Washington State Insurance Update

Non-profit health insurer surplus legislation advances in WA legislature

2012-01-31T08:47:00.000-08:00

A bill we requested, Senate Bill 5247, was approved by a key state Senate committee last night.

The bill would allow us, when considering premium rates proposed by non-profit health insurers, to take into account the large surpluses that the companies have built up in recent years. (Surpluses are not the same thing as reserves. Theres' been some confusion out there on this point.)

These surpluses have grown dramatically over the past decade. The state's three major nonprofit health insurers together now have more than $2.4 billion in surplus.

Meanwhile, the cost of individual health policies more than doubled from 2005 to 2011.

At least 11 other states, including neighboring Oregon, have the authority to consider surpluses when reviewing rates. We think it's time Washington did the same.

What's a health care exchange?

2012-01-31T05:59:00.000-08:00

Stateline, a news service that covers state government, put together a story summarizing the new health care exchanges scheduled to launch in 2014, how they work, and the status of the efforts to create them at the state level. From the article:

Considered the engines of the national health law, state exchanges are online marketplaces designed to make it easier for individuals and small businesses to shop for insurance policies. They will also be one-stop enrollment centers for low-income people who qualify for Medicaid and moderate income individuals who qualify for federal tax credits.

There's a tremendous amount of behind-the-scenes work taking place in Olympia in preparation for these exchanges. Again, from Stateline's article:

One small group of states — led by Maryland, Washington, Oregon, Rhode Island and California — is running significantly ahead of the rest. Statutes have been enacted to create the exchanges and the basic decisions about how to run them have already been made.

Our office and Gov. Chris Gregoire have also requested additional exchange legislation in Washington this year.

Tacoma insurance agent sentenced for stealing from clients

2012-01-30T06:17:00.000-08:00

An insurance agent in Tacoma has pleaded guilty to second-degree theft for misappropriating checks from dozens of policyholders.

Michel Anthony James, an independent contractor who was working for State Farm, is believed to have deposited checks from more than 40 policyholders into his own business bank account. State Farm discovered the problems when it audited James' accounts. It subsequently terminated its contract with James.

Based on a subsequent iinvestigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit, James:
• failed to apply premiums to policies,

•wrongly withdrew cash from his premium fund account (which is where those policyholder checks were supposed to go),

•failed to refund overpayments to policyholders,

•and violated contractual agreements with State Farm.

The theft added up to $23,926.87.

On Jan. 13 in Pierce County Superior Court, he pleaded guilty to second-degree theft. He was sentenced to community service, electronic home monitoring and $1,800 in costs and assessments. He has also paid back the misappropriated money.

(Updated Feb. 1 to note that James no longer works for State Farm.)

Tacoma man pleads guilty to forgery and insurance fraud

2012-01-27T11:03:00.000-08:00

A Tacoma man has pleaded guilty to two counts of forgery and one count of felony insurance fraud for filing a false auto insurance claim.
Cash B. Knott, 46, pleaded guilty Jan. 13 in Pierce County Superior Court.
On Nov. 6th, less than a month after getting coverage from Progressive Direct Insurance Co. for his 1992 Ford Ranger pickup, Knott filed a $5,674 insurance claim with Progressive. He said someone had scratched the paint, stolen his chrome wheels and tires, and stolen his navigation and entertainment system, 1,000 watt amplifier and other electronic components.

He provided Progressive with a Sept. 2 stereo shop invoice for $4,547.84 worth of stereo equipment, a copy of his check, and a bank statement showing the withdrawal from his checking account.
The problem: When contacted by an insurance adjuster, the stereo shop said it had no record of such a purchase. All they could find was that Knott had bought an amplifier -- for $109 -- on Sept. 2.
Insurance Commissioner Mike Kreidler's Special Investigations Unit obtained a search warrant for Knott's bank records. The bank found no checks written to the stereo shop, and none whatsoever for $4,547.84.
He's slated for sentencing on Feb. 17th. The standard range for the charges are 22 to 29 months in prison.

What are my odds of dying from...?

2012-01-27T06:48:00.000-08:00

The Insurance Information Institute has released some interesting data about the odds of dying in a wide variety of accidental (or sometimes not-so-accidental) injuries.

According to the III, your odds of dying from:

A car accident: 1 in 303.
Being shot: 1 in 306.
Falling down the stairs: 1 in 2,018.
An airplane crash: 1 in 7,032.
Falling off a ladder: 1 in 8,912
A lightning strike: 1 in 84,079.

See the link above for more examples.

Anti-fraud group releases its "Hall of Shame" for 2011

2012-01-26T05:55:00.000-08:00

The Coalition Against Insurance Fraud has compiled its annual "Insurance Fraud Hall of Shame" list. And this batch is pretty horrifying:

A debt-plagued Arizona homeowner torched his home for $440,000 in insurance money -- and killed a witness and the witness' family. He got 14 years in prison for the insurance fraud, and the death sentence for the murders.

A Rhode Island radio DJ who wanted to upgrade her home and pool had several friends simulate storm damage to her home -- smashing a hole in her roof with a tree limb, messing up the pool, etc. The problem: The weather was fair and in the 70s that day. And one of the DJ's accomplices was caught on an unrelated federal wiretap bragging about the job.

Another home-arson case involved a California couple who hired a man to burn down their home. The man used a lot of gasoline, leading to a blast that left him horribly burned. He died later that day. The couple went to prison.

There are several others, but we'll end with what's probably the strangest case. A mortuary workers and medical worker faked the death of a man who'd never existed. There was even a grave. And a funeral service. Using forged documents, the workers and accomplices had taken out $950,000 in life insurance policies on the fictitious man.

When one company had doubts, the workers exhumed the coffin, filling it with a mannequin, cow meat, and bones before hauling it to a crematorium. But when they tried to bribe a doctor to forge medical records, he instead cooperated with investigators and recorded the conversations. One of the workers was sentenced to two years in prison, the other other is awaiting sentencing.

Long-term care insurance: Is it right for you?

2012-01-25T14:37:00.000-08:00

Kaiser Health News and the Washington Post have an article today on the pros and cons of long term care insurance. From the article:

The question of whether to get long-term care insurance bedevils consumers and their advisers. Unlike medical insurance, it is intended primarily to cover people who need assistance with so-called activities of daily living -- for example, the care of a dementia patient or someone recovering from a broken hip. It can be expensive: Premiums range from $1,000 to $5,000 a year, depending on the age, sex and health of the purchaser as well as the extent of the coverage. And policy details can be confusing.

Even advocates acknowledge that it isn't for everyone. Jesse Slome, executive director of the American Association for Long-Term Care Insurance, an industry group, sums it up well: "Long-term care is a universal issue facing all Americans who are getting older. But long-term-care insurance is not a universal solution."

Many people think that their health insurance will cover long term care, but most don't. Nor do Medicare or Medicare supplemental policies. Medicaid will pay, but to qualify for Medicaid, your assets must dwindle away to almost nothing.

In recent years, we've received numerous complaints about the cost of the policies. 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.

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 is a problem across the country. Again, from the article:

"It's probably the most frequent complaint I hear," says (Kansas Insurance Commissioner Sandy) Praeger, who heads the National Association of Insurance Commissioners' health and managed care committee. "The problem is, the older policies weren't priced right to begin with. Companies expected about 8 percent of customers to stop paying their premiums, when, in fact the lapse rate is closer to 2 percent." That meant the insurers had to cover more beneficiaries than they expected at a time when the economic downturn has meant less returnon their investments.

Praeger acknowledges that rate increase requests have posed a dilemma for insurance commissioners. "If we don't give them the rate increase they need, the insurance carriers could become financially impaired, and that doesn't help people," she says. In fact, in recent years, a number of companies have stopped selling policies. As a result, she adds, it's hard to turn the increases down.

Insurer fined $100,000

2012-01-25T08:40:00.000-08:00

A company that issued thousands of medical insurance policies to college students has been fined $100,000 for charging unapproved rates, as well as other violations.

Indiana-based Unicare Life and Health Insurance Co. has agreed to pay the fine.

Between mid-2004 and mid-2009, Unicare sold thousands of medical insurance policies to students at community colleges, technical schools, colleges and universities across Washington state. Insurance Commissioner Mike Kreidler’s office later determined that there were substantial problems with the coverage. Among them:

• For more than six years, the company used unapproved methods to set its rates.

• Unicare continued to wrongly cite a policy exclusion for 5 years after the law had changed to ban insurers from using the exclusion.

• Unicare allowed unlicensed insurance agents to market and sell the policies. The primary company marketing the policies was not licensed to do business in Washington until June 2009. At that point, it had been selling the policies for four years.

The company was unable to respond to Kreidler’s requests for supporting documentation on rates at specific colleges, saying that the documents were prepared by employees who no longer worked there.

Fines collected by the insurance commissioner’s office do not go to the agency. The money is deposited in the state’s general fund to pay for other state services.

The policies included international students at the University of Washington, Washington State University, Bellevue Community College, Seattle Pacific University, Shoreline Community College, Tacoma Community College and South Puget Sound Community College, among others.

Tips on winter storm-related insurance claims

2012-01-19T12:14:00.000-08:00

As this week's snowstorm turns into an ice storm, we figured that it would be a good time for a Q&A re: winter storms and insurance claims. For more, please see our winter weather page.

My neighbor’s tree fell on my house. Who pays?

Usually your insurance, even if it was the neighbor's tree. And you’ll be responsible for the deductible.

Sometimes your insurer can prove the neighbor was at fault (diseased tree, etc.) and make their insurer pay. But that can be hard to prove.

If possible, take steps to prevent further damage. For example, you might try to cover holes in walls or the roof, but only if it's safe to do so. Beware of snow, ice, and falling limbs.

And save your receipts: Your insurer may reimburse you for those costs.

A tree fell on my car or carport. Am I covered?

Car: Yes, if you have comprehensive coverage.

Carport: Yes, usually your homeowners coverage will usually cover the damage. But unattached buildings – like a garden shed – are often not covered.

Lots of limbs fell in my yard. Will an insurance company pay for cleanup?

Usually not. Homeowners insurance is mainly for the home.

Lost power and freezer thawed. Am I covered?

Most homeowners policies cover this, but it may not be worth filing a claim, esp. if you have a high deductible.

I’m concerned about flooding. Will I be covered?

Probably not. A standard homeowners insurance policy doesn't cover floods. You have to buy a separate policy, usually through the National Flood Insurance Program (NFIP).

My television set was ruined when the power came back on. Am I covered?

Most homeowner policies do cover appliances ruined by power surges. But consider your deductible -- in many cases, it may be more than the cost of simply replacing the damaged equipment.

Tips on auto insurance claims

2012-01-19T11:58:00.000-08:00

After this week's record-setting snowstorm, it seemed like a good time to post some tips on auto- and homeowners claims. We'll start with auto, and then put up a second post specifically about homeowners claims. For more, please see our auto claims web page.

Claims process
• Get the name, contact info and insurance info of the other driver.
• Get the names and contact info of anyone in the other car. We've seen fraud cases in which friends of a car's sole occupant claim that they were in the car, too, so they can file claims.
• Call your agent or the company. They’ll walk you through the process.
• That said, if it’s just your car and the damage is minor, you may want to just pay for repair yourself., especially if you have a high deductible.

