We have a job opening for a full-time, permanent actuary at our main office in Tumwater.
The person will be reviewing health and disablity insurance rate filings, as well as helping our company supervision divisions financial analysis work. For a full description of the job, salary range, benefits, etc., please see the job listing.
.
Saturday, February 28, 2015
Insurance News - Thursday, February 28, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, February 28, 2013:
- Arch Insurance non-renews 2,500 taxis and limos as the business remains unprofitable despite 2010 auto insurance reforms.
- Ontario Human Rights Tribunal rules that Ontario insurers can charge elderly drivers higher premiums. Ruling is consistent with 1992 Supreme Court of Canada decision Bates v. Zurich.
- Today was the launch of Fraud Prevention Month.
WA insurers and agents fined $2 million in 2012
From a news release we issued minutes ago:
Insurance Commissioner Mike Kreidler issued more than $2 million in fines against insurers, agents and brokers in 2012.
“Ideally, we’d have full compliance and no fines,” said Kreidler. “But the reality is that sometimes it takes a fine to get a company to address problems. And in many cases, these fines were accompanied by compliance plans aimed at making sure the problems don’t recur.”
The fines totaled $2,033,990. Violations included charging customers for coverage they’d never agreed to, charging unapproved rates, allowing unlicensed staffers to sell policies and failing to register with the state.
“Fortunately, these cases are the exception,” said Kreidler. “Most companies, agents and brokers follow the rules.”
The agency posts all disciplinary orders – including those that don’t include fines – at www.insurance.wa.gov/orders/enforcement.asp.
The total for 2012 was higher than the previous year’s $1.4 million.
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.
Over the past 12 years, Kreidler has issued more than $15 million in fines for violations of Washington’s insurance laws.
Insurance Commissioner Mike Kreidler issued more than $2 million in fines against insurers, agents and brokers in 2012.
“Ideally, we’d have full compliance and no fines,” said Kreidler. “But the reality is that sometimes it takes a fine to get a company to address problems. And in many cases, these fines were accompanied by compliance plans aimed at making sure the problems don’t recur.”
The fines totaled $2,033,990. Violations included charging customers for coverage they’d never agreed to, charging unapproved rates, allowing unlicensed staffers to sell policies and failing to register with the state.
“Fortunately, these cases are the exception,” said Kreidler. “Most companies, agents and brokers follow the rules.”
The agency posts all disciplinary orders – including those that don’t include fines – at www.insurance.wa.gov/orders/enforcement.asp.
The total for 2012 was higher than the previous year’s $1.4 million.
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.
Over the past 12 years, Kreidler has issued more than $15 million in fines for violations of Washington’s insurance laws.
My (last) new article is up....
At Answers.com:
"A professional insurance agent can provide timely, expert advice on both the types and amounts of coverage you may need, and you don't have to pay extra to access or benefit from it."
This is actually my last long-form article: they've changed the role of CEWs. I'm actually grateful for that, as well as the opportunity to "stretch" my writer's muscles.
This is actually my last long-form article: they've changed the role of CEWs. I'm actually grateful for that, as well as the opportunity to "stretch" my writer's muscles.
Cavalcade of Risk #203: Call for submissions
Bob Wilson hosts next week's Cav. Entries are due by Monday (the 3rd).
To submit your risk-related post, just click here to email it.
You'll need to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.
To submit your risk-related post, just click here to email it.
You'll need to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.
Friday, February 27, 2015
Insurance News - Wednesday, February 27, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Wednesday, February 27, 2013:
- Insurers using mobile, social media to tackle customer retention problems.
- Maine Bill requiring ‘full disclosure’ of credit use in insurance-scoring models fails. So much for transparency.
- NDP and Tories claim Ontario highways not cleared of snow fast enough leading to higher collisions and fatalities.
- Ontario Court of Appeal decides that insurance brokers may take book of business elsewhere, absent an agreement.
- Finally, how to protect your car from hail damage:
What if I need to see a provider that's not in my health plan's network?
Many of the health plans for sale in Washington's new Exchange - Wahealthplanfinder - have narrower provider networks. This trend helps keeps premiums down, but it can be confusing and upsetting to consumers who are used to seeing certain providers.
If you don't qualify for a subsidy and you want a broader selection of providers, you may want to consider buying a health plan outside of the Exchange. You can do so by contacting a health insurer directly or an insurance agent can help you. Here's a list of all plans available inside and outside the Exchange by county. Make sure you check the plan's provider directory before you sign up.
Consider these tips on network issues to consider before signing up for coverage.
If you need medical care that cannot be provided by a provider or facility in your plan's network, your health plan must allow you to see the out-of-network provider network at no greater cost than if they were a contracted provider. Read more about your rights to see certain providers.
If you believe you're being treated unfairly by your insurance company, file a complaint with us - we'll look into if for you and make sure your health plan is following the rules.
Want to get more involved? We're currently working on new rules about provider networks. One of the goals is to increase transparency - so you know which providers are covered by your plan and how to access care you need, if they're not. Join our listsev to get updates on this new rule.
If you don't qualify for a subsidy and you want a broader selection of providers, you may want to consider buying a health plan outside of the Exchange. You can do so by contacting a health insurer directly or an insurance agent can help you. Here's a list of all plans available inside and outside the Exchange by county. Make sure you check the plan's provider directory before you sign up.
Consider these tips on network issues to consider before signing up for coverage.
If you need medical care that cannot be provided by a provider or facility in your plan's network, your health plan must allow you to see the out-of-network provider network at no greater cost than if they were a contracted provider. Read more about your rights to see certain providers.
If you believe you're being treated unfairly by your insurance company, file a complaint with us - we'll look into if for you and make sure your health plan is following the rules.
Want to get more involved? We're currently working on new rules about provider networks. One of the goals is to increase transparency - so you know which providers are covered by your plan and how to access care you need, if they're not. Join our listsev to get updates on this new rule.
'Huis Clos' Updated
Jean-Paul Sartre's 1944 classic "No Exit" described a group of (dead) people, forever locked in a room, trying to ascertain the nature of and reason for their punishment.
Fast forward 7 decades, and FoIB Jeff M alerts us to the story of 64 year old David Carpenter and his 62 year old wife, Sandra, locked in an even scarier scenario: the ObamaTax.
Seems that Mr C made a fateful and (as it turned out) costly mistake: he signed up for an ACA plan at the 404Care.gov site. This would prove to be a disaster, since it turned out that he also began to receive his well-earned VA benefits this year. Since there's not supposed to be any "double-dipping," he needed to cancel his ACA plan forthwith.
That's when he turned to his insurance agent, Stephanie Sheffield. As a Marketplace-certified agent, she was prepared to do battle on the Carpenter's behalf, but quickly learned that "[w]hen there is something that needs to be changed on the policy through the marketplace, no one seems to know how to fix it — not people at the marketplace nor their supervisors."
