Insurance News - Wednesday, April 30, 2014

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Wednesday, April 30, 2014:

• Having mastered 700,000 miles of freeways driving, Google self-driving cars are now driving themselves in congested city streets.
• Colorado passes bill legalizing ride-sharing which will now require insurance coverage, vehicle inspections and driver background checks.
• Wal-Mart now offers price comparison shopping for auto insurance in the U.S.
• Ontario ombudsman warns that driving with medical conditions can be deadly.

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

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

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

 

OIC seeks innovator who wants to help implement ACA statewide

OIC has a unique job opening in our Rates and Forms Division as a Health and Disability Insurance Forms/Contracts Manager (WMS Band 3). The position reports to the Deputy Commissioner for Rates and Forms, which is the division that reviews insurance plans and rates.

This is an exciting opportunity for someone who wants to work on the cutting edge of Affordable Care Act implementation in Washington state. We need someone who can lead a team of expert staff; work closely with people in the division who review rates and provider networks; and who understands insurance and contracts. The person in this position needs to be innovative and adaptable.

Here are a few of the position’s duties, as outlined in the job announcement:

• Serves as the statewide expert on health and disability forms filings.
• Plans and directs the review and approval or disapproval of health and disability contracts submitted by regulated entities; analyzes filing data to discover complaint trends or patterns of unfair, inequitable or unlawful insurance practices; prepares files and recommends referral of such practices for enforcement action.
• Attends and participates in assigned and agency training to enhance requisite skills and knowledge needed to supervise professional staff.
• Represent the OIC on a local and national level, attending NAIC events, speaking on behalf of the agency, and providing leadership on work groups and task forces.

We are requiring:

• A bachelor of arts or bachelor of science degree.
• Expert knowledge of insurance products.
• Expert knowledge of the insurance code and related rules and case law related to insurance products.
• Extensive experience analyzing contracts, and providing effective oral and written communication.
• Five years' supervisory experience of professional-level staff.

The salary will depend on qualifications, with a maximum of $80,000 per year.

Read more about the job and how to apply. 

Minister Charles Sousa Announces Auto Insurance Premium Roll-Back

Today Ontario Finance Minister Charles Sousa announced that the government intends to introduce legislation that if passed with lower average annual premiums by 15% or $225 per vehicle for safe drivers.

It appears that FSCO will be authorized by legislation to compel insurers to refile rates to achieve the 15% average roll-back.  Although not mentioned, I expect FSCO will be able to make exceptions where a full roll-back could create solvency issues for an insurer.
 
The Minister said there should be an immediate impact but did not say exactly when drivers would see the savings. Based on past roll-backs, it may not be until a driver renews their insurance.

The Minister appeared to link rate roll-backs with fraud prevention initiatives and road safety improvements. FSCO will be provided with expanded powers to investigate fraud and enforce compliance.

FSCO will also be authorized to license and oversea health clinics and practitioners that invoice auto insurers. When asked about regulating the towing industry, the Minister was non-committal.

Finally, the Insurance Act is to be amended to make Superintendent's Guidelines, incorporated by reference in the SABS, to be binding. This proposed amendment appears to specifically address a view expressed by the arbitrator in the Scarlett and Belair decision.

SSDD [UPDATED]

Nothing changes . . .

Outgoing Health and Human Services Sec. Kathleen Sebelius is now refusing to testify before the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, a Senate aide told The Daily Caller Tuesday.

 Sebelius had originally been set to testify before the subcommittee about the department’s 2015 $70 billion budget request on April 2.

According to another aide, however, several weeks after confirming the hearing date, she requested a date switch with the National Institutes of Health budget hearing on May 7. The committee accommodated her request.

Now, after announcing her resignation on April 11, she is refusing to testify according to the two aides, even though she is still the sitting secretary — remaining at the post until her successor, OMB Director Sylvia Mathews Burwell is confirmed.

Daily Caller

ADDENDUM [HGS]: One wonders if this news may have something to do with Ms Kathy's reluctance to perjure herself testify:

"The contractor hired to fix the ObamaCare exchange website announced Tuesday that it would cost $121 million to get the site ready for a second open enrollment period in 2015"

That's a cool $30 million more than CGI's deal. Nice.
 

I'm a little confused, though:

"... second open enrollment period in 2015"

The second Open Enrollment period begins in the fall of 2014, so wouldn't the 2015 season be the third?
 

Or am I missing something?