Repairs
• In Washington state, you can generally choose which shop to take your car to, but the shop and the insurer must agree on price. If they can't agree, you may be stuck paying the difference.

Who pays
• If you have collision coverage, the fastest thing may be to file a claim to your own insurer.
• There’s often disagreement over who’s at fault. Unfortunately, these disputes fall outside our administrative authority. Work with the person processing the claim. In major disagreements, you may want to seek legal advice.
• But if you’re confident that another person was at fault, you may want to wait for their insurance to pay. That way you won’t have a claim on your record
• If the other person’s at fault, your insurer can also recover its costs from their insurer. This is called subrogation. If you file the claim against your insurer and they get the other driver's insurer to pay, you may get your deductible back.

Rental car?
• If other person was at fault, their insurer will negotiate with you to pay for a rental car.
• Or your policy might pay it for you.
• Pay attention to the limitations, though: Rental car coverage is often limited to a short period of time. We often get complaints from people about this.

Diminished value
• This is the difference in value between a repaired car and one that was never damaged. See if your policy covers this.
• If you're making claim to other driver’s insurance, you need to prove that the value is diminished. This can be tough to do.

Our offices will remain closed today

2012-01-19T09:58:00.000-08:00

Our Thurston County and Seattle locations will remain closed today due to the the road conditions as the yesterday's snowstorm became today's ice storm. Sorry for the inconvenience; we just want to keep our staff safe today.

All online services are still available at our website at http://www.insurance.wa.gov.

We expect to be fully operational during regular business hours starting tomorrow morning. We'll let you know here. Be safe!

OIC closes offices in Thurston County due to snow and ice

2012-01-18T09:10:00.000-08:00

We've had to close our Thurston County offices this morning due to lots of snow and ice on the roads (and more coming down). This includes our office in the Insurance Building on the state capitol campus and our largest office, which is in Tumwater. We're sorry for the inconvenience, but conditions are pretty bad out there right now.

The good news: You can still:

Having some phone system problems this morning

2012-01-12T09:03:00.000-08:00

Just fyi: We're having some trouble with our telephone network this morning. Callers may get just a steady busy signal or will hear the phone ringing but the call won't go to voicemail.

This affects many of our lines, including our consumer hotline (1-800-562-6900) and our main number (360-725-7000).

The folks who maintain the network are aware of the problem and are working to fix it now.

Update (11:30 a.m.) We believe everything's fixed and working now. Thanks for your patience.

Sensible Home Warranty ordered to stop selling insurance in WA

2012-01-11T16:21:00.000-08:00

A New York-based home warranty company has been ordered to stop selling insurance in Washington state.

Sensible Home Warranty LLC, formerly known as CHW, LLC, sold Washington consumers approximately 142 home warranty service contracts since 2009. The contracts were for parts and labor necessary to fix major systems and appliances that failed in a consumer's home. The company solicits customers through telemarketing and through a website: http://www.sensiblehomewarranty.com/.

In Washington, service contracts like the ones sold by Sensible Home Warranty are considered insurance. But neither the company nor its principals, Harrison Gindi and Elliot Dabah, are authorized to transact insurance in Washington state. Nor are they registered as service contract providers.

Nothing in the order, which took effect immediately Jan. 6, 2012, prevents the company from fulfilling the terms of its contracts or providing a refund to Washington consumers who ask for one.

The company has the right to demand a hearing.

Note: The company's registered office address is in Sparks, Nev., but its principal place of business and sales office is 1724 E. 12th St., Brooklyn, NY.

Kreidler on nonprofit health insurer surpluses: "How much is enough?"

2012-01-11T10:42:00.000-08:00

Commissioner Kreidler recently had an op-ed in the Seattle Times, talking about the large surpluses that have been built up by non-profit health insurers in recent years. From it:

In Washington, the three major health insurers — Premera Blue Cross, Regence BlueShield and Group Health Cooperative — are sitting on a total of more than $2.4 billion above and beyond what they expect to ever pay out in claims. All of them are not-for-profits. And they continue to propose substantial rate increases.

He is proposing legislation that would give the insurance commissioner's office explicit authority to consider those surpluses when reviewing rate requests.

We're working on a web page that explains this issue in more detail, and includes charts of the major insurers' surpluses over the past decade. Stay tuned...

Lynnwood auto repair shop charged with insurance fraud

2011-12-29T15:04:00.000-08:00

A Snohomish County auto repair shop has been charged with insurance fraud after charging for repairs it didn't do and parts that it never installed.

Northwestern Collision, of Lynnwood, was charged Dec. 14 in Snohomish County Superior Court. Arraignment is set for Jan. 9.

In 2009, Farmers Insurance investigators inspected 11 vehicles that had been repaired by the shop between 2007 and 2009. Of the 11, 10 "had substantial and specific" deviations from the repair estimates that Farmers had agreed to.

Among the problems: parts missing and not replaced, repairs not performed, and repairing items that were supposed to be replaced.

On Dec. 8, 2010, officers from the state insurance commissioner's Special Investigations Unit, the State Patrol and the Snohomish County Sheriff's Office served a warrant at the company's Lynnwood office. They gathered up paper files on 10 of the 11 vehicles.

The records indicated that in some cases, new parts that were supposed to be installed were instead returned to the parts dealer.

The insurer was overcharged nearly $11,000, and had to buy one customer's car, which had been rendered unsafe to drive, for another $15,446.

Cease and desist order issued to TracGuard Services

2011-12-28T16:39:00.000-08:00

The Washington state insurance commissioner's office has told a Florida-based vehicle service contract provider to stop selling unauthorized contracts in Washington state.

TracGuard Services LLC, Jose L. Terry and Alberto Tudela, all of North Miami, have been ordered "to immediately cease and desist from engaging in or transacting the unauthorized business of insurance" in Washington.

Neither the company nor the two men are authorized to solicit or transact insurance in the state. They have not registered as a motor vechicle service contract provider in Washington.

The three have been ordered to notify all Washington residents who have purchased a service contract from them. It also warns that, pursuant to Washington state law, unauthorized insurers "shall remain personally liable for performance of the contract."

Cease and desist order issued to Mill Creek man

2011-12-28T09:50:00.000-08:00

A Mill Creek man and company have been ordered to stop selling unauthorized vehicle service contracts.

The order names Scott L. Stevens and RVProtection.net, Inc., both of Mill Creek, Wash. In August of 2010, they sold a consumer a vehicle service contract offered by Genuine Warranty Solutions, Inc.

The problem: Genuine Warranty Solutions, Inc. is not a registered vehicle service contract provider in Washington.

The Dec. 19 order took effect immediately. Stevens and the company have the right to appeal the order.

Public notices and hearings: Change of incorporation, proposed acquisition, etc.

2011-12-24T08:39:00.000-08:00

Notices and upcoming hearings from our public notices web page:

Proposed acquisition: Humana is proposing to become the sole owner of Arcadian Management Services and its affiliates. We've completed our review of the application for acquisition of control. No hearing's been scheduled yet, but will be soon.

Incorporation change: The Safeco Companies have requested approval to have New Hampshire be their state of incorporation. The companies, which were acquired by Boston-based Liberty Mutual in 2008, say the change would not affect any Washington policyholders, and that there would be no interruption in coverage. A hearing is scheduled for Jan. 10, 2012 at 10 a.m. in our Tumwater office, which is at 5000 Capitol Blvd. Annual reports and other documents re: the request are posted here.

Change in port of entry/redomestication: Industrial Alliance Pacific Insurance and Financial Services have filed documents to change their port of entry/redomestication to Texas. A hearing is scheduled for Feb. 1, 2012 at 1 p.m. at our Tumwater office, which is at 5000 Capitol Blvd. Documents re: the request are posted here.

Judge issues insurance fraud ruling...in the form of a poem

2011-12-22T12:40:00.000-08:00

And now for something completely different:

A Pennsylvania judge has issued a ruling in an insurance fraud case. What's unusual is that the judge issued his ruling in the form of a poem. From the Associated Press:

Justice J. Michael Eakin, writing for a 4-2 majority, concluded in six-line stanzas that a man's attempt to deposit a forged check appearing to be from State Farm didn't constitute insurance fraud.

"Sentenced on the other crimes, he surely won't go free, but we find he can't be guilty of this final felony," Eakin wrote. "Convictions for the forgery and theft are approbated — the sentence for insurance fraud, however, is vacated. The case must be remanded for resentencing, we find, so the trial judge may impose the result he originally had in mind."

A 3-page dissent by another judge, AP writer Marc Levy noted, did not rhyme.

GEICO fined $100,000 for overcharging customers in WA; company will also refund $7.5 million

2011-12-21T10:46:00.000-08:00

A Maryland-based insurance company has been fined $100,000 after overcharging thousands of its Washington state customers.
The insurer, GEICO, is also refunding $7.5 million – plus 8 percent interest -- to the 25,267 affected auto insurance consumers by the end of the year.

“A computer database error caused the problem, which the company reported to us promptly,” said Washington State Insurance Commissioner Mike Kreidler. “GEICO has also agreed to a two-year compliance plan that includes multiple audits.”

An additional $50,000 fine was suspended, on the condition that the company abides by the terms of the compliance plan.

The refunds, many of which have already been paid, will average roughly $300. The company has been contacting active and former customers affected by the issue and expects to have all refunds paid by the end of the year.

On May 26, 2011, GEICO representatives self-reported the computer error, which resulted in 7 percent of the company’s Washington customers being overcharged for insurance between Aug. 24, 2009 and June 2011.

Fines collected by the insurance commissioner’s office do not go to the agency. The money is deposited in the state’s general fund to pay for other state services.

The complete order is posted at: http://www.insurance.wa.gov/oicfiles/orders/2011orders/11-0273.pdf.

Social media, liability and insurance

2011-12-16T09:53:00.000-08:00

Social media and insurance? Hard to imagine those words together, but the new report by the Insurance Information Institute is pretty interesting reading.

Most of us rely on social media more and more these days - whether for work or to keep with friends and family. But we probably never think about the insurance impact (ie. liability issues).

Find out if you or your business could be at risk - here's the report.

Number of uninsured in WA hits 1 million

2011-12-13T09:22:00.000-08:00

We posted a report this morning detailing our estimates of the number of Washingtonians with no health insurance, the amount of uncompensated care, and how those numbers are trending.

The upshot: We calculate that:

The number of uninsured has reached 1 million, or 14.5 percent of the state's population.
Uncompensated care (bad debt and charity care at hospitals, clinics, etc.) is nearly $1 billion.
And that both numbers are likely to continue to rise until 2014, when the major provisions of federal health care reform are slated to take effect.
The percentage of residents without health coverage worsened in 31 of 39 counties.
In several counties, more than 1 in 5 residents has no health coverage.

“This is a grim milestone for the state, and we believe the situation will remain bleak for two more years,” said Kreidler. “But it’s important for people to know that there is hope is on the horizon.”

Counties with a particularly high percentage of uninsured residents include: Adams, Grant, Okanogan, Franklin and Yakima. But the problem also worsened in King, Pierce, Snohomish and Spokane counties.

The good news: Assuming that federal health care reform takes effect as planned, more than 800,000 uninsured Washingtonians will be eligible in 2014 for expanded Medicaid eligibility or subsidies to help low- and middle-income families pay for health coverage.

This is the third report on the uninsured our office has put out since 2006.