So in addition to being breeding grounds for ID theft, it turns out that Ms Shecantbeserious and her crew have no idea how to actually service their customers' changes. As a result, the Carpenters could end up owing Uncle Sam some major bucks:
"Carpenter’s dilemma is that at year’s end, he’ll have to pay back any insurance subsidy ... $8,160 for the whole year."
That's a lot of scratch for a couple who've been funemployed for the last 14 months.
But remember:
Fast forward 7 decades, and FoIB Jeff M alerts us to the story of 64 year old David Carpenter and his 62 year old wife, Sandra, locked in an even scarier scenario: the ObamaTax.
Seems that Mr C made a fateful and (as it turned out) costly mistake: he signed up for an ACA plan at the 404Care.gov site. This would prove to be a disaster, since it turned out that he also began to receive his well-earned VA benefits this year. Since there's not supposed to be any "double-dipping," he needed to cancel his ACA plan forthwith.
That's when he turned to his insurance agent, Stephanie Sheffield. As a Marketplace-certified agent, she was prepared to do battle on the Carpenter's behalf, but quickly learned that "[w]hen there is something that needs to be changed on the policy through the marketplace, no one seems to know how to fix it — not people at the marketplace nor their supervisors."
So in addition to being breeding grounds for ID theft, it turns out that Ms Shecantbeserious and her crew have no idea how to actually service their customers' changes. As a result, the Carpenters could end up owing Uncle Sam some major bucks:
"Carpenter’s dilemma is that at year’s end, he’ll have to pay back any insurance subsidy ... $8,160 for the whole year."
That's a lot of scratch for a couple who've been funemployed for the last 14 months.
But remember:
Want to work at OIC? We are hiring!
The Office of the Insurance Commissioner has three positions open in its Tumwater office. All are open until filled.
- Financial Examiner 4 (Senior Financial Analyst) to examine and analyze insurance companies and health carrier filings to discern financial condition, difficulties, trends and compliance. This position also supervises three financial examiners in our Company Supervision division.
- Investigator 4 (Supervisor) to investigate complaints against insurance companies, agents and brokers. This position also supervises seven investigators in our Legal Affairs division.
- Human Resource Consultant Assistant 2 to help with all things human resources, including working in the state’s Human Resources Management (HRMS) system.
OIC is a small state agency – just over 200 employees statewide – and our mission is to protect consumers, the public interest, and our state’s economy through fair and efficient regulation of the insurance industry. Read more about our agency on our website.
Health Wonk Review: Marchin' like a lion edition
David Harlow hosts this week's round-up of wonky blog posts, with a little trip to the wild side.
What's so great about this edition is how seamlessly David weaves so many different posts together into a very compelling narrative.
Do check it out.
What's so great about this edition is how seamlessly David weaves so many different posts together into a very compelling narrative.
Do check it out.
Thursday, February 26, 2015
Hearing set to consider request to buy Soundpath Health
We've scheduled a hearing on March 1 at 10 a.m. to consider Catholic Health Initiative's request to acquire Washington-based Soundpath Health Inc.
From our public notice about the hearing:
Catholic Health Initiatives (CHI) through its subsidiary, CollabHealth Plan Solutions, is proposing to acquire common shares of Soundpath Health from Soundpath’s current owners, Northwest Physicians Network and Physicians of Southwest Washington. The acquisition would allow CHI and CollabHealth Plan Solutions to own approximately 56 percent of common shares of Soundpath Health and become controlling entity of Soundpath Health.
Catholic Health Initiatives is a national nonprofit health system with headquarters in Englewood, Colo. The faith-based system operates in 19 states and includes 81 hospitals; 40 long-term care, assisted, and residential-living facilities; two community health-services organizations; two accredited nursing colleges; and home health agencies. In fiscal year 2012, CHI provided more than $715 million in charity care and community benefit, including services for the poor, free clinics, education and research. With total annual revenues of more than $10.7 billion and approximately 86,000 employees, CHI ranks as the nation’s second-largest faith-based health system.
If approved, CHI through CollabHealth Plan Solutions, Northwest Physicians Network and Physicians of Southwest Washington would be co-owners of Soundpath Health.
The public is notified that all interested parties may submit letters of support or concerns or objections and/or may participate in the hearing by appearing in person or by telephone at no charge.
To view the Notice of Hearing, which includes advice on how to participate in the hearing process, and to view all documents filed in this matter including the Purchase Agreement between the parties, and all other documents such as organizational charts and finances, current and past states’ regulatory actions and other litigation filed in this proceeding, go to Soundpath Health #13-0039 at
http://www.insurance.wa.gov/laws-rules/administrative-hearings/judicial-proceedings/s-t/.
From our public notice about the hearing:
Catholic Health Initiatives (CHI) through its subsidiary, CollabHealth Plan Solutions, is proposing to acquire common shares of Soundpath Health from Soundpath’s current owners, Northwest Physicians Network and Physicians of Southwest Washington. The acquisition would allow CHI and CollabHealth Plan Solutions to own approximately 56 percent of common shares of Soundpath Health and become controlling entity of Soundpath Health.
Catholic Health Initiatives is a national nonprofit health system with headquarters in Englewood, Colo. The faith-based system operates in 19 states and includes 81 hospitals; 40 long-term care, assisted, and residential-living facilities; two community health-services organizations; two accredited nursing colleges; and home health agencies. In fiscal year 2012, CHI provided more than $715 million in charity care and community benefit, including services for the poor, free clinics, education and research. With total annual revenues of more than $10.7 billion and approximately 86,000 employees, CHI ranks as the nation’s second-largest faith-based health system.
If approved, CHI through CollabHealth Plan Solutions, Northwest Physicians Network and Physicians of Southwest Washington would be co-owners of Soundpath Health.
The public is notified that all interested parties may submit letters of support or concerns or objections and/or may participate in the hearing by appearing in person or by telephone at no charge.
To view the Notice of Hearing, which includes advice on how to participate in the hearing process, and to view all documents filed in this matter including the Purchase Agreement between the parties, and all other documents such as organizational charts and finances, current and past states’ regulatory actions and other litigation filed in this proceeding, go to Soundpath Health #13-0039 at
http://www.insurance.wa.gov/laws-rules/administrative-hearings/judicial-proceedings/s-t/.
Insurance News - Wednesday, February 26, 201
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Wednesday, February 26, 2014:
- Distracted driving fines in Ontario increase to $255 on March 18 - the highest in Canada.
- Potholes are eating away at municipal budgets just about everywhere.
- If your car is damaged from driving over a pothole in the City of Toronto, this is how to make a claim.
- Yet another attempt by Michigan at auto reforms. A new proposal would pair a mandatory two-year, 10 percent rate reduction with a cap on personal injury protection coverage.
- Older driver accident rates going down not up because cars are safer and seniors are healthier.