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

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

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

Cavalcade of Risk #207 - Workin' Hard for Risk edition

Rebecca Shafer hosts this week's round-up of risk-related posts. It's particularly interesting to see such a wide variety of topics, including Wounded Warriors and venture capitalists, Aristotle and ERM.

Do check it out.

Insurance News - Tuesday, April 30, 2013

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday, April 30, 2013:

• Self-driving cars are going to save lives by removing human error which makes up about 99% of auto fatalities.
• Matheson v. Lewis decision could have an impact on cases where insurers try to deny coverage to occupants of uninsured vehicles.  In this case although the ATV in question  was a “self-propelled implement of husbandry” under the CAIA,which would not have been required to be insured under an automobile policy, the judge still ruled in favour of the plaintiff,
• An interesting human interests story.  An affluent insurance broker by day and blogger by night offers Toronto’s homeless something more meaningful than spare change.
• According to the Toronto Star, Ontario Finance Minister Charles Sousa will announce this morning the government's plan to lower auto insurance premiums by 15% but also to lower the ROE benchmark for insurers when filing for rate changes. So part of the rate reduction is to be in the form of lower profits.
• Another polls also has Ontario Liberals and Progressive Conservatives in a close race. With the NDP falling behind it only reinforces my view that Andrea Horwath will not be forcing an election this spring.

Insurance, building codes and rebuilding after a disaster

Q: Part of my home burned, and I'm repairing the large burned section of the home. County building codes require upgrades from what was originally there. Does my homeowners policy cover this added expense?

A: It depends. If your policy has what's called "law and ordinance coverage" -- it's often referred to as "L&O" or "upgrade coverage," then yes, your policy would address the added costs to make the required upgrades.

As a precaution, ask your agent or insurer if you already have the coverage or if you can add it to your policy.

Note: This is one of a series of common -- or in some cases, particularly unusual -- questions received by our consumer advocacy staff, who answer questions from consumers.


Got a question or insurance problem of your own? If you live in Washington, feel free to give us a call, toll-free at 1-800-562-6900. We'll do our best to help. (And if you live in another state or territory, here's a handy map that lists the contact info for your local insurance regulatory office.)

FSCO Releases A Draft Statement Of Priorities For 2014

Section 11 of the FSCO Act requires FSCO to deliver to the Minister of Finance and publish in The Ontario Gazette by June 30th of each year, a statement setting out the proposed priorities of the Commission for the fiscal year in connection with the administration of this Act and all other Acts that confer powers on or assign duties to the Commission or the Superintendent.

 FSCO has released a draft Statement of Priorities for 2014 and invites stakeholders to submit comments on the proposed priorities and initiatives by May 30, 2014. The draft is loaded with auto insurance initiatives which reflects the high level of activity on this file by the government over the past few years. Here is a summary of the auto insurance initiatives:

Licensing Business Systems and Business Practices of Service Providers 

In the 2013 Ontario budget, the government committed to take further action to tackle fraud in the auto insurance sector. Among other measures, the government expanded FSCO’s mandate to include the licensing and regulation of the business systems and business practices of healthcare service providers that directly invoice auto insurers for statutory accident benefits. In 2014, FSCO plans to launch a licensing regime to reduce fraudulent billing practices in the sector.

Develop Minor Injury Treatment Protocol 

FSCO has contracted scientists and medical experts to develop an evidence-based protocol to treat auto accident claimants who sustain minor injuries. The protocol will inform the Superintendent when developing a revised Minor Injury Guideline.

Support the Ministry of Finance in the implementation of a Cost and Rate Reduction Strategy for auto insurance 

Work with Ministry of Finance on statutory and system reviews 

In 2013, FSCO commenced a consolidated three year review of Part VI (Auto Insurance) of the Insurance Act, and related regulations. Once the review is complete, FSCO will submit a report to the Minister of Finance in the Fall, 2014.

Design and implement an information technology Enterprise Development Program 

A new web-based information management platform will provide FSCO with the required tools to effectively regulate in an increasingly challenging financial marketplace, while providing stakeholders with centralized access to the services they expect. The first phase will be launched in Spring 2014 to complement licensing of the healthcare service providers sector.