A $200,000 patio cover? Spokane man charged with insurance fraud

2011-12-09T06:31:00.000-08:00

A Spokane man has been charged with insurance fraud and attempted theft after a snow-damaged patio cover worth about $4,000 mushroomed into a nearly $200,000 claim.

Keith R. Scribner, 47, was arraigned Monday in Spokane County Superior Court on one count of insurance fraud and one count of attempted theft.

In late July 2009, Scribner's mother, Marilyn Warsinske, filed a claim with Liberty Mutual insurance. 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.

Insurance problem? We can help

2011-12-08T11:50:00.000-08:00

We're the state agency that regulates insurance in Washington state. If you're a Washingtonian, we're happy to help answer insurance questions and help try to solve problems with insurers/agents/etc.

What can you expect? If you file a complaint, for example, we will:

■ Contact the insurance company regarding your concerns, review their response, and share the results of our review with you.

■ Research and complete your complaint within 60 days.

■ Suggest steps you might take to resolve your issue.

■ Make your complaint a part of the company's public record.

■ Require the company to address your concerns and follow Washington state insurance laws and regulations.

And we get results. We get millions of dollars a year in delayed or denied claims paid to Washington consumers.

For a complete list of our customer service standards -- as well as links to easily file a complaint online -- please see our complaint help web page. You can also call our Insurance Consumer Hotline toll-free at 1-800-562-6900.

We'll try our best to help.

Medicare drug and Advantage plan enrollment ends Dec. 7

2011-12-02T15:13:00.000-08:00

Medicare's open enrollment for prescription drug plans (Part D) and Medicare Advantage plans ends Dec. 7.

This year's enrollment period was moved and expanded, thanks to the Affordable Care Act, giving people additional time to consider their choices.

Still need to make a decision and need some help? Our Statewide Health Insurance Benefit Advisors (SHIBA) program can answer questions and help you evaluate plans. Call our Insurance Consumer Hotline at 1-800-562-6900 and ask to make an appointment with a SHIBA volunteer in your area.

Before you make your decision, consider these tips:

Plan costs and coverage can change every year, so carefully review all letters and notices from your current plan.

Make a list of all current prescription drugs you take, the doses, and how often. Then, use the Plan Finder at www.medicare.gov to compare Part D plans.

Review the 2012 Medicare & You handbook. You should have received it in September.
If you have questions, call 1-800- MEDICARE (1-800-633-4227) before you sign up.

If you have limited income and need help paying for prescription drugs, check out Medicare’s “Extra Help” program. To see if you qualify, contact the Social Security Administration at 1-800-772-1213 or go to www.socialsecurity.gov and click on Medicare.

But most importantly, don't wait! Remember, open enrollment ends Dec. 7. Here's a list of prescription drug plans and Medicare Advantage plans

Insurance when you're laid off: What to ask for on your way out the door

2011-11-30T12:24:00.000-08:00

Nobody wants a layoff notice, but critical insurance moves on your way out the door can help extend your health insurance (and other coverage) and save you thousands of dollars at a critical time.

Insurance.com spelled this out today in an article titled "Insurance smarts during a layoff: 3 must-do moves."

Among the advice:

Ask for an extension of health care benefits. Ask for the employer to keep you covered for 3-6 months.
Negotiate with your employer to have them pay COBRA insurance premiums, which can be very expensive.
Convert group life insurance or group disability coverage to an individual plan, particularly if you're older.

Report: Health costs' rapid rise

2011-11-30T08:38:00.000-08:00

The Commonwealth Fund has published a new report looking at state trends in health insurance premiums and deductibles from 2003 to 2010.

The upshot: employees' annual share of premiums increased by 63 percent over those 7 years (and premiums themselves rose 50 percent as well). In Washington state, for example, family health insurance premiums rose from $9,212 to $14,188 during that period. That's a 54 percent increase.

Not surprisingly, given stagnant incomes in recent years, premiums as a percentage of median household income during that time increased dramatically. In 2003, only a single state (West Virginia) had average premiums above 20 percent of median household income. Today, about half the states are in that category.

For a look at premiums (single and family) by state, here's a good interactive map from the report.

The report continues:

At the same time, per-person deductibles doubled in large, as well as small, firms.

If premium trends continued at that rate, the researchers predicted, "the average premium for family coverage will rise 72 percent by 2020, to nearly $24,000."

Federal health care reform, passed in early 2010 but taking effect largely in 2014, offers the hope of some savings, the report says:

Health reform offers the potential to reduce insurance cost growth while improving financial protections. If efforts succeed in slowing annual premium growth by 1 percentage point, by 2020 employers and families together would save $2,161 annually for family coverage, compared with projected premiums at historical rates of increase.

Colorado couple ordered to stop selling insurance in Washington state

2011-11-30T08:22:00.000-08:00

A Colorado couple, Robert W. Ramlet and Patricia Ramlet, has been ordered to stop selling insurance in Washington state.

In 2006, the two sold two life insurance policies in Washington state without being licensed as insurance agents here.

Commissioner Kreidler on health care reform, the individual mandate, and rate transparency

2011-11-23T16:41:00.000-08:00

Commissioner Kreidler was interviewed by host Austin Jenkins on TVW's Inside Olympia program this morning to discuss health care reform, health insurance costs, and his successful push to release confidential rate information from health insurers.

On the federal Affordable Care Act: "While this act is not perfect, it is the best thing that we have going right now to get our hands around a very serious problem for this country of ours...People are really being hurt...The current system is broken."

On the individual mandate to buy health coverage, starting in 2014: "If you have people opting in when they're sick and out when they're well, it just plain won't work."

On health care exchanges: "It's going to be a lot like online shopping that a lot of people are familiar with. And that's going to be a huge advantage over what we have now."

Additional flood warnings in WA

2011-11-23T10:11:00.000-08:00

After overnight rain in parts of the state, the National Weather Service has issued another flood warning, including:

The Nooksack River at North Cedarville (Whatcom County)
The North Fork of the Stillaguamish near Arlington (Snohomish County)
The Deschutes near Rainier (Thurston County)
The Chehalis at Porter (Grays Harbor County)

Minor flooding is expected at some of those locations today or tonight. The Chehalis River at Porter was close to flood stage at 8:45 this morning.

See the link above for details.

Update: (11:41 a.m.) Another warning's been issued, including some other area rivers. The upper reaches of most rivers crested this morning or will crest this afternoon, with crests moving downstream through Thursday.

Flood warning issued for parts of Lewis, Thurston, Pierce counties

2011-11-22T10:13:00.000-08:00

The National Weather Service has issued a flood warning for the:

Newaukum River near Chehalis (reaching flood stage this evening, continuing through Weds night or Thursday)
Chehalis River near Doty (this evening)
Chehalis River at Centralia (late tonight)
and the Chehalis River near Grand Mound. (late tonight)

"Minor to moderate flooding is expected along the Chehalis and Newaukum Rivers beginning this evening," the weather service says.

In addition, a flood watch remains in effect for the lower reach of the Chehalis River in Grays Harbor County, where the NWS says flooding is possible starting late Wednesday.

Up to 4 inches of rain has fallen in the Chehalis River Basin during the past 24 hours. Another 2-5 inches is expected from now through Wednesday night. For more details, including specific roads and areas likely to flood, click the link above.

Here's the critical part, from our perspective: Flood damage is not covered under a standard homeowners insurance policy. If you want coverage against flooding -- and your lender may require it if you live in a flood-prone area -- you'll need to buy extra coverage.

For most homeowners, that means going to the National Flood Insurance Program, a federally run insurance plan that's sold by local agents. But the coverage takes 30 days before it goes into effect. Flood season is long in the Pacific Northwest. If you think you're at risk -- and see the red "One-stop flood risk profile" box check your flood risk and get an estimate of premiums -- definitely consider flood insurance. And don't delay.

Update: (12:02 p.m.) A new alert has been issued for minor flooding along the Puyallup River near Orting and the Deschutes River near Rainier.

Two warranty companies ordered to stop selling in Washington

2011-11-22T09:09:00.000-08:00

We issued a cease and desist against Charter Warranty Services of Detroit, MI and TracGuard Services of North Miami, FL, ordering both to stop selling protection products in our state without a license.

Both companies were selling motor vehicle service contracts and protection products guarantees but had not registered with us. In Washington state, all motor vehicle service contract and protection product providers must register with our office.

If they fail to do so, they're required to get a certificate of authority to act as an insurer and get an agent or producer license in order to sell their products.

Don't recognize these two companies, but still wondering if you should get a warranty on your next big purchase? We can help. See if the company is registered before you buy a policy.

And consider these helpful tips on negotiating a price and what to ask before you buy.

Wind warning for tonight

2011-11-21T16:01:00.000-08:00

The National Weather Service is predicting gusts of up to 60 miles per hour in parts of Washington state tonight, including San Juan County, western Whatcom County, western Skagit County and the Admiralty Inlet area.

The day after windstorms, we often get a wave of calls from people with toppled trees, debris-damaged cars, etc.

To help, we put together this list of typical questions, including:

Am I covered if my car was damaged by falling tree limbs?
My yard is covered with branches and debris. Will my insurer pay the cleanup costs?
My boat sank from strong winds. Am I covered?
My business' awning was damaged by the wind. Can I file a claim?

Be careful out there.

Sentencing this afternoon for insurance agent who stole $1 million from elderly clients

2011-11-18T12:19:00.000-08:00

Former insurance agent Jasmine Jamrus-Kassim is scheduled to be sentenced later today for stealing more than $1 million in retirement savings from several elderly clients. Jamrus-Kassim pleaded guilty last month to 10 counts of first-degree theft.

The King County Prosecutors Office is seeking an exceptional prison sentence of 68 months. The case is State v. Jamrus-Kassim, with sentencing slated at 3:30 p.m. before Judge Sharon Armstrong in courtroom E-847.

From 2007 to late 2009, several of Jamrus-Kassim's clients cashed out large portions of their retirement accounts, apparently thinking they were re-investing the money. In reality, the money went to Jamrus-Kassim, who spent tens of thousands of dollars on a psychic hotline, clothes, jewelry and a trip to Mexico.

An investigation by the Washington insurance commissioner's Special Investigations Unit led to her arrest in March.

And Bankers Life and Casualty, one of the companies that Jamrus-Kassim worked for, agreed last month to repay the money that Jamrus-Kassim stole.

Update: As it turned out, sentencing was continued until Dec. 9 after Jamrus-Kassim demanded a new attorney.

Are insurers looking at your Facebook page?

2011-11-14T15:40:00.000-08:00

There's an interesting article in Insurance & Technology, detailing the ways in which insurers could use -- and in some cases, are starting to use -- the information you post on your social media sites.

"When placed in public areas of users' profiles, these photos -- not to mention location information and personal statements in status updates -- represent data insurers can potentially use for claims and underwriting purposes,"

writes I&T's Nathan Golia, citing an October report from consulting firm Celent.

In a summary of the report, ABA Banking Journal called social media "a huge marketing and engagement potential for insurers," adding that:

"Most insurers are currently involved in only defensive actions. Celent expects that over the next three years, companies familiar with social media will being to apply social data to their buisinesses," and looking for vendors to help them capture, store and analyze social media data.

Insurance Networking News also reports that:

Celent predicts that social data will be incorporated into core underwriting and claims processes over the next three years and become standard inputs into risk evaluation and settlement activities."

In other words, your insurer may not be reading your Facebook profile or Tweets yet. But it may be soon.