- Can the driver of an automatic car be charged with a DUI?
Kreidler orders insurance loan seller to stop doing business in Washington
Washington state Insurance Commissioner Mike Kreidler issued a cease and desist order against Insurance Finance Corp., headquartered in Des Moines, Iowa. The company has been illegally financing insurance premiums in Washington and charging consumers more than allowed under state law.
Essentially, Insurance Finance Corp. sells loans to people who purchase insurance and can’t or don’t want to pay the full premium up front. This type of loan is typically sought by people who purchase commercial insurance policies. Individual policies, including homeowner, renter and auto insurance, typically allow consumers to pay a monthly premium rather than making large yearly or twice-yearly payments.
Kreidler ordered Insurance Finance Corp. to stop doing business in Washington because it violated two state laws – it’s not licensed to do business in Washington and it is overcharging Washington customers. State law limits service charges to $10 per $100,000 per year, and a one-time acquisition charge of $10 per loan.
We identified 429 Washington customers who have purchased loans totaling more than $630,000 from August 2010 through July 2013. However, there could be more customers that we have not identified. We are unable to determine the total amount of overcharges to Washington customers until we can identify all of its customers and loans. Customers may have been referred to the firm by insurance brokers and agents. Washington insurance agents and brokers can help by not referring clients to Insurance Finance Corp. while the cease and desist order is in place.
Insurance Finance Corp. has 90 days to appeal the cease and desist order.
Anyone who sells insurance or insurance products to people in Washington must be licensed by OIC. You can look up a company’s licensing status and see if a company has complaints on our website.
Oh, sure - NOW they tell us!
As we've long noted, the ObamaTax Exchange sites are a veritable treasure trove of ID-theft opportunities. Turns out, though, we may have under-estimated the breadth and scope:
"Security experts worried that 35 state health exchange websites were vulnerable to hackers and were rated as "high risk" for security problems before ObamaCare's launch"
Really? That's a tad over 60% of the Exchanges, and they were known to be high-risk? Thanks, Ms Shecantbeserious, for the heads' up.
"Security experts worried that 35 state health exchange websites were vulnerable to hackers and were rated as "high risk" for security problems before ObamaCare's launch"
Really? That's a tad over 60% of the Exchanges, and they were known to be high-risk? Thanks, Ms Shecantbeserious, for the heads' up.
Insurance Topics - Tuesday, February 26, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday, February 26, 2013:
- Georgia state House approves use of electronic auto insurance card, proposal now heads to state Senate.
- Opinion piece by Howard Pawley in Windsor Star: Public auto insurance: Why not?
- Fraud Prevention Month begins on Friday. FSCO and others will be attending media launch at Toronto Police Headquarters on Feb 28th at 10 am.
- Aviva planning to return to Usage-Based Insurance but instead of a 'black box' they intend on using smartphone technology.
- British Columbia Automobile Association has introduced a free online tool to calculate the cost of vehicle ownership.
- Strange but true, it can cost you $448 to drive just one mile.
- This is a collision you don't see every day:
Wednesday, February 25, 2015
Insurance News - Monday, February 25, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Monday, February 25, 2013:
- Anonymous tip line in Sudbury to ‘rat out’ unfit elderly motorists unfairly targets seniors according to CARP.
- NDP continues to press for auto premium reductions in the Ontario budget. My guess is that any insurer that was planning to reduce rates will now wait and see.
- 2010 Ontario auto insurance reforms has a significant impact on Accident Benefit claim costs in 2011.
- Good weekend for stunt driving charges. Suspended driver clocked at nearly 150 kilometres an hour on Don Valley Parkway and then a second man was clocked at 188 kilometres an hour on the Gardiner Expressway.
- New Forum Research poll suggests that Hudak Tories could form a minority government, Horwath NDP have lost some support and Wynne Liberals have stopped falling in the polls. An election right now would be impossible to call.
Insurance tips: "My insurer wants more money due to an 'audit.' What's that?"
Q: I paid my business policy premium, and now, after the policy period is over, the insurer wants more premium because of an "audit." What's going on?
This is a common question.
This issue deals with the audit provision found in the typical commercial policy. Because businesses may experience both decreases or increases due to business cycles, estimated premiums are commonly used in commercial policies when they are first issued, with an annual audit option to identify any premium that needs to be added or subtracted due to the business cycle. Insurers may or may not decide to exercise their right to audit.
The good news is that the audit, while it may increase your premium for the prior business period, could also decrease it.
This is a common question.
This issue deals with the audit provision found in the typical commercial policy. Because businesses may experience both decreases or increases due to business cycles, estimated premiums are commonly used in commercial policies when they are first issued, with an annual audit option to identify any premium that needs to be added or subtracted due to the business cycle. Insurers may or may not decide to exercise their right to audit.
The good news is that the audit, while it may increase your premium for the prior business period, could also decrease it.
Tuesday, February 24, 2015
TRAGIC Wins Shallow Victory in SHBP Battle
T.R.A.G.I.C, the teacher group we blogged about in January formed to protest #Obamacare changes to the Georgia SHBP (State Health Benefit Plan) won a shallow victory. State and local government groups and school systems that use SHBP as their health plan received an email today, announcing retroactive changes in the health plan.
Readers may recall the uproar over the loss of copay plans and the announcement that BCBSGA was awarded the contract as the sole claims administrator for the health plan that covers 650,000 Georgia residents.
But Blue Cross was awarded the business in August of 2013 and there were no protests then.
During October SHBP particpants were given details on the new benefit packages. It was obvious there were no copay options. We had three choices, Bronze, Gold and Silver. All were high deductible HRA plans.
Where was TRAGIC then?
Crickets chirping
The state caved and agreed to overlay a doctor copay RETROACTIVELY to January 1, 2014. Yeah, that's going to be fun when Blue has to calculate refunds and then figure out if they restore dollars to an HRA or pay them to the policyholder.
So why is this a shallow victory?
The new copay's only apply to ER and doc visits.
Copay's do not count toward the major medical deductible.
SHBP participants still have the lousy Blue Cross POS limited provider network.
The Rx plan is still managed by Express Scripts. The amounts paid for Rx copay's still do not count toward the major medical deductible or OOP (out of pocket) limit.
Like I said. Shallow victory. The people behind TRAGIC fought to have doc copay's reinstated and completely missed the big picture.
Now that is tragic.
Readers may recall the uproar over the loss of copay plans and the announcement that BCBSGA was awarded the contract as the sole claims administrator for the health plan that covers 650,000 Georgia residents.
But Blue Cross was awarded the business in August of 2013 and there were no protests then.
During October SHBP particpants were given details on the new benefit packages. It was obvious there were no copay options. We had three choices, Bronze, Gold and Silver. All were high deductible HRA plans.
Where was TRAGIC then?
