-370.

If you have a claim that you feel is taking unreasonably long -- and you live here in Washington -- feel free to contact our consumer advocacy staff and we'll try to help. You can fill out an online complaint form 24/7, or you can call us toll-free at 1-800-562-6900.\

Here are more tips about filing an auto insurance claim, as well as tips on filing a homeowners insurance claim, and tips on how to file an appeal when your health insurer says no to a payment or treatment.

Job opening: senior market analyst

We're recruiting for a senior market analyst to fill an opening in our main building in Tumwater, Wash.

The position is responsible for conducting market analyses of regulated entitites under the direction of our chief market analyst. The goal is to protect consumers' interests and promote a health business environment in Washington, both of which we help do by providing regulatory oversight of market interactions between consumers and insurance carriers.

For more specifics, including detailed duties, salary, timeline, etc., please see the full job listing.

We knew it! Actuary named best job of 2013.

The jobs website CareerCast.com has named the best (and worst) jobs of 2013. Topping the list (again, yes) is actuary.

The ratings, according to this summary in the Wall Street Journal, were based on physical demands, work environment, income, stress and hiring outlook.

And there are some surprises on the list. Dental hygienist came in among the top jobs, as did veterinarian. Actors, roofers and dairy farmers are among the worst, no surprise there, but so are senior corporate executives and military generals.

The police cited the other driver, but his insurer says I'm partly at fault? How can that be?

We get a lot of consumer calls like this.

Police have the authority to issue citations based on their interpretation of the accident scene and the rules of the road. Drivers who disagree can make their case in traffic court.

But here's the key thing when it comes to insurance: A citation doesn't necessarily establish the issue of negligence, which can include factors including your own driving behavior, weather, speed and visibility. And the reality is that insurers sometimes attribute some portion of fault to both drivers rather than rely solely on who got a ticket at the scene. If an insurer does that, however, they should explain the basis for their decision.

Want to know more? Here in Washington state, the law that allows for this apportionment of fault is RCW 4.22, titled "Contributory fault."

Here's more about your rights when you file an auto insurance claim, and guidelines on what to do if you're in an accident and what to do if you're hit by an uninsured driver.

"Is there an insurance law that says when my car has to be totaled?"

Not that we're aware of, at least here in Washington state.

That said, we're aware that sometimes there is hidden collision damage to a car that can add substantially to the cost of the initial estimate.

With that in mind, insurers may decide to total a car when their initial repair estimate is around 70 percent of the vehicle's current market value. Otherwise, if the repairs are started and costs due to hidden damage escalate another 30 percent or more, they can end up spending more to fix the vehicle than it's actually worth.

The short answer: there is no "official" formula in the law for totalling a vehicle. But insurers look at the repair cost potential. If it's close to the value of the car, they may decide not to even begin repairs, and to simply compensate you for the value of the vehicle.

How do they establish that value? The insurer owes you the actual cash value -- i.e. the retail market value -- of your car. Insurers have to look at local values for comparable vehicles, although with your permission, your insurer can extend the search beyond 150 miles.

If you disagree on the value -- and we get these calls all the time -- you can hire an appraiser and go through the appraisal process in your auto policy. If the dispute is with someone else's insurer, you can either file a claim with your own insurer, or you may want to consider taking the matter to court.

Please see our "What happens after your car gets totalled" page for  much more on totalled car values, disputes, and what happens if you opt to keep your totaled car.

We saved Washington consumers $5.6 million in auto insurance premiums last year

Little-known fact: When many types of insurers want to change their premium prices, they must file the new rates with us. Our actuaries and analysts go over the numbers, and -- where justifiable -- we hold those increases down.

Through this process, we've saved Washington state consumers nearly $11 million over the past three years. Here's the annual difference between requested rates and approved rates during that time:

• 2010: $2,655,927
• 2011: $2,714,917
• 2012: $5,603,182