Tacoma landlords charged with insurance fraud

2011-11-09T10:35:00.000-08:00

A Pierce County couple and an acquaintance of theirs have each been charged with one felony count of insurance fraud.

William Harold Dummitt and Carole A Dummitt-Dombrowski rent out a cottage behind their home in Tacoma. On Nov. 25, 2010, the cottage had a water leak. The Dummitts submitted a claim to their insurer, USAA.

But they allegedly inflated their loss by claiming they’d been getting more rent from the cottage than they did – and to try to prove that by forging a renter’s signature on a false rental agreement.

Their acquaintance, Philip R. Burgess, told an investigator that he’d moved into the cottage on Dec. 1, 2010 and had to move out because of the sudden leak. But when the leak actually happened – Nov. 25, 2010 – Burgess was actually living in Portland, Ore.

Arraignment is scheduled for Nov. 18.

Update: (Feb. 1, 2012): William and Carole Dummitt each pleaded guilty to one count of false claims or proof in an insurance claim. Both were ordered to pay $1,200 in costs and assessments, and were each sentenced to 3 days in jail, which was converted to 24 hours of community service.

Tired of being suprised by health rate changes?

2011-11-01T11:02:00.000-07:00

Now you can sign up to get notified by e-mail whenever your health plan wants to make a rate change - and when we've made our decision.

A newly enhanced website, built with grant funds from Affordable Care Act, allows you to search rate requests for individual and small employer health plans, sign up to get an e-mail when your health plan wants a change, and make a public comment about requests still under review.

Eight requests are pending and eight decisions have been made - see the full details for yourself.

Agent pleads guilty, taken into custody

2011-10-31T14:12:00.000-07:00

Former Washington insurance agent Jasmine Jamrus-Kassim pleaded guilty this morning to 10 counts of theft for stealing more than $1 million in retirement funds from elderly insurance clients.

Jamrus-Kassim, who had been free on bond, was immediately taken into custody.

From 2007 to late 2009, several of Jamrus-Kassim's clients cashed out large portions of their retirement accounts, apparently thinking they were re-investing the money. In reality, the money went to Jamrus-Kassim, who spent tens of thousands of dollars on a psychic hotline, clothes, jewelry and a trip to Mexico.

An investigation by the Washington insurance commissioner's Special Investigations Unit led to her arrest in March.

And Bankers Life and Casualty, one of the companies that Jamrus-Kassim worked for, agreed last month to repay the money that Jamrus-Kassim stole.

Sentencing in King County Superior Court is slated for Nov. 18.

Children's open enrollment ends Monday, Oct. 31

2011-10-27T13:50:00.000-07:00

If you need an individual health plan for your child or want to add them to your insurance, you have until Monday, Oct. 31. After that, unless you meet certain requirements, you'll have to wait until March 15-April 30, 2012.

There are some exceptions that allow children to be enrolled anytime during the year. Parents must apply for their child within 31 days of the following events if either they or their child:

No longer qualify for a state program.
Lose coverage due to a divorce.
Lose employer-sponsored coverage (including COBRA).
Move and their plan is not available where they live.
Also, parents or guardians can apply year-round for individual coverage within 60 days of birth, adoption, or placement of a child for adoption.

Does insurance cover space junk crashing to earth?

2011-10-24T12:12:00.000-07:00

If pieces of a satellite crash on your home or car -- or on you -- does insurance cover that?

Yes, according to the Insurance Information Institute:

"Damages caused by falling objects are generally covered under standard auto, business, homeowners, and life insurance policies..."

the industry group says. It also noted, however, that the odds of being struck by space debris are extremely low.

Is the weather really getting worse? Insurer's data suggests yes

2011-10-18T14:23:00.000-07:00

Munich Re, a major reinsurance company, this summer released a very interesting report on natural disasters, and the data suggests that, as one newspaper columnist put it, it's not your imagination. The weather really is getting worse. Click on that link, and take a look at the chart you'll see.

Munich Re's full report is online and entitled the 2011 Half-Year Natural Catastrophe Review. There's also a 47-minute webinar on the topic posted online.

Red cars, insurance and speeding tickets

2011-10-17T16:44:00.000-07:00

There's an urban myth out there that holds that the color of a car affects your insurance rate. The rumor is so pervasive that some insurers mention it on their corporate websites.

It's not true. In our experience, the color of a car has nothing to do with how much you pay for auto coverage. We review auto insurance rates (among many others) here in Washington state, and we can't recall ever seeing an auto insurance rate schedule that takes color into account. Insurers do often raise rates for high performance vehicles, which may be more likely to come in red, but color itself is meaningless in determining rates.

(Here are the sorts of factors insurers take into account, including things that might surprise you -- like your credit score.)

While we're on the topic, how about the widespread belief that red cars get more speeding tickets? Snopes.com, the rumor-busting website, says that doesn't seem to be true, either:

"...It does not appear that red cars get cited for speeding more often than they statistically should."

Don't get fooled by official-looking health insurance website

2011-10-14T10:42:00.000-07:00

The federal Centers for Medicare and Medicaid Services (CMS) is warning consumers about a site that "has the appearance of being an official government website" but isn't. The website is http://preexistingconditioninsuranceplan.com/. Here's a partial screenshot:

From CMS:

This new website...is not maintained by any government programs and consumers are strongly urged not to submit any personal information requested by this website under the assumption that it is a government website.

The site includes a small disclaimer acknowledging that it's not a government-run site, but is:

"rather (a) solicitation by a licensed insurance entity/agent/broker seeking to assist and enroll individuals in the PCIP program or other insurance products."

Pre-existing Condition Insurance Plans -- PCIPs for short -- were created under federal health care reform. They're a good option for people who have a problem getting insurance due to a pre-existing medical condition. Here's our official, real website that explains more about Washington's PCIP program.

Not in Washington? Here's the official federal PCIP site.

Premera refiles rate request

2011-10-13T10:46:00.000-07:00

Premera Blue Cross has refiled a rate change for its individual health plans - this time seeking a 4.7 percent increase. We disapproved it's earlier request for a 3.1 percent increase in September. We have 60 days to review the request and make a decision.

The new rate, if approved would take effect on Jan. 1, 2012 and would impact approximately 3,874 people.

You can view the entire rate filing, a summary of key date supplied by Premera and why we turned down their last request at www.insurance.wa.gov/health-rates.shtml

Insurance company not paying a life insurance claim? Here's what you can do...

2011-10-10T06:18:00.000-07:00

Generally, insurance companies can only deny life insurance proceeds within the first two policy years for two reasons. This is called the "contestability period." After the two years, the insurer generally cannot contest the benefits.

The two reasons are if the death of the insured:

1. Is due to suicide (this does not apply to group life policies).
2. Didn't tell the truth on the application for coverage. This is called the “contestability period.” After the two years, the insurance company cannot contest the benefits.

(Bonus round: Here's a link to our ever-popular post on "How to find old life insurance policies.")

If you’re the beneficiary of a life insurance policy and you think the insurer is wrongly denying your claim for benefits, file a complaint with our office, if you live in Washington state. (If you don't, here's a handy map showing how to contact your own state insurance regulator.) We'll look into the matter and see if we can help you resolve the problem. File a complaint online or give us a call at 1-800-562-6900.

Where you can find a flu shot

2011-10-07T15:31:00.000-07:00

Here's a new site, developed by the feds, where you can type in your zip code and immediately get a list of local pharmacies, etc. that have the flu vaccine. (Your doctor or clinic's probably got the shots, too.)

We thought it was pretty clever and useful.

Insurance agent who sold fake policies sentenced to more than two years in prison

2011-10-07T12:34:00.000-07:00

An insurance agent who sold hundreds of thousands of dollars in fake business-insurance policies has been sentenced to more than two years in prison.

Brenda MacLaren-Beattie, 68, of Des Moines, Wash., was sentenced Thursday in King County Superior Court to 26 months in prison. She was immediately taken into custody. She was also ordered to pay back $532,659 in restitution.

“I’m very pleased that the court took this as seriously as we did,” said Insurance Commissioner Mike Kreidler. “This agent sold fictitious coverage to dozens of medical offices in Washington and Oregon, often for years. People thought they had coverage and they didn’t.”

An investigation by Kreidler’s office found that from late 2001 through 2009, MacLaren-Beattie issued fake insurance to 25 oral surgeons in Washington and 16 in Oregon. During that time, she is believed to have collected more than $532,000 in premiums for fictitious insurance policies, often issuing counterfeit certificates of insurance to doctors and clinics. Her insurance license expired in 2009. (And here's the cease-and-desist order issued at the time.)

In a few cases – a lost camera, some water damage – she paid out small insurance claims herself. One of her clients became suspicious after a claim check was issued by MacLaren-Beattie, rather than from an insurance company.

The fictitious policies were for business owners’ general liability insurance, which typically covers things like slip-and-fall accidents, employee theft, and damage to rented property.

MacLaren-Beattie pleaded guilty in August to eight counts of first-degree theft, a felony. On Thursday, she received eight 26-month sentences, which will run concurrently.

How to avoid buying a flood-damaged car

2011-10-07T06:24:00.000-07:00

With hurricane and storm season winding down, an insurance industry organization is warning about the likelihood that flood-damaged vehicles will be sold to salvage dealers, their flood-damage history illegally hidden, and sold as normal cars in the used-car market.

An anti-fraud group, the National Insurance Crime Bureau, has created an online tool where you can look up -- for free -- a car's vehicle identification number and see if it's been declared a salvage vehicle by an insurer. (The VIN number is typically visible through the front windshield, where the windshield meets the car's hood. It's usually a long combination of numbers and letters.)

Also, the Insurance Information Institute suggests being on the lookout for several warning signs that a car may have been flooded:

 Mildew, debris and silt in places where it wouldn't normally be found, such as under the carpeting in the trunk, or around the engine compartment

 Rust on screws and other metal parts

 Waterstains or faded upholstery; discoloration of seatbelts and door panels

 Dampness in the floor and carpeting; moisture on the inside of the instrument panel

 A moldy odor or an intense smell of Lysol or deodorizer; this is a tactic frequently used by dealers to cover up an odor problem

If you suspect that your local car dealer is committing fraud by knowingly selling flooded cars as regular used cars, the III suggests contacting your insurance company, local law enforcement agency or the NICB at 800-TEL-NICB.

Scammed seniors will be repaid more than $1 million

2011-10-04T12:35:00.000-07:00

Retirees who lost more than $1 million to an unscrupulous insurance agent will be repaid, under an agreement reached between the insurance company and state Insurance Commissioner Mike Kreidler.

Bankers Life and Casualty, one of the companies that the independent agent worked for, has agreed to replace the money allegedly stolen by the agent.

An investigation by Kreidler’s office found that several of Jasmine Jamrus-Kassim’s clients repeatedly cashed out large portions of their annuities with Banker’s Life and Casualty from late 2007 to late 2009. The money was then pocketed by Kassim.

Jamrus-Kassim, of Kent, was arrested in March 2011 and charged with 21 counts of first-degree theft. Her trial is pending in King County Superior Court.

“I commend Bankers Life for stepping up and making these victims whole, to the extent possible,” said Kreidler. “I’m deeply saddened that one victim, stripped of his life’s savings, has already passed away. In his case, restitution will go to his estate.”