Crickets chirping
The state caved and agreed to overlay a doctor copay RETROACTIVELY to January 1, 2014. Yeah, that's going to be fun when Blue has to calculate refunds and then figure out if they restore dollars to an HRA or pay them to the policyholder.
So why is this a shallow victory?
The new copay's only apply to ER and doc visits.
Copay's do not count toward the major medical deductible.
SHBP participants still have the lousy Blue Cross POS limited provider network.
The Rx plan is still managed by Express Scripts. The amounts paid for Rx copay's still do not count toward the major medical deductible or OOP (out of pocket) limit.
Like I said. Shallow victory. The people behind TRAGIC fought to have doc copay's reinstated and completely missed the big picture.
Now that is tragic.
Coming soon to a hospital near you
In case you were (still) wondering about how the ObamaTax would affect your health care, well:
"The Royal College of Surgeons wrote to healthcare inspectors last year warning of “grave concerns” that too many people were dying in the south of the country because of long waits for heart surgery."
No, not Mississippi or Alabama (yet), but the quaint subset of Great Britain called Wales (soon to be Wails?). Turns out that there are (at least) "150 cases in which patients died waiting for life-saving treatment." All part of the grand scheme we call the Much Vaunted National Health System©.
But hey, at least it's "free," right?
"The Royal College of Surgeons wrote to healthcare inspectors last year warning of “grave concerns” that too many people were dying in the south of the country because of long waits for heart surgery."
No, not Mississippi or Alabama (yet), but the quaint subset of Great Britain called Wales (soon to be Wails?). Turns out that there are (at least) "150 cases in which patients died waiting for life-saving treatment." All part of the grand scheme we call the Much Vaunted National Health System©.
But hey, at least it's "free," right?
Helping Sarah Kliff Solve Her Medical Bill Issue
Former WaPo Wonkblog health policy writer Sarah Kliff is a huge proponent of Obamacare and the expansion of health insurance. She's also been a recipient of excellent employer sponsored insurance benefits. Sarah has a problem. Here is what she tweeted:
2/20 at 11:27am
Sarah Kliff @sarahkliff
Received today an $820 medical bill that I was not expecting nor can I decipher because American health care.
2/20 at 11:35am
Sarah Kliff @sarahkliff
2/20 at 11:27am
Sarah Kliff
Received today an $820 medical bill that I was not expecting nor can I decipher because American health care.
2/20 at 11:35am
Sarah Kliff
Monday, February 23, 2015
Insurance News - Thursday, February 23, 2012
'Project Whiplash' Leads to Early Morning Arrests
Toronto Police Services news release on Project Whiplash.
FSCO Lays Charges Against Rehabilitation Clinics
The Financial Services Commission of Ontario (FSCO) has charged four rehabilitation clinics and six individuals affiliated with these clinics with offences under Ontario’s Insurance Act. These clinics and individuals are alleged to have submitted false invoices to insurers as part of a staged auto accident ring.
FSCO Arbitrator Recognizes 60-Day Timeline for Mediations
A recent decision by FSCO Arbitrator Jeffrey Rogers supports that a mediation can be deemed to have failed if it has not been mediated within the 60 day timeframe noted in both the Insurance Act as well as The Dispute Resolution Practice Code.
More than three dozen people are in custody Thursday following multiple arrests across the Greater Toronto Area overnight which targeted a vehicle insurance fraud ring.
The investigation, code named "Project Whiplash" concentrated on an accident and insurance fraud ring allegedly run by members of the Tamil community. The 37 suspects arrested in Scarborough, Brampton and Markham face 130 charges.
read more....Toronto Police Services news release on Project Whiplash.
FSCO Lays Charges Against Rehabilitation Clinics
The Financial Services Commission of Ontario (FSCO) has charged four rehabilitation clinics and six individuals affiliated with these clinics with offences under Ontario’s Insurance Act. These clinics and individuals are alleged to have submitted false invoices to insurers as part of a staged auto accident ring.
On February 23, 2012, the following clinics were charged with one count each of knowingly making false or misleading statements to an auto insurer to obtain payment for goods and services provided to an insured and engaging in an unfair or deceptive act or practice:
- McCowan Rehabilitation Clinic (1583 Ellesmere Road, Suite 104, Scarborough, Ontario)
- Ontario Rehabilitation Clinic (3031 Markham Road, Suite 31, Scarborough, Ontario)
- Physiotherapy Clinic (1920 Ellesmere Road, Suite 110, Scarborough, Ontario)
- North York Health & Rehabilitation Centre (1280 Finch Avenue West, Suite 519, Toronto, Ontario)
FSCO Arbitrator Recognizes 60-Day Timeline for Mediations
A recent decision by FSCO Arbitrator Jeffrey Rogers supports that a mediation can be deemed to have failed if it has not been mediated within the 60 day timeframe noted in both the Insurance Act as well as The Dispute Resolution Practice Code.
In the decision, Leone and State Farm, Arbitrator Rogers states the following:
There is no merit to State Farm’s submission that the Application is not filed until a mediator is appointed. The definition of “file” does not suggest that interpretation. The Insurance Act and the Rules themselves treat filing and appointing a mediator as separate events. Section 280(2) of the Act sets the requirement for filing the application. Section 280(3) then requires the Director to “ensure that a mediator is appointed promptly.” Rule 13.1 states that on “receipt of a completed Application for Mediation… a mediator will be appointed promptly.” The Commission recognized this separation when it advised Mr. Leone that “[C]omplete applications are taking longer to be assigned to a mediator as a result of the large volume of applications which we continue to receive.read more...
Warranty buyers beware - know what you are paying for
Consumers can buy warranties on any number of products these days, ranging from a new vehicle to a small gadget or appliance. Before you lay down more money for a warranty, here are a few things you should know:
- Be sure you fully read any warranties before you buy them and don't be afraid to ask questions if something you read needs clarification.
- Warranties do not cover all damage. For example: Vehicle warranties may exclude damage related to after-market modifications to engines, power trains or suspension systems. If you buy a used vehicle that comes with these types of modifications, the warranty may not cover damage to or in the event that those modifications fail. Be sure you understand the limitations of any warranty you are thinking about buying.
- Some warranties require you to pay a fee or copayment if you need to use the warranty. For example, smartphone warranties often require you to pay a fee each time you use them.
- Do the math. Weigh the cost of the warranty over the time period it covers. Would it cost you the same or less money to replace the item if it broke during the warranty period?
- Does your homeowner or renter's insurance cover the item? Your policy may cover you if the item is stolen or destroyed in a fire or other incident. Check your policies and deductibles first, and remember that insurance policies typically don't cover damage to items that you break.
Sunday, February 22, 2015
Insurance companies and agents fined
We'll be posting a news release on this shortly, but we've issued the following fines and other enforcement actions:
- Fidelity National Title Insurance Co. and Chicago Title Insurance Co.: Fined $100,000 for wrongfully offering discount club memberships to people who were in a position to send title business to the companies.
