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.