The victims, who ranged from age 74 to 90, typically made out their checks to “S.A. Saad” and gave them to Kassim. Several said they believed that S.A. Saad was an insurance company official. They thought their money was being reinvested.

In reality, Kassim has two daughters, both with the initials and surname “S.A. Saad.” Most of the money was deposited briefly in the girls’ accounts, then moved to Kassim’s personal credit union account. Kassim’s financial records show thousands of dollars spent on clothes, jewelry, and a trip to Mexico. They also show large payments to online psychic advisors, including $20,000 in charges from one psychic website in one month.

The victims live in Bellevue, Renton and Seattle. The payment amounts are:

• $512,112

• $488,071

• $116,070

• $65,321

• And $929

Bankers has also agreed to pay interest.

Class-action settlement covers hundreds of thousands of insurance customers

2011-10-04T12:29:00.000-07:00

Hundreds of thousands of people who were led to expect more interest than they got from annuities are eligible for a multi-million dollar class-action settlement – if they sign up on time.

“Consumers across the country were misled, and I’m very glad to see this case finally resolved with restitution,” said Insurance Commissioner Mike Kreidler. “I urge anyone who qualifies to sign up for their share of the settlement.”

The settlement involves Northern Life Insurance Company’s marketing of tax-sheltered fixed annuities, primarily to teachers, starting in 1995. (The company, which was based in Seattle, merged with Minnesota-based Reliastar Life Insurance Co. in 2002.)

The annuity documents, Kreidler said, misrepresented to consumers the way that interest would be calculated over the life of the annuities. Instead, Northern Life paid a high interest rate only in the first year of the contract, reducing the rate during all the remaining years.

Under the settlement, Northern Life has agreed to pay $29 to $40 for each $10,000 in value of a person’s annuity. The settlement provides up to $31 million for the payments. A King County Superior Court judge recently approved the mediated settlement, in which Northern Life did not admit wrongdoing.

Northern Life has notified 406,000 account holders that they are potentially affected by the settlement. An estimated 20,000 of those people are in Washington state.

“People are naturally skeptical of mailings,” said Kreidler, “but don’t just toss this one in the trash.”
The one-page claim form, also available at http://www.curtissettlement.com/, must be mailed back on or before Oct. 17, 2011. (It can also be scanned and emailed by that date.) Under penalty of perjury, signers must certify that they owned a fixed annuity issued by Northern Life sometime between Jan. 1, 1995 and the present time.

Typical payments are likely to range from $60 to $80, although some will be significantly larger.
The claimants were represented by private attorneys in the 10-year court case, which involved more than 1 million pages of documents.

Kreidler’s office investigated the issue and filed an amicus brief in the case, saying that consumers had been substantially harmed by misleading marketing.

Turned down for life insurance? Here's what you can do...

2011-10-03T07:12:00.000-07:00

If you apply for life insurance and get rejected, it's usually due to a specific health condition. Here’s what you can do to appeal their decision:

1. Ask the insurer to tell you, in writing, what specific condition disqualified you for coverage and where they obtained that information.

2. Review their information for accuracy. If you find any discrepancies, contact the doctor and ask him or her to correct the information. If the information is accurate, discuss the condition with your doctor. If the doctor thinks the condition is not a major health risk, ask him or her if they’d be willing to write a letter on your behalf to the insurer.

Other options:

• Asking the company if they would consider issuing coverage at what's called a "rated premium."

• Applying to other companies. Just because one company doesn’t want to take on your risk doesn’t mean another one won’t. Each company determines which risk they are willing to take. (Brokers can help with this.)

• If ultimately, you don’t qualify for coverage through a standard life insurance company, consider applying for coverage through a company that offers covereage specifically for high-risk people. You’d pay more, but at least you'd have coverage.

Job openings: Actuaries, actuarial analyst, market conduct examiner

2011-09-29T09:34:00.000-07:00

Actuaries: Due to retirements, we have two openings for actuaries now, helping with financial examinations, analysis and licensing of life insurers or health insurers. Other typical duties include reviewing rates, equity-indexed annuities, etc. For details on these jobs, including salary and benefits, please see this job listing for both acturarial jobs.

Actuarial analyst: We're also looking for an actuarial analyst to fill a vacancy created when a staffer shifted over to a federally-funded project that we're working on (part of health care reform). Duties include reviewing actuarial calculations submitted by health insurance carriers to determine if rate requests are justified. For specifics, here's that job listing. The deadline for applying is 4:59 p.m. on Thursday, Oct. 6.

Market Conduct Examiner: We also have a vacancy in our Seattle office for a market conduct examiner. This job includes reviewing and analyzing company records and procedures. Here's a detailed job listing, including other duties, salary, etc. The deadline for applying is 5 p.m. on Friday, Oct. 7, 2011.

Home warranty company ordered to stop selling illegal coverage

2011-09-29T08:41:00.000-07:00

A Florida company, its principals and subsidiaries have been ordered to stop selling unauthorized home warranties in Washington state.

Insurance Commissioner Mike Kreidler has ordered International Warranty Administration Services, Inc. and related entities to stop selling service contracts in Washington. The company and its subsidiaries are believed to have sold dozens of unauthorized service contracts in the state, but are not licensed to solicit insurance here.

Kreidler's order also includes The Metropolitan Benefit Group, Inc., doing business as HomeChoice Plans, HomeChoice Household Service Plans, Choice Plans LLC, and "ChoicePlans a division of the IWASI Group." Also named were International Warranty Administration Services' principals Kacey L. Crouch, also known as Kasey L. Crouch, and Mark Lowenstein.

See the link above for the full text of the order.

Insurance agents and brokers fined for violations

2011-09-29T05:48:00.000-07:00

Insurance Commissioner Mike Kreidler has ordered fines and other disciplinary action for more than a dozen insurance agents and brokers.

Violations include failing to properly disclose fees, using a false Social Security number and wrongly disclosing a customer’s private health information.

“I should point out that these cases are only a tiny fraction of the more than 118,000 agents and brokers licensed to do business here in Washington,” said Kreidler.

Any Washingtonian with a complaint against an insurer, agent or broker can contact Kreidler’s office at 1-800-562-6900 or file a complaint online at http://www.insurance.wa.gov/.

Any fines collected do not go to the agency. They are deposited in the state’s general fund to pay for other state services.

Fines and disciplinary actions from early June through early September include:

■HSBC Securities (USA) Inc., New York, NY: Fined $7,000 for violations including failing to report administrative actions taken against it.

■Conover Insurance Inc., Yakima, Wash.: Fined $6,000 for providing false information on 12 license renewal applications.

■Kimberly A. Kelly, doing business as Peoples Insurance Agency, Inc., Renton, Wash.: Fined $250 for using a fee disclosure form that didn’t comply with state law.

■Kimberly D. Brookey, Kent, Wash.: Fined $250 for using a fee disclosure form that didn’t comply with state law.

■Ryan J. Graczyk, Spokane Valley, Wash.: Fined $500 for incorrectly and incompletely answering questions on a disclosure form to a consumer.

■Warren M. King, doing business as Exact Financial Group, Inc., Renton, Wash.: Fined $500 for violations including submitting a life insurance application with inaccurate information.

■Swiss Valley Agency, Inc., doing business as North Town Insurance, Spokane, Wash.: Fined $250 for using a fee disclosure form that didn’t comply with state law.

■Rick L. Clatfelter, Chandler, Ariz.: License not renewed for making misleading statements on an insurance application.

■Lucky Bail Bonds, Inc. and Eric Arps, Bellingham, Wash.: Fined $5,500 for violations including misrepresenting to the court that he personally completed and signed certain documents.

■Robert J. Mills Jr., Wilton, CT: Fined $5,000 and ordered to stop selling insurance in Washington without a license.

■Colleen S. Schmertz, Bellingham, Wash.: Fined $500 for issuing bail bonds without a proper insurance license.

■Maria E. Bejines, Monroe, Wash.: License revoked for violations including using a false Social Security number on her insurance license application.

■Phyllis N. Golden, Seattle, Wash.: Fined $250 for providing false information about continuing education courses.

■Tiffany Lynn Lewis, Irving, Tx.: License revoked due to a felony conviction for stealing money from a client.

■Northpoint Escrow & Title, LLC, Bellevue, Wash: Fined $500 for improperly sponsoring a promotional event.

■James Timothy Shelnut, Augusta, Ga.: License revoked for failing to report administrative actions in other states, including violations of Georgia’s Ethics in Government Act.

■Ticor Title Co., Renton, Wash.: Fined $1,500 for improperly sponsoring a promotional event and offering to refund class tuition if attendees failed the quiz at the end of the class.

Orders and specific details about each of these cases are posted online at http://www.insurance.wa.gov/orders/enforcement.asp.

Note: In some cases, the fines were larger, but a portion was suspended on the condition that the companies follow compliance plans to remedy the problems. The fines listed above are what’s actually being paid.

Insurers fined for violations

2011-09-28T15:48:00.000-07:00

Insurance Commissioner Mike Kreidler has fined insurance companies nearly $1 million this year for violating Washington insurance laws. Violations included charging unapproved rates, improper advertising, and failing to offer health coverage to children.
The fines collected do not go to the agency. They are deposited in the state’s general fund to pay for other state services.
Any Washingtonian with a complaint against an insurer, agent or broker can contact the office at 1-800-562-6900 or file a complaint online at http://www.insurance.wa.gov/.

Fines and other disciplinary actions against insurers from June to September include:
■UNUM Life Insurance Co., Portland, Me.: Fined $75,000 for selling long term care coverage using unapproved policies.

■Allstate Insurance Co., Northbrook, Ill: Fined $50,000 for issuing policies using unfiled and unapproved rates.

■UnitedHealthCare, Hartford, Conn.: Fined $26,000 for sending people wishing to appeal the insurer’s decisions to the wrong entity.

■Arch Insurance Co., Kansas City, Mo.: Fined $20,000 for violations including failing to keep adequate accounts and records.

■Chicago Title Insurance Co., Omaha, Neb.: Fined $10,000 for improperly advertising with producers of title insurance business.

■Lifewise Health Plan of Washington, Mountlake Terrace, Wash.: Fined $10,000 for failing to offer coverage to children in certain cases.

■Metropolitan Life Insurance, New York, NY: Fined $10,000 for failing to calculate benefit amounts in accordance with Washington law.

■Victoria Fire & Casualty Co., Cleveland, Ohio: Fined $5,000 for failing to adequately respond to inquiries.

■Fidelity National Title Insurance Co. (Santa Barbara, Calif.) Chicago Title Insurance Co. and Commonwealth Land Title Insurance Co. (both of Omaha, Neb.): Ordered to stop offering discounts to producers of title insurance business.

Orders and details about each of these cases are posted online at http://www.insurance.wa.gov/orders/enforcement.asp.

Note: In some cases, the fines were larger, but a portion was suspended on the condition that the companies follow compliance plans to remedy the problems. The fines listed above are what’s actually being paid.

Two more health plans request rate changes

2011-09-27T15:23:00.000-07:00

Kaiser Foundation Health Plan of the Northwes t is requesting a 9% average rate increase for its individual health plans (health plan you buy yourself) and Regence BlueCross BlueShield of Oregon is asking to lower its small employer plan rates (health plans for employers with 1-50 employees) by an average of 1.6%.

See the all of the information submitted with the rate requests and a brief summary of both on our new health rate page. Both rates, if approved, take effect Jan. 1, 2012.