- Aetna Life Insurance Co.: Fined $20,000 for failing to promptly handle appeals from consumers.
- Charter Warranty Services, Inc., Mechanical Breakdown Protection, Inc., and Paul Pawlusiak, of Detroit, Mich.: Ordered to stop selling unauthorized motor vehicle service contacts.
- Scott L. Stevens and RV Protection.net, of Mill Creek: Ordered to stop acting as an agent for a service contract provider not authorized to do business in Washington state.
- Cynthia L. Rushing, of Spokane: License revoked for misappropriating funds.
- Trevor D’Jon Losse, of Cle Elum: Fined $1,000 for multiple violations, including failing to disclose other state disciplinary actions against him.
- Robert Tychsen, of El Cajon, Calif.: Fined $1,750 for selling insurance in Washington without a license.
- Douglas D. Wellsandt, of Hayden, Idaho: Fined $5,000 for violations including falsely stating that Washington policies had been sold in Idaho.
- Ross S. Wolf, of Sammamish: Fined $2,000 for violations including acting as an insurance company’s agent without having been appointed by the company.
The fines collected do not go to the agency. They are deposited in the state's general fund to pay for other state services.
Washington consumers with questions, problems or complaints can call us at 1-800-562-6900 or e-mail AskMike@oic.wa.gov. (Not in Washington? Here's how to reach your state's insurance regulator.)
Insurance News - Saturday, February 22, 2014
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Saturday, February 22, 2014:
- Ontario's 15% rate rollback has started strong insurer interest in telematics as a mechanism to control claim costs and expenses.
- Louisiana is considering auto insurance reforms to address the "soft tissue industry" in New Orleans. Sounds familiar.
- The most expensive U.S. cities for auto insurance are in states with no-fault car insurance laws.
- This is a good way to kill telematics: UK Insurers sending their own speeding tickets to policy holders with telematics.
- It appears that in the future my office will likely move to my car once it's able to drive itself so I can answer all those emails.
- Another article on how vehicle-to-vehicle communication could revolutionize auto insurance.
Saturday, February 21, 2015
A company that insured the Titanic goes under, leaving behind maritime relics
The Wall Street Journal's Leslie Scism has a story today about Atlantic Mutual, the company that insurered the Titanic and many other ships for more than a century, before the company was ordered into liquidation two years ago.
The story details the maritime artifacts and records amassed by the company. Many of the items -- model ships, paintings, old maps, gold coins, barometers, etc. -- may be sold soon.
The story details the maritime artifacts and records amassed by the company. Many of the items -- model ships, paintings, old maps, gold coins, barometers, etc. -- may be sold soon.
Insurance News - Thursday, February 21, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, February 21, 2013:
- Another blog post on usage-based insurance: Auto insurers bank on Big Data to drive new business.
- How insurers thrive in an era of ‘stable instability.’
- Hey it's not just the Ontario NDP. Florida Senate Leader to Insurers: Where Are Savings from PIP Reforms?
- Florida apologizes to Canadians for driver’s licence mix-up, seems we do speak English. But the law is still in force so what happens to Canadian drivers that get into accidents?
- NDP reiterate their pre-throne speech demands for lowering auto insurance rates, closing tax loopholes and a 5-day home care guarantee.
- Economical Insurance reports 2012 net income of $152.7 million, compared to $91.0 million in 2011, increase of 67.8%.
Tacoma man sentenced to prison for insurance fraud, forgery
A Tacoma man has been sentenced to more than two years in prison for insurance fraud and forgery after filing a false auto insurance claim.
Cash B. Knott, 46, was sentenced Friday in Pierce County Superior Court to 29 months in prison and must pay $1,200 in costs and assessments. He pleaded guilty in January to two counts of forgery and one count of felony insurance fraud.
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.
Cash B. Knott, 46, was sentenced Friday in Pierce County Superior Court to 29 months in prison and must pay $1,200 in costs and assessments. He pleaded guilty in January to two counts of forgery and one count of felony insurance fraud.
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.
Taxpayer Give Away
If you want free money, where do you go? Not the lottery. Not lost and found. Jackson
Hewitt and H & R Block.
The store-front firm Jackson Hewitt is probably the most enthusiastic about the model. Its staffers will complete and even mail the Medicaid paperwork for clients who are eligible for expanded coverage. They are not licensed brokers so can’t sell insurance directly, but the firm has created a partnership with the commercial online insurance marketplace Getinsured which will help Jackson Hewitt customers buy coverage.
For no extra fee, Jackson Hewitt will figure your subsidy (and your penalty) when it prepares your taxes. And, if you want, it will send that information directly to Getinsured, where you can buy a policy.
Tax preparers participating in the largest wealth redistribution scheme in the history of the United States.
Jackson Hewitt isn’t alone: H&R Block HRB +0.35% is partnering with the commercial online health exchange GoHealth to help people enroll through Block-branded online chat and phone support. In a pilot program, Block also will have insurance agents located in some Arizona tax offices.
Get your R.A.L. and #Obamacare at the same place. Why not food stamps and voter registration too?
Are Insurers Having Difficulty Keeping Claimants in the MIG?
I previously reported that based on HCAI data that it appears the minor injury definition was holding up. However, that doesn't mean claimants are remaining in the Minor Injury Guideline (MIG). I would like to continue to examine data related to minor injuries.
Again the information is based on first set of standard HCAI reports which were published by the IBC in December 2013. The standard reports are published on an “accident half year” basis. In accident half year statistics, the experience of all claims with accident dates in the same accident half year is grouped together. The accident half years are defined as calendar half years, with January to June being the first half and July to December being the second half for each of the stated years.
The chart below provides some insight into what might be happening to MIG claims over time. Although as many as 75% of claims are classified as strains and sprain and should fall under the minor injury definition, only a fraction of those claims receive MIG treatment only. A majority of those claims actually receive treatment within the MIG and additional treatment outside the MIG. One might conclude that the situation has been improving over time since each accident half year, fewer claims are receiving both MIG and non-MIG treatment. However, the newer claims are likely still open and many of those in the MIG only category could move over time into the MIG and non-MIG category.
This doesn't necessarily mean that insurers are having a serious problem keeping claimants categorized as having minor injuries. The MIG provides up to $2,200 in treatment but the SABS caps medical and rehabilitation expenses for minor injuries at $3,500. So many of the claimants receiving both MIG and non-MIG treatment may topping up to the $3,500 cap. In fact, the average amount paid per claimant in each accident half year never exceeds $3,500 for those receiving both MIG and non-MIG treatment. You will have to make your own conclusion whether claimants are escaping the minor injury cap. I would suggest that it might not be a problem.
Again the information is based on first set of standard HCAI reports which were published by the IBC in December 2013. The standard reports are published on an “accident half year” basis. In accident half year statistics, the experience of all claims with accident dates in the same accident half year is grouped together. The accident half years are defined as calendar half years, with January to June being the first half and July to December being the second half for each of the stated years.
