Friday, June 7, 2013

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.