Bizarre insurance claims

2011-09-27T09:22:00.000-07:00

Forbes has posted a list of bizarre insurance claims compiled by Chartis Insurance Co. Don't try these at home. Among them:

A man who set his Porsche on fire trying to dry out the floor mat with a leaf blower.

Someone who slowly melted an Andy Warhol painting by hanging it above a fireplace.

A man who managed to destroy his car engine -- and the car was a Bentley Continental -- by trying to charge it up by setting a brick on the accelerator, and then going to take a shower. The overheated engine seized.

Click on the link above for the rest.

Kreidler: Health insurer rate requests now public

2011-09-27T08:45:00.000-07:00

For the first time, consumers can now see health insurers' complete rate requests, Washington State Insurance Commissioner Mike Kreidler recently told Comcast's Newsmakers program.

Kreidler pushed for a change in state law to allow the forms to be disclosed. Soon, consumers will not only be able to view the documents easily online, but comment on the requested rates.

How to appeal when your insurer says no

2011-09-21T13:34:00.000-07:00

We've updated our online guide showing how you can file an appeal when your health insurer denies a claim or turns down a medical procedure. We've added sample letters, tips, and updated it to reflect new regulations.

See "How to Appeal a Health Care Insurance Decision: A Guide for Consumers in Washington State."

Premera's rate increase disapproved

2011-09-16T11:22:00.000-07:00

We've disapproved a request from Premera Blue Cross to increase its individual health plans by 3.1 percent. The company used a medical trend of 7.24 percent to calculate its increase. Medical trend is the change in claims costs over a specific period of time (usually one year) and is often based on both the company's past claims costs and what they expect to spend on claims in the future.

After a careful review of the company's supporting documentation, we don't believe it made its case - specifically, we believe the annual medical trend is likely to be 5.17 percent or less.

The rate was scheduled to take effect on Jan. 1, 2012 and would've impacted 4,039 people.

See if your health plan has filed ra te change.

Parents: If you need individual coverage for your children, open enrollment is NOW

2011-09-16T09:52:00.000-07:00

Open enrollment for individual health plans started Sept. 15 and runs through Oct. 31. (Individual health plans are those bought by individuals, as opposed to health plans offered by employers or groups.)

We can't say this enough: If you need health insurance for your child, make sure you enroll early. If you miss this open enrollment period, you'll have to wait until March 15, 2012, unless you meet certain qualifications. And if you wait until even the beginning of October, your coverage may not kick in until Nov. 1.

Federal health reform prevents health insurers from denying coverage to children because of a pre-existing health condition. However, just like employer-sponsored health plans, insurers can create open enrollment periods. During these open-enrollment times, children under age 19 do not have to complete a health questionnaire and cannot be denied health insurance.

We should note that there are some exceptions. You can apply for coverage for your child anytime, for example, after the birth or adoption of a child, or when the parent:

Is no longer eligible for a state program such as Medicaid.

Loses coverage due to a divorce.

Loses employer-sponsored coverage (including COBRA coverage).

Moves and their plan is not available where they live.

Alien abduction insurance? Really? Really.

2011-09-14T16:44:00.000-07:00

Bloomberg Businessweek's Joel Stonington has put together an interesting slide show of "the oddest insured things", from Bruce Springsteen's voice ($5.7 million) to the hard-working tongue of a British coffee taster ($16 million).

Arguably the most interesting detail, though, is the fact that one insurer apparently offers insurance in case you are abducted by aliens. Stonington notes that the insurer "is currently paying out on a pair of claims deemed legitimate."

See the link above for the slideshow.

Group Health seeks rate hike

2011-09-14T15:59:00.000-07:00

Group Health Options has requested a 11.6% rate increase for its small employer plans. The rate is currently under review and if approved, would take effect Jan. 1, 2012. Group Health Cooperative filed a 0% rate change for its small employer plans.

Summaries of all individual and small employer plan rate requests and memos detailing our decisions can be found on our new Web page www.insurance.wa.gov/health-rates.shtml.

We're able to post these requests and the entire rate filings thanks to a bill passed last session (HB 1220). For years, we've heard from consumers upset with the rising costs of their health insurance - and rightly so. Health care costs are rising well above the rate of general inflation. Unfortunately, before this new law, all rate requests were considered proprietary.

If someone contacted us for information, we could only say "trust us, we carefully reviewed the rate change, and it's justified." Not a lot of comfort if you've experienced double-double digit increases year after year.

Now - thanks to this new law - you can see what we see: How your company spent your premium. and how much of it went to pay medical claims, cover administrative costs (including salaries) and how much was profit.

Our authority over these rates is still limited. If the company can justify the change and prove that the rate is reasonable in relation to the benefit the plan provides, then we must accept it. But at least now if you're paying more for your health plan, you know why.

Other insurers with pending rate requests for small or individual health plans include: Asuris Northwest Health, Kaiser Foundation Health Plan of the Northwest, Lifewise Health Plan of Washington, Premera Blue Cross, Providence Health Plan, and Regence BlueShield.

Tacoma insurance agent charged with theft

2011-09-12T14:19:00.000-07:00

An insurance agent in Tacoma has been charged with theft for misppropriating checks from dozens of policyholders.

Michel Anthony James, an independent contractor working as an agent for State Farm, is believed to have deposited checks from more than 40 policyholders into his own business bank account. State Farm discovered the problems when it audited James' accounts.

Based on a subsequent iinvestigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit, James:

failed to apply premiums to policies,
wrongly withdrew cash from his premium fund account (which is where those policyholder checks were supposed to go),
failed to refund overpayments to policyholders,
and violated contractual agreements with State Farm.

He has been charged in Pierce County Superior Court with one count of first-degree theft.

Small-business health insurance tax credits: key deadlines and tips

2011-09-08T11:16:00.000-07:00

If you're a small business that provides health coverage for employees -- or wants to -- a couple of key deadlines for taking advantage of tax credits are coming up soon.

From the U.S. Department of Health and Human Services:

If you have up to 25 employees, pay average annual wages below $50,000, and provide health insurance, you may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. This will bring down the cost of providing insurance.

In order to take advantage of these tax credits, you must file by a certain date. Here are two important tax filing deadlines in coming weeks that you should be aware of:
September 15. Corporations that file on a calendar year basis and requested an extension to file to September 15 can calculate the small employer health care credit on Form 8941 and claim it as part of the general business credit on Form 3800, which they would include with their corporate income tax return.

October 17. Sole proprietors who file Form 1040 and partners and S-corporation shareholders who report their income on Form 1040 have until October 17 to complete their returns. They would also use Form 8941 to calculate the small employer health care credit and claim it as a general business credit on Form 3800, reflected on line 53 of Form 1040.

Important tips:

Even if you've already filed your 2010 taxes, you can still claim the credit. Just file an amended 2010 return.
Even if you don't have tax liability this year, you can still benefit, since eligible small businesses can carry back the tax credit five years. (It used to be that you could carry back general business credits like this just one year.)
Businesses that couldn't use the credit in 2010 can claim it in future years.

See the link above for more details and specifics.

Kreidler orders Regence to fix health insurance problems

2011-09-07T16:09:00.000-07:00

We just issued a press release about The Regence Group and its subsidiaries here, which have been having ongoing problems with billing and claims, including a computer system error that resulted in more than 6,000 incorrect transactions.

The same error apparently caused Regence to accidentally withdraw money from the bank accounts of people are not even Regence members. (Some of the withdrawals totaled thousands of dollars.) In the process, some Regence members' names and identification numbers were accidentally disclosed to strangers.

Last week, we and insurance regulators from three other states -- Oregon, Idaho and Utah -- met with Regence Group CEO Mark Ganz and other company officials in Salem, Ore. We provided the company with a list of the problems we've noted or that consumers have complained to us about.

For more details, please see the news release link above.

Need health insurance for your children?

2011-09-02T10:16:00.000-07:00

Open enrollment for individual health plans starts Sept. 15 and runs through Oct. 31. If you need health insurance for your child, make sure you enroll early. If you miss this open enrollment period, you'll have to wait until March 15, 2012, unless you meet certain qualifications.

And if you wait until even the beginning of October, your coverage may not kick in until Nov. 1.

Federal health reform prevents health insurers from denying coverage to children because of a pre-existing health condition. However, just like employer-sponsored health plans, insurers can create open enrollment periods. During these times, children under age 19 do not have to complete a health questionnaire and cannot be denied health insurance.

These open enrollment periods apply to all individual health plans. People buying this type of coverage do not get health insurance from their employer or their employer doesn't cover dependents.

Exceptions where you can apply for coverage for your child anytime include after the birth or adoption of a child, or the parent:

Is no longer eligible for a state program such as Medicaid.
Loses coverage due to a divorce.
Loses employer-sponsored coverage (including COBRA coverage).
Moves and their plan is not available where they live.

Need more help understanding the open enrollment periods or think you're not being treated fairly? Send us an e-mail or file a complaint with us.

September is National Preparedness Month

2011-09-01T05:49:00.000-07:00

We know, we know. National designations like these often fade into the ether. But why not pay attention this time? Recent earthquakes - even if on the other coast - and hurricanes ripping up the eastern seaboard should make us pay attention. Let this be the call to see how prepared you are.

Do you have flood insurance? Should you have it? How about earthquake insurance? We can help you learn more about these types of coverage at www.insurance.wa.gov.

Why not take an part of an evening this month to look at your homeowner policy. And talk to your family about your emergency plan. Don't have one? Well, now's the time. What are you waiting for?

Here's some more help to get you started.

Free Android and iPhone apps to create home inventory for insurance

2011-08-30T06:36:00.000-07:00

The National Association of Insurance Commissioners has launched an Android application that lets you use your mobile device to create a home inventory to document your possessions for insurance purposes.

The free app let you easily photograph your stuff, add descriptions and serial numbers, and stores the information electronically for safekeeping. It organizes everything by room and categoy, and creates an e-mailable backup file.

There's also an improved iPhone version, which is also free.

The apps are available through iTunes and the Android Marketplace. Search "NAIC" or "Scr.APP.book" at either site to download them.

Don't have a smartphone or other mobile device? You can still be prepared. Here's a simple, printable home inventory checklist, also from the NAIC.

Insurance and college students

2011-08-29T06:43:00.000-07:00

As students head off to college, here are some things to consider:

Health insurance:

Federal health care reform now means that your children, up to age 26, can stay on your health insurance plan. That's likely to be the option that provides the most medical benefits.
Another option is to buy an individual insurance plan for the student.
Or you could consider a student health plan, typically offered by the college. Be aware that these policies tend to have limited benefits and more exclusions than traditional health insurance plans.

Renter's insurance:

If the student lives off-campus, consider renter's insurance. It's pretty inexpensive, and covers personal property (computers, TVs, bicycles, furniture, etc.) if it gets destroyed, damaged or stolen. It can also provide coverage if someone gets hurt where the student lives.
If the student lives on-campus, the parent's homeowner's policy will generally cover his or her belongings. If they have expensive electronics, though, they might need extra coverage. Talk to your agent or company.

Auto insurance:

If the student drives a car to college, his or her existing auto coverage typically goes with them. But check with your agent to be sure.
It's also a good idea to let the agent know each quarter or semester if the student maintains good grades. Many companies offer a "good student" discount.