The chart below provides some insight into what might be happening to MIG claims over time. Although as many as 75% of claims are classified as strains and sprain and should fall under the minor injury definition, only a fraction of those claims receive MIG treatment only. A majority of those claims actually receive treatment within the MIG and additional treatment outside the MIG. One might conclude that the situation has been improving over time since each accident half year, fewer claims are receiving both MIG and non-MIG treatment. However, the newer claims are likely still open and many of those in the MIG only category could move over time into the MIG and non-MIG category.
This doesn't necessarily mean that insurers are having a serious problem keeping claimants categorized as having minor injuries. The MIG provides up to $2,200 in treatment but the SABS caps medical and rehabilitation expenses for minor injuries at $3,500. So many of the claimants receiving both MIG and non-MIG treatment may topping up to the $3,500 cap. In fact, the average amount paid per claimant in each accident half year never exceeds $3,500 for those receiving both MIG and non-MIG treatment. You will have to make your own conclusion whether claimants are escaping the minor injury cap. I would suggest that it might not be a problem.
Friday, February 20, 2015
Job openings: Market analyst and financial analyst
We have three job openings, both in our main office in Tumwater, Wash.
One is for a financial analyst. Duties include examining and analyzing insurance company financial filings and data to discern their financial condition, difficulties, trends and compliance with laws and rules.
Required qualifications include a bachelor's degree with major study in finance, business administration, economics or accounting; a CPA license or Accredited Financial Examiner credential, and three years of professional experience in accounting or auditing.
For a full list of duties, qualifications, and application information, please see the full job listing.
The other job openings -- two of them -- are for market analysts. These people -- this won't be surprising -- conduct market analysis and participate in data surveys, using data from various sources, including other states' insurance departments. They also review company information on Facebook, Twitter, carrier websites, agent sites and blogs.
The market analyst jobs require a bachelor's degree in business administration or a related field, although work experience may also be submitted. They also require two years of experience in life, helath or property and casualty insurance company operations. For details, application info, etc., please see that full job listing.
Thanks for your interest!
One is for a financial analyst. Duties include examining and analyzing insurance company financial filings and data to discern their financial condition, difficulties, trends and compliance with laws and rules.
Required qualifications include a bachelor's degree with major study in finance, business administration, economics or accounting; a CPA license or Accredited Financial Examiner credential, and three years of professional experience in accounting or auditing.
For a full list of duties, qualifications, and application information, please see the full job listing.
The other job openings -- two of them -- are for market analysts. These people -- this won't be surprising -- conduct market analysis and participate in data surveys, using data from various sources, including other states' insurance departments. They also review company information on Facebook, Twitter, carrier websites, agent sites and blogs.
The market analyst jobs require a bachelor's degree in business administration or a related field, although work experience may also be submitted. They also require two years of experience in life, helath or property and casualty insurance company operations. For details, application info, etc., please see that full job listing.
Thanks for your interest!
Does your insurance premium seem high? Make sure your agent has right info
If you receive your homeowner or automobile insurance renewal and think the premium doesn’t seem right, it’s a good idea to check in with your insurance agent to make sure the company is using accurate information in the rating of your policy. Insurers use many factors to determine the amount you pay for insurance, some of which include where you live, the type and value of the property you are insuring, your driving record, marital status and your driving habits.
You should confirm all of that information is accurate, including your social security number, which insurers collect for to get your credit score. Most insurance companies use information in your credit history and other factors to calculate your rate. Each company weighs these factors differently, so your credit score’s effect on your insurance rates will vary from company to company. Read more about credit scoring and insurance.
If your insurance agent or company has any of this information incorrect, it can result in you paying more—or less--than you should for your insurance.
If you have questions about insurance, contact our consumer advocates online or at 1-800-562-6900.
You should confirm all of that information is accurate, including your social security number, which insurers collect for to get your credit score. Most insurance companies use information in your credit history and other factors to calculate your rate. Each company weighs these factors differently, so your credit score’s effect on your insurance rates will vary from company to company. Read more about credit scoring and insurance.
If your insurance agent or company has any of this information incorrect, it can result in you paying more—or less--than you should for your insurance.
If you have questions about insurance, contact our consumer advocates online or at 1-800-562-6900.
The California Push - A Potential Net Negative
Thanks to the "Lie of the Year" Covered California is able to claim victory. According to data released yesterday Covered CA has now enrolled over 825,000 people which is greater than the goal of 700,000 they had set back in September.But as Lee Corso would say: "Not so fast my friend."
That
For those scoring at home, Covered California used their power to cancel 1,000,000 policies and so far has a total enrollment of 825,000. This is what the government calls a win?
Insurance News - Wednesday, February 20, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Wednesday, February 20, 2013:
- State Farm sues Assessment Direct Inc. for $11 million over false and fraudulent documentation.
- 7 US states now allow digital proof of insurance instead of a pink slip. When will Ontario and the rest of Canada?
- SMA survey shows 70% of U.S. auto insurers plan some form of usage-based insurance.
- From the Ontario Throne Speech: implement the recommendations of the Auto Insurance Anti-Fraud Task Force and work to reduce insurance rates across Ontario; improve rural roads and bridges, suburban transit, and solve gridlock that threatens to cripple the GTA and Hamilton; and restrain program spending to reduce Ontario's debt-to-GDP ratio to 27%, while eliminating the deficit by 2017-2018.
- Fraser Institute Study: Ontario debt is worse than California, Province must address soaring public sector wages to slay deficit.
Homeowners insurance: What's NOT covered
People often assume that homeowners insurance is a catch-all, covering virtually any event.
Not true, unfortunately. There are many things that a typical homeowners policy does NOT cover. Among them:
Not true, unfortunately. There are many things that a typical homeowners policy does NOT cover. Among them:
- floods
- earthquakes
- breaks in a water line leading to your home
- termites
- stolen pets
- damaged or stolen cars, boats and motorcycles (these would typically be covered, however, by your car/boat/etc. insurance)
Insurance tips: "My PIP claim is months late. What's going on?"
Q: My auto insurance was supposed to pay for medical expenses under my Personal Injury Protection (PIP) coverage, but my insurer didn't pay all the bills. They waited for two months before making a decision. What's going on?"
Our consumer advocacy hotline gets questions like this fairly frequently. Insurers should be reviewing the bills as they are received. As a general rule, we would expect that an insurer would review the bills and make a coverage decision within 30 days of getting them. If there are delays, we'd expect the insurer to be able to explain why.
If you're having problems getting your insurance -- health, auto, homeowners, etc. -- to pay a claim, feel free to contact us. We accept complaints online 24/7, and have a toll-free consumer hotline (1-800-562-6900) staffed by experts.