Need help? Feel free to give us a call at 1-800-562-6900. We won't try to sell you anything; we're the state agency that regulates insurance in Washington state.

Hurricane Irene storm tracker

2011-08-26T13:54:00.000-07:00

For those of you with family, friends, property, etc. in the Northeast, we've temporarily added a Hurricane Irene storm-tracking widget created by the National Oceanic and Atmospheric Administration. It's the little map on the right side of this blog.

(Update: With the storm now largely over (8/29), we're taking it down. You can see what it looked like here.)

What if the Japan quake hit the Pacific Northwest?

2011-08-25T16:57:00.000-07:00

Living in the Pacific Northwest, you can't help but ponder or speculate about the "big one" - especially when quakes hit elsewhere. Today's article in Outsideonline.com "Totally Psyched for the Full-Rip Nine" will likely keep some of us up tonight.

Not sure you can handle it? Here's your teaser: What would happen in the Pacific Northwest, minute by minute, if the Japanese earthquake hit here.

NAIC cancels summer meeting due to Hurricane Irene

2011-08-25T13:49:00.000-07:00

Just heard from the NAIC:

The National Association of Insurance Commissioners has decided to cancel its Summer National Meeting, which was scheduled for August 29-September 1 in Philadelphia. More than 1,500 insurance regulators, industry representatives and interested parties had registered to attend the conference.

“In evaluating the potential threat of Hurricane Irene, our decision to cancel the meeting was informed by considering the safety of all attendees and members,” said Susan E. Voss, NAIC President and Iowa Insurance Commissioner. “The first priority for all state regulators is responding to disasters and we are fully committed to assisting the states affected by this disaster.”

“Many of our members and attendees had already decided to cancel travel plans due to their responsibilities for assisting consumers in disaster situations, as well as weather-related travel safety concerns,” said Therese M. (Terri) Vaughan, NAIC Chief Executive Officer. “As the storm subsides, we will re-evaluate the priorities and establish next steps for conducting business.”

Information about committee work will be updated regularly on the NAIC website at http://www.naic.org./

The NAIC Fall National Meeting is scheduled for November 3-6 in Washington, D.C.

Earthquake insurance 101

2011-08-23T16:34:00.000-07:00

An earthquake rumbled across much of the East Coast today, startling folks in a region not known for quakes. So it seemed like a good time to highlight the basics of earthquake insurance. Among them:

A standard homeowner's or renter's policy does not, repeat not, cover earthquake damage.
Unlike homeowners coverage, earthquake insurance is designed to cover catastrophic damage. Deductibles of 10 percent to 25 percent of a structure's value are common.
Earthquake insurers often temporarily suspend sales of new coverage after a quake. They do this to limit their exposure in case of aftershocks.

For more, including tips on what to do before and during a quake, see the earthquake insurance page.

Auto glass company owner ordered to pay $1.6 million in insurance fraud case

2011-08-22T13:35:00.000-07:00

A Burien auto glass company owner has been ordered to pay more than $1.6 million in restitution to several insurance companies for an overbilling scam.

Michael Alan Perkins, 44, on Friday was ordered in King County Superior Court to pay the following:

State Farm Insurance: $864,640
Allstate Insurance Co.: $726,700
Metropolitan Property & Casualty Insurance Co.: $24,888

Perkins pleaded guilty July 1 to three counts of first-degree theft. He was sentenced to 9 months in jail, with 30 days of the sentence converted to 240 hours of community service.

Perkins is the owner of Autoglass Express Inc. and Premier Auto Glass, LLC., both run out of Perkins' Burien home. An investigation by Washington Insurance Commissioner Mike Kreidler's anti-fraud Special Investigations Unit, which spent months combing through more than 10,000 records, found more than $1.5 million in deceptive billing by Perkins' companies between September 2005 and December 2009.

In some cases, the insurers paid full price for car windows that Perkins had gotten from auto wrecking yards. One Toyota windshield billed at more than $1,000 actually cost $92. A Lexus windshield that cost $145 was billed at $1,082.

State Farm was tipped off to the scheme by Lynx Services, a third-party administrator that handles glass claims. Lynx became suspicious after a random search of their database turned up an unusually high percentage of OEM (original equipment manufacturer) glass being installed in cars worked on by Autoglass Express.

State Farm investigators began contacting policyholders, inspecting the recently-installed glass, and comparing it to the bills. State Farm turned the case over to the insurance commissioner’s Special Investigations Unit, which obtained search warrants and seized more than 50 boxes of invoices and hard drives belonging to Perkins’ companies.

For more, see the press release we issued when Perkins was charged last year.

Consumer hotline delays -- we're working on it

2011-08-22T10:51:00.000-07:00

We are experiencing problems this morning with our toll-free insurance consumer hotline (1-800-562-6900). We believe this resulted from a power failure over the weekend that triggered network problems.

We have a temporary work-around, but callers are experiencing longer-than-usual wait times, and in some cases we cannot connect the call.

Our apologies. We're working to fix this.

Update: 11:54 a.m.: The problem -- which multiple state agencies are having this morning -- means that some of our phone numbers are not able to receive any incoming calls.

Thanks for your patience. We're working on the problem and will get it fixed as soon as we can.

Update: 3:53 p.m.: Still...working...on...it. But a number of our phone lines remain unable to receive incoming calls. If you have a complaint or question, the best thing for the time being is to email us for help or use our online forms for complaints against insurers and agents.

Update: 8:54 a.m. Tuesday: FIXED! Thanks much for your patience.

A little fun on a Friday: Macaroni insurance

2011-08-19T12:37:00.000-07:00

OK, so this is really just a macaroni ad pretending to be an insurance commercial. (And we're not endorsing this brand, or pasta in general, or anything else, thank you very much.) But we chuckled.

(And thanks to our colleagues at the North Dakota Insurance Department, which tipped us off to this via their excellent @NDID Twitter feed.)

Health reform makes shopping for a health plan easier

2011-08-17T10:48:00.000-07:00

When shopping for health insurance, most people base their decision on the plan's monthly premium. But there are a lot of additional costs to consider: How much is the deductible? What will you pay out-of-pocket for a doctor visit? How about an ER visit? Hard to know. And it's even harder to compare these costs between plans.

But help is on the way. A new regulation under health reform is forcing health insurers to use a standard form to show potential customers the true costs of each plan. You'll also get a copy of this form each time your health plan renews - showing you any changes in costs.

Aside from the plan's average premium, the new form will include cost for a primary care visit, medications, tests, surgeries and for ER visits. Also, it'll give three coverage examples so people can better understand what they'll likely pay for having a baby, receiving cancer treatment, or managing diabetes.

The new regulation is out for public comment now and takes effect on March 23, 2012. Want to weigh in?

How to appeal when your health insurer refuses to pay for something

2011-08-16T09:44:00.000-07:00

Few people know that when their health insurer refuses to pay for something, you can appeal that decision.

Fewer still know how to do it.

To help, we've prepared a guide to appeals, including sample templates and example letters you can send.

It can be a complex process, mainly because the appeal rules are different depending on what kind of plan you have. But the guide helps you figure that out. We offer tips, things to avoid, and pointers for writing a good appeal letter.

Key things to remember: Your health plan CANNOT drop your coverage or raise your rates because you ask them to reconsider a denial. You CAN appeal. It's your right.

And you can win. Even if your insurer turns you down, you can appeal to an independent third-party, which has the power to reverse a denial. Over the past three years, nearly a quarter of consumers who took their appeals to an independent review organization were successful.

Check it out.

Kreidler fines Regence $100,000 for not covering contraceptives

2011-08-15T10:22:00.001-07:00

About a year ago we told you of how Regence BlueShield unfairly denied contraceptive coverage to nearly a 1,000 women.

Today, we fined the company $100,000 for violating state law.

Washington State Insurance Commissioner Mike Kreidler learned of the denial from a consumer who called his office to complain. Regence covered the insertion of her contraceptive of choice -the intrauterine contraceptive device (IUD) but denied her claim for the cost of it removing it.

According to Regence, removing an IUD was not "medically necessary" simply because the device was outdated or the woman wanted to become pregnant. The company was ordered to reprocess all similar 984 claims from Jan. 1, 2002-May 25, 2010, totalling $148,740.37.

In addition to the $100,000 fine, Regence also must pay 8 percent interest to the policyholders on each the claims that were improperly denied. Here's a link to our order.

So what's the lesson here? If you believe your health insurer is treating you unfairly, give us a call (1-800-562-6900) or file a complaint online. Of the 984 women who were denied coverage by Regence, only three appealed the decision -- and all the denials were upheld. One woman's call to our office resulted in coverage for nearly a thousand other women.

Percentage of uninsured motorists, by state

2011-08-15T06:22:00.000-07:00

Each year, the Insurance Research Council, an industry group, estimates the number of uninsured drivers, by state.

The IRC estimates that in 2009 -- there's a lag time in the data -- roughly 1 out of every 7 drivers on the road has no insurance coverage. That's a slight improvement from the previous year, when the recession is believed to have led to a spike in the number of uninsured motorists.

The highest number of uninsured motorists, the group says, is in Mississippi (an astounding 28 percent), followed by New Mexico (26 percent) and a three-way tie between Tennessee, Oklahoma and Florida (all at 24 percent). Washington comes in at 16 percent, along with states like Indiana, Arkansas, Ohio and Georgia. Oregon and Idaho are among the lowest in the country, at 10 percent and 8 percent.

(Here's the full list, posted by Automotive-fleet.com.)

How to make sense of your auto insurance policy

2011-08-12T13:47:00.000-07:00

The National Association of Insurance Commissioners has put out an excellent interactive guide to that confusing-looking "declarations page" that your auto insurer sends you.

It explains -- shortly and simply -- what the form means. (Collision? Comprehensive? Uninsured/underinsured? PIP? What?)

Check it out.

Insurance agent charged with theft

2011-08-11T10:30:00.000-07:00

Branko Cekarmis, a 37-year-old insurance agent from Kent, Wash., has been charged with four counts of theft for allegedly misappropriating thousands of dollars from his customers.

When Cekarmis, an Allstate agent, collected premium payments, he was supposed to deposit the checks and cash into a specific bank account managed by Allstate. The company would then apply those premiums to the customers' policies.

But 20 times between early February 2009 and late January 2010, Cekarmis either failed to deposit the money or failed to properly allocate it to the appropriate customers' policies. In some cases, he only allocated part of the payment to a policy. In others, he put the money toward a different customer's policy.

All told, he's believed to have misappropriated $7,767.

Allstate's corporate security department investigated the matter and sent the case to state Insurance Commissioner Mike Kreidler's Special Investigations Unit.

On June 3rd, the insurance commissioner's office revoked Cekarmis' insurance license. On Monday, Cekarmis was charged in King County Superior Court with four counts of second-degree theft.

Life expectancy table

2011-08-09T14:53:00.000-07:00

We recently heard from an unhappy consumer who was searching our agency website:

"Could not find the life expectancy chart. As a result, have lost all of this time and effort -- thereby reducing my life expectancy."

Happy to help: Here's the life expectancy table. (It's not a new one; it's been in effect since late 2004.)

Job opening: life and health insurance compliance analyst

2011-08-09T14:14:00.000-07:00

We're looking for a life and health insurance compliance analyst to work in our Consumer Protection division in Tumwater, Wash.