Our consumer advocacy hotline gets questions like this fairly frequently. Insurers should be reviewing the bills as they are received. As a general rule, we would expect that an insurer would review the bills and make a coverage decision within 30 days of getting them. If there are delays, we'd expect the insurer to be able to explain why.
If you're having problems getting your insurance -- health, auto, homeowners, etc. -- to pay a claim, feel free to contact us. We accept complaints online 24/7, and have a toll-free consumer hotline (1-800-562-6900) staffed by experts.
Thursday, February 19, 2015
Consumer alert: Recent widows are target of life insurance scam
We’ve received reports that a scammer is targeting people who recently lost a spouse in the Spokane area.
The scammer has called several women who recently lost their husbands. The caller says there’s a life insurance policy on the spouse, but the policy hasn’t been paid on in recent months. The caller instructed the surviving spouse to send cash or gift cards in order to get the life insurance benefit. In all cases, no policy existed.
If you get an inquiry from someone who says they have an insurance policy you’ve never heard of, document as much information as you can in case you need to report it to the police. Then, call the insurer and determine whether there is in fact a policy. You can look up insurance companies and their phone numbers on our website. If you find out someone is attempting to scam you, report it to your local law enforcement agency. You can find a list of law enforcement agencies on the state's 211 website.
An insurance company will never call you and ask you to send them cash or gift cards in order to get a life insurance benefit. Sadly, even during a time of grief, consumers have to be on guard against scammers.
More information:
The scammer has called several women who recently lost their husbands. The caller says there’s a life insurance policy on the spouse, but the policy hasn’t been paid on in recent months. The caller instructed the surviving spouse to send cash or gift cards in order to get the life insurance benefit. In all cases, no policy existed.
If you get an inquiry from someone who says they have an insurance policy you’ve never heard of, document as much information as you can in case you need to report it to the police. Then, call the insurer and determine whether there is in fact a policy. You can look up insurance companies and their phone numbers on our website. If you find out someone is attempting to scam you, report it to your local law enforcement agency. You can find a list of law enforcement agencies on the state's 211 website.
An insurance company will never call you and ask you to send them cash or gift cards in order to get a life insurance benefit. Sadly, even during a time of grief, consumers have to be on guard against scammers.
More information:
- If you have questions about insurance, contact our consumer advocates online or at 1-800-562-6900.
- Read about how to find an old life insurance policy on our blog.
Garcon, how much for the insurance?
Here's an interesting idea:
"The owners of Republique on La Brea have added a 3% fee to every bill to pay for insurance for every employee"
The idea is that, instead of paying for or subsidizing employees' insurance costs and reflecting that in the menu prices, the cost is unbundled and there for all to see.
I like this form of transparency.
On the other hand, some folks are concerned that they have "no way of knowing whether the restaurant will use the extra money for the stated cause."
Which is a valid objection.
So, what do IB readers think? An idea whose time has come or not?
"The owners of Republique on La Brea have added a 3% fee to every bill to pay for insurance for every employee"
The idea is that, instead of paying for or subsidizing employees' insurance costs and reflecting that in the menu prices, the cost is unbundled and there for all to see.
I like this form of transparency.
On the other hand, some folks are concerned that they have "no way of knowing whether the restaurant will use the extra money for the stated cause."
Which is a valid objection.
So, what do IB readers think? An idea whose time has come or not?
Cunningham Report Recommends a New Tribunal to Deal With SABS Disputes
I assisted Justice Douglas Cunningham carry out his review of the Ontario auto insurance dispute resolution system (DRS). His report was recently submitted to the government and included 28 recommendations which if implemented would remove the system from Financial Services Commission of Ontario (FSCO) and create a new government administrative tribunal.
A New Tribunal
Arbitrators would no longer be Ontario public servants but government appointees, similar to adjudicators on a number of other government tribunals. The Insurance Bureau of Canada and a number of member companies proposed that the entire system be privatized. Cunningham’s report did recommend some private sector involvement. He proposed that the tribunal establish tendered contracts with one or more private-sector dispute resolution service providers to address any future backlog.
A More Streamlined Process
Cunningham’s report envisions a radically streamlined and quick process. The report recommends that an insured who submits an application to the proposed tribunal would have an arbitrator’s decision within 6 months if the dispute proceeds to arbitration. The tribunal would have a registrar who would deal with jurisdictional issues at the time the application is received without a hearing.
As well, doing away with many of the preliminary hearings that currently take place, Cunningham recommends that pre-arbitration meetings, neutral evaluation meetings (a step that hasn’t been used since 2008) and appeals to the Director’s delegate be eliminated.
An End to Mediation
A significant change found in the report is the elimination of mandatory mediation as the first step in the dispute resolution process. Instead, a settlement meeting would be scheduled with an arbitrator rather than a mediator. This step would have elements of mediation as well as the current pre-arbitration meeting.
The report also recommends doing away with telephone mediations. Instead settlement meetings would have to take place in person or through video conferencing.
During a settlement meeting, the arbitrator might provide one or both parties with an opinion regarding the likely outcome of a future arbitration if the parties fail to reach a settlement.
Three Arbitration Streams
Justice Cunningham has called for three arbitration streams: paper reviews, expedited in-person hearings and full in-person hearings. The determination would be made by an arbitrator and not be subject to appeal. A paper review would take place cases where there are $10,000 or less of medical and rehabilitation benefits in dispute, or where the dispute involves a determination as to whether the claimant’s injuries meet the minor injury definition. The tribunal would be expected to restrict the length of expert reports and briefs.
Arbitration hearings would be conducted as an expedited in-person hearing in cases that do not qualify as either a paper review or full in-person hearing. An expedited in-person hearing would last no longer than one day and the arbitrator would let parties know how much time would be allocated for them to present their cases.
Arbitration hearings would be conducted as full in-person hearings for disputes involving catastrophic impairment determinations, whether the claimant qualifies for 24-hour attendant care or income replacement benefit claims beyond 104 weeks. The length of a full in-person hearing would be determined by the arbitrator.
The arbitrator’s report should be no longer than five pages for an expedited hearing and ten pages for a full hearing.
Appeals of arbitration decisions should be heard by a single judge of the Ontario Superior Court of Justice on a question of law.
New Penalties for Those Not Meeting Timelines
The report recommends a number of timelines that would be incorporated in legislation along with penalties for those that do not comply. Parties who cannot commit to appear for settlement meetings or arbitrations within the timelines set out would not be eligible to claim their costs at arbitration. If the tribunal is unable to schedule an arbitration within those same timelines, the tribunal would be expected to reduce the arbitration fees it collects from the parties. Parties would also get financial relief if arbitration decisions are late being issued.
A Shift in Culture
Justice Cunningham made it clear he would like to see a change in culture within the DRS. A number of recommendations are expected to accomplish that cultural change.