The person will help investigate consumer complaints against insurance companies and answer consumer questions about insurance issues. The person will also be a technical expert on helping consumers appeal insurance denials, as well as on writing and formatting consumer publications for the Web.

For more details, including salary and application process, please see the job listing. Deadline is 4:59 p.m. on Aug. 19, 2011.

We're also still accepting applications for a financial examiner job, but time's running out. The deadline for applying for that job is Friday, Aug. 12 at 5 p.m.

To keep up with any job openings at our agency, please check our jobs page frequently.

Health care reform update

2011-08-04T14:23:00.000-07:00

Here's an update on health care reform from Barb Flye, our senior health policy advisor:

A song about insurance fraud? Really? Really.

2011-08-04T12:22:00.000-07:00

It turns out that someone has actually written a song about, yes, insurance fraud.

A reporter for the Seattle Weekly (thanks, Jonathan) turned us on to the tune.

Insurance agent pleads guilty to theft for selling bogus insurance

2011-08-03T10:30:00.000-07:00

Brenda MacLaren-Beattie, a longtime insurance agent in Des Moines, Wash., has pleaded guilty to first-degree theft for selling fake insurance to oral surgeons in two states.

Our investigation found that MacLaren-Beattie, 67, sold thousands of dollars in fake business-insurance policies, often issuing counterfeit certificates of insurance to doctors and clinics. She pleaded guilty yesterday in King County Superior Court to eight counts of first-degree theft, a felony.

From late 2001 through 2009, she issued fake insurance to 25 oral surgeons in Washington and 16 in Oregon. During that time, she is believed to have collected more than $532,000 in premiums for fictitious insurance policies. Her insurance license expired in 2009.

In some cases -- a lost camera, some water damage -- she paid out small insurance claims. One of her clients became suspicious after a claim check was issued by MacLaren-Beattie, rather than from an insurance company.

The fictitious policies were for business owners' general liability insurance. General liability insurance typically covers things like slip-and-fall accidents, employee theft, and damage to rented property.

Sentencing in King County Superior Court is expected later this month.

New guidelines expand preventive coverage for women

2011-08-02T15:32:00.000-07:00

New guidelines issued by the federal government require health plans to cover many preventive services for women with no additional cost.
The Affordable Care Act requires health plans to include preventive services with no cost-sharing (ie. deductibles, copays, etc.). The guidelines issued yesterday describe the specific preventive services for women that apply. They include:

Well-woman visits
Screening for gestational diabetes
Human papillomavirus (HPV) DNA testing for women 30 years and older
Sexually-transmitted infection counseling
HIV screening and counseling
FDA-approved contraception methods and counseling
Breastfeeding support, supplies, and counseling
Domestic violence screening and counseling

Here's a chart showing the specific preventive service, a description of the service, and frequency (ie. whether the coverage is annual or for a specific occurrence.)

10 things your homeowners insurance DOESN'T cover

2011-07-21T15:26:00.000-07:00

Surprise: Here are 10 things a typical homeowners policy doesn't cover:

Damage due to animals or rodents.
Mold, mildew or dry rot.
Earthquakes -- including earth movement, landslides, etc.
Slow leaks.
Flooding: You have to buy a separate flood insurance policy to be covered for floods, tidal surges and tsunamis.
Intentional damage.
Foundation settling and cracking.
Volcanoes: Deposits of volcanic ash? Not covered. Nor is damage from tremors caused by the eruption.
A home business: If you operate a home-based business, you might be uninsured and not even realize it. Your homeowners policy may provide a limited amount of coverage for business-related personal property in the home, but don't wait until you have a loss to find out if you're covered. Talk to your agent.
A second residence on the property: Most homeowner policies don't cover a second residence.

Here, on the other hand, is a list of what is covered under a typical homeowners policy.

Need help with insurance problems?

2011-07-21T11:21:00.000-07:00

If you live in Washington state, we can help with insurance questions and problems. (We're the state agency that regulates insurers, agents and brokers. We get tens of thousands of calls a year from consumers.)

What kind of help? Here are a few examples of recent cases we've handled:

-We helped a dentist get paid when one insurer didn't process a claim because it didn't have the medical codes from the primary insurer. We looked up the codes (on the primary insurer's website; not so hard), provided them, and passed along a friendly reminder about the legal requirements for timely claims processing. The insurer processed the claim the next day.

-We helped another consumer get a life insurer to pay out the proceeds -- more than $250,000 -- on his mother's annuity policy.

-We helped a consumer after an insurer found him 100 percent at fault for an accident. We reviewed their investigation and discovered that they'd failed to get statements from key players (the other driver, for one, and a police officer witness who happened to be sitting beside the road when the accident occurred). We asked the company to contact the two. Result: they reversed their decision, finding the other driver 100 percent at fault for the accident.

-We helped a homeowner expedite and settle a disputed home repair claim for more than $145,000.

Need help? Call us at 1-800-562-6900 or see http://www.insurance.wa.gov/.

(And if you live in another state, here's a handy map with contact info for your own state's insurance regulator.)

Health insurance exchanges: Who's doing what?

2011-07-20T16:11:00.000-07:00

The Kaiser Family Foundation has put together handy maps illustrating what each state is doing in terms of setting up health insurance exchanges. The maps are sortable by actions, status, etc.

Exchanges are new marketplaces where consumers will be able to comparison shop for health insurance.

Health insurance rate requests now public

2011-07-18T10:58:00.001-07:00

Individual and small employer health insurance rate requests are now public. See the complete filings received since July 1, as well as a summary for each request.

Several health insurers filed rate requests prior to July 1, but have voluntarily made their filings public. They include: Asuris Northwest Health, Kaiser Foundation Health Plan, and Regence BlueShield.

Insurance Commissioner Mike Kreidler proposed the legislation (HB 1220) making health rates public on behalf of the consumers who contact his office, demanding to know what's driving their higher premiums. State law prevented him from sharing the information that insurers use to justify rate requests - even after the rate was approved.

The new law makes most individual and small employer health insurance rate filings public shortly after they're received. This includes how much of the requested rate will be spent on medical claims, administrative costs and profit. Also, the public will see if their rate change includes any benefit changes.

Kreidler's office is building an interactive web tool where the public can search rate requests, post comments, and sign-up to get an e-mail when their health plan requests a change and a decision is made. The new tool is scheduled to go live early this fall.

Owner of auto glass companies sentenced in $1.6 million fraud case

2011-07-15T14:05:00.000-07:00

A Burien auto glass company owner has been sentenced to jail for a billing scheme that's believed to have cost insurers more than $ 1.5 million.

Michael Alan Perkins, 44, pleaded guilty to three counts of first-degree theft in King County Court July 1. He was sentenced to 9 months in jail, with 30 days of the sentence converted to 240 hours of community service.

Investigators for state Insurance Commissioner Mike Kreidler are recommending a total of more than $1.6 million in restitution to the companies. The court will decide the amount at an upcoming hearing.

Perkins is the owner of Autoglass Express Inc. and Premier Auto Glass, LLC., both run out of Perkins' Burien home. The glass shops overbilled insurers, including State Farm, Allstate and MetLife insurance companies.

An investigation by Kreidler's office's anti-fraud Special Investigations Unit, which spent months combing through more than 10,000 records, found more than $1.5 million in deceptive billing by Perkins' companies between September 2005 and December 2009. Read the full release.

10 things to do after a car crash

2011-07-06T15:51:00.000-07:00

The National Association of Insurance Commissioners recently put out a checklist to help you gather the neccessary information after a car crash. Here are the their 10 things to do after a car crash: (And here's a printable form for your glove compartment)

1. Remain calm.

2. Assess the scene. Do not get out of your car if it is not safe to do so.

3. Check for injuries.

4. Call the police. Tell them where you are, what happened and if there are injuries.

5. DO NOT admit fault.

6. Exchange information with the other drivers. Get: NAME, ADDRESS, PHONE, INSURER’S NAME, INSURER’S PHONE and POLICY NUMBER for all of the drivers involved.

7. Get names and phone numbers of witnesses.

8. Take photos/video of the scene including the damage to all cars. Cell phone photos will work to document initial damage.

9. Write down/record your record of the events.

10. If the police respond, find out where to get a copy of the police report for your claim. If the police do not come to the scene, ask police dispatch where you can file an incident report.

Your homeowners policy probably does NOT cover flooding

2011-06-24T11:00:00.000-07:00

Many residents of Minot, North Dakota believed they were safe from flooding due to a revised flood map and either canceled their flood insurance or failed to purchase a policy. Today, only one in ten residents have flood insurance.

A New York Times article today chronicles how the number of people in Minot with flood insurance was cut in half in just a year.

Most people know this, but your standard homeowners policy doesn't cover flooding. If you want coverage, you must buy a policy from the National Flood Insurance Program.

Get a flood map or learn more about flood insurance.

Job opening: Chief market conduct examiner

2011-06-22T06:24:00.000-07:00

Due to a retirement, we have a job opening for a chief market conduct examiner in our Seattle office.

The person will supervise the market conduct team of examiners, who work directly with insurance companies to determine compliance with consumer protection laws and regulations.

For more details, salary info, and more about the agency, travel requirements, etc., please see the full job listing.

If you want to stay up to date on any future openings at the Insurance Commissioner's Office, here's our job opportunities page.

Insurance companies and agents fined more than $750,000 this year in WA

2011-06-21T15:33:00.000-07:00

Washington State Insurance Commissioner Mike Kreidler has fined insurance companies, agents and brokers more than $750,000 this year. Violations included charging unapproved rates and submitting false documents.
“These fines are the `teeth’ that help us protect insurance consumers,” said Kreidler. “It’s our job to see that the insurance industry’s playing by the rules.”

From January through mid-June, the insurance commissioner’s office has imposed $787,815 in fines. The largest, by far, was a $534,000 fine issued in January. More recent fines are listed below.

The money does not go to the agency. It is deposited in the state’s general fund to pay for other state services.

Any Washingtonian with a complaint against an insurer, agent or broker can contact the office at 1-800-562-6900 or file a complaint online at http://www.insurance.wa.gov/.

For a list of companies fined recently, read the press release here.

Pierce County man charged in insurance fraud case

2011-06-14T13:33:00.000-07:00

A Tacoma man faces multiple charges after allegedly filing forged documents in an auto theft claim.

Cash B. Knott, 45, has been charged in Pierce County Superior Court with three counts of forgery, one count of insurance fraud, and one count of attempted 2nd degree theft.

On Nov. 6th, less than a month after getting coverage from Progressive Direct Insurance Co. for his 1992 Ford Ranger pickup, Knott filed a $5,674 insurance claim with Progressive. He said someone had scratched the paint, stolen his chrome wheels and tires, and stolen his navigation and entertainment system, 1,000 watt amplifier and other electronic components.

He provided Progressive with a Sept. 2 stereo shop invoice for $4,547.84 worth of stereo equipment, a copy of his check, and a bank statement showing the withdrawal from his checking account.

The problem: When contacted by an insurance adjuster, the stereo shop said it had no record of such a purchase. All they could find was that Knott had bought an amplifier -- for $109 -- on Sept. 2.

Insurance Commissioner Mike Kreidler's Special Investigations Unit obtained a search warrant for Knott's bank records. The bank found no checks written to the stereo shop, and none whatsoever for $4,547.84.

The upshot: The investigators believe that Knott altered the invoice, forged a check, and created a phony bank statement.

He's scheduled for arraignment on June 27th.