Every insurer would have to establish an internal company review process and be required to inform an insured how to access the process following a benefit denial. However, insureds would not be required to use the internal company review process before submitting an application to the new tribunal. Companies would be free to determine how their internal review process would to be structured, but must provide an insured with a written response within 30 days.
Justice Cunningham recommends that the settlement of future medical and rehabilitation benefits should be prohibited until two years after the date of the accident which is one year longer than the current prohibition.
The government would be expected to create a sliding scale of fees. Justice Cunningham proposes that incentives be introduced to encourage parties to settle early.
Experts would be required to certify their duty to the tribunal and to provide fair, objective and non-partisan evidence. Arbitrators would be expected to ignore evidence that was not fair, objective or non-partisan and, in those circumstances, the expert would not receive compensation for appearing as a witness.
What Happens Next
In January 2014, the government indicated that it will propose legislative amendments in the spring session based on recommendations of the Dispute Resolution System Review. However, the legislation may not pass if a spring election takes place. Once legislation finally passes, it will take some time to establish a new tribunal which means DRS users may be waiting some time before they benefit from possible changes.
In Medicine Teamwork Is an Invention of Administrators and the Government
I recently had the opportunity to give a team-building group exercise to my staff of Medical and Administrative professionals. The focus was on how to build a better team of individuals to better handle our increased patient load. In the beginning of the Seminar, I had everybody fill out an assessment as to how they felt we operated as a team. There were five categories to judge: Trust, Conflict, Commitment, Accountability and Results. The majority of the scores were low, demonstrating that this room full of people, who work with each other day in and day out, some for years, did not feel that they were a team.
Over three hours I discussed trust, conflict, communication, respect, personality types, the ego, how to disagree and how to come together as a group. We did numerous exercises to delve into these areas and discussed them as a team. At the end, when we are supposed to move into being a team, two members stated emphatically that they will never trust an administrator or any superior as long as they carried a license. So after three hours these people were no closer to begin working as a team than before.
Now I do need to make an observation: the Administrative Staff were more willing to work together for the common good than were the medical personnel. They were steadfastly islands unto their own.
So now I have twenty some people who instead of working together for the betterment of the organization, they will work for the betterment of themselves.
And that about sums up medicine.
The government has been attempting to make medicine a team event instead of an individual event. We use the term Provider instead of Doctor. We want to pay for a medical appointment based on how we judge the quality of the work, not for the work that was done.
For example, as an Administrator of an ASC (Ambulatory Surgery Center), I need to gather information on my GI doctors' Colonoscopy Documentation to report back to the government. When it is brought up to the powers that be that, gee, maybe they should ask the doctors for this information, we are told this is a great opportunity to build a connection with our physician’s office.
In surgeries, there is a Time Out, where someone other than the doctor calls for a pause to review the case, make sure they have the right person, make sure they know what body part they are operating on, if an arm or leg, which side, etc. The doctor has to wait for the Time Out to finish before s/he can begin.
Government and Administrators have tried to pigeon hole medical people into being a team, when in reality medical people are, for the most part, lone wolves. They have been trained to think this way, that if they make a mistake only they will be held responsible and they will go to jail. As such, all medical people have the mindset of “Trust but Verify.” They will not agree to anything they are told, until they see the rule, policy, guideline in black and white, and even then, if they don’t agree with what they are reading, it is disregarded.
So the battle will rage on between the Government that is trying to make medicine into their image and the medical personnel who will leave rather than comply, until medicine in America is fundamentally transformed.
Over three hours I discussed trust, conflict, communication, respect, personality types, the ego, how to disagree and how to come together as a group. We did numerous exercises to delve into these areas and discussed them as a team. At the end, when we are supposed to move into being a team, two members stated emphatically that they will never trust an administrator or any superior as long as they carried a license. So after three hours these people were no closer to begin working as a team than before.
Now I do need to make an observation: the Administrative Staff were more willing to work together for the common good than were the medical personnel. They were steadfastly islands unto their own.
So now I have twenty some people who instead of working together for the betterment of the organization, they will work for the betterment of themselves.
And that about sums up medicine.
The government has been attempting to make medicine a team event instead of an individual event. We use the term Provider instead of Doctor. We want to pay for a medical appointment based on how we judge the quality of the work, not for the work that was done.
For example, as an Administrator of an ASC (Ambulatory Surgery Center), I need to gather information on my GI doctors' Colonoscopy Documentation to report back to the government. When it is brought up to the powers that be that, gee, maybe they should ask the doctors for this information, we are told this is a great opportunity to build a connection with our physician’s office.
In surgeries, there is a Time Out, where someone other than the doctor calls for a pause to review the case, make sure they have the right person, make sure they know what body part they are operating on, if an arm or leg, which side, etc. The doctor has to wait for the Time Out to finish before s/he can begin.
Government and Administrators have tried to pigeon hole medical people into being a team, when in reality medical people are, for the most part, lone wolves. They have been trained to think this way, that if they make a mistake only they will be held responsible and they will go to jail. As such, all medical people have the mindset of “Trust but Verify.” They will not agree to anything they are told, until they see the rule, policy, guideline in black and white, and even then, if they don’t agree with what they are reading, it is disregarded.
So the battle will rage on between the Government that is trying to make medicine into their image and the medical personnel who will leave rather than comply, until medicine in America is fundamentally transformed.
Insurance Q&A: "How much is a pet worth?"
The reality is that pet owners usually can't recover much more than their out of pocket expenses when an animal is killed due to someone's negligence. And sometimes they won't even cover medical expenses for the injured animal.
Here's why: under current law, pets are valued as property and valued at what they'd cost to replace. (That's the same way insurers decide the worth of, for example, a totaled car.) You may be able to negotiate a slightly higher payment -- our consumer advocacy staff once helped get more money for a slain goat -- but the sentimental value of a longtime pet is often much, much higher.
In recent years, there have been a growing number of cases in which plaintiffs are arguing that a beloved pet is more than just property, and that insurance payouts should recognize that.
The Wall Street Journal last week reported on a Texas case in which a shelter mistakenly put a dog to death. The owners sued, claiming emotional damage from the loss of their 7-year-old dog, whom they felt was part of their family. An appellate court ruled in the couple's favor in 2011, saying that the special value of "man's best friend" should be recognized.
The case is now in the hands of the Texas Supreme Court.
Insurance News - Tuesday, February 19, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday, February 19, 2013:
- Steep hikes proposed for motorcycle insurance by Saskatchewan Government Insurance.
- What if the black box in your new car becomes a tool to invade your privacy? What if, on the other hand, it winds up saving your life after an accident?
- NICB reports a 27 percent rise in questionable claims since 2010 covering property, casualty, commercial, workers’ compensation, vehicle and miscellaneous.
- Small tweaks will cut fraud at root of high auto insurance premiums.
- Car insurance based on driving habits comes to Utah.
- Calls for a national accreditation system to identify top body shops and pay them better rates.
- Movement against texting while driving develops across U.S.