Work with the Ministry of Finance on the Dispute Resolution System Review implementation 

Enhance auto insurance information and analysis 

• Examining factors contributing to cost changes in third-party liability bodily injury, and releasing a final report on the findings in 2014. 
• Reviewing actuarial data to gauge the effect of the automobile insurance reforms, and studying the effect of the reforms on automobile insurance rate levels. 
• Working with the General Insurance Statistical Agency to collect Ontario’s 2013 auto insurance statistical data, and analyzing the data to monitor automobile insurance cost changes and to review the reasonableness of automobile insurance rates. 
• Reviewing the Health Claims for Auto Insurance system to determine reports necessary to provide additional information on statutory accident benefits treatment trends.

Implement fraud awareness stakeholder engagement strategy

Provide information to consumers about fraud prevention 

Review and implement requirements for usage-based auto insurance

Insurance News - Tuesday April 29, 2014

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday April 29, 2014:

• Usage-based insurance confers competitive advantages to early users.
• California legislature introduces ride-sharing bill which clarifies service is a commercial activity for insurance purposes.
• Meanwhile, the Arizona Governor vetoes a bill mandating drivers subsidize ride-sharing companies.
• The reality is that Uber and Airbnb cut out the middleman. Why are governments so rattled?
• SGI is seeking input from the public and stakeholders in a comprehensive review of its auto injury program.

Told Ya So (Part XIV)

As we've noted for a while now, a plurality (if not a majority) of those signing up through the Public Exchanges have enrolled in Medicaid, not "commercial" insurance plans. This is itself problematic not just for the sustainability of the ObamaTax, but as it turns out, for the newly-enrolled themselves:

"States are working through hundreds of thousands of backlogged applications due to Obamacare’s Medicaid expansion, but the administration is threatening to cut funding for dealing with them."

Since Medicaid is run by the 58 states, this creates somewhat of a dilemma: are the states capable of cutting through the backlog (let alone funding these new beneficiaries) or are their citizens destined to hang in Medicaid limbo for the foreseeable future?

By withdrawing not just active support, but actual financing, how are the states supposed to process this influx?

A partial answer comes from HHS Secretary Shecantbeserious herself, whose grasp of logic (if not common sense) is underwhelming:

"[She] theorized that looming cuts would incentivize states to get their backlogs under control as soon as possible."

Alternate version: the chocolate ration has been increased from 20 grams to 15.

Insurance News - Monday, April 29, 2013

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Monday, April 29, 2013:

• Guarantee CEO, Alister Campbell, suggests that Ontario auto insurance regulations and OSFI's capital requirements are contributing to a decline in foreign P&C carriers in Canada.
• The Scarlett and Belair decision is beginning to gain media attention: Accident victim wins challenge to Ontario’s $3,500 minor injury cap.
• Conflicting FSCO arbitration decisions have made the interpretation of what is an "accident" about as clear as mud.
• A number of no-fault auto insurance states are exploring reforms to address fraudulent claims.
• An RSA executive indicates that brokers are still losing market share to direct writers as customers want more web and mobile services but the decline will begin to slow down. 
• Ontario polling numbers all over the map.  Now a Forum Research poll is indicating that Wynne’s Liberals have jumped into a first-place tie with Tories.

ObamaTax Navigators: What are they hiding?

Y'know, for "the most transparent administration ever," Ms Shecantbeserious and her minions sure do like to keep their little secrets. Problem is, these secrets affect each and every one of us, often in ways we may not even be aware of.

Take, for instance, the care and feeding of Navigators. We've been exposing their potential for massive fraud for quite a while. The folks at Judicial Watch have kicked it up a notch, though:

"Judicial Watch announced a lawsuit ... against the Department of Health and Human Services after officials failed to comply with a November 8, 2013 Freedom of Information Act Request about Obamacare navigators."

According to the Feds, there are some 50,000 Navigators out there preying on innocents plying their trade. That's a lot of unlicensed, unvetted, unaccountable folks with access to your private medical, financial, health and tax information. It doesn't seem unreasonable that we, the public, should understand exactly how (or even if) Navigators are trained, and what safeguards are in place to prevent massive identity theft.

And it's fair to point out that Ms Kathy herself has admitted that many, if not most, Navigators may be felons, as in California, where "at least 43 convicted criminals have worked as navigators and handling sensitive information of private citizens."

Warm fuzzies, no?

Of course, that's not to say that it's all work and no play for these hardworking Navigators:

"On a call outlining its strategy to get people to sign up for Obamacare over the summer, leading Obamacare advocacy group Enroll America said it will get more creative with its outreach tactics – including hitting up night clubs"

Which is ironic, since it's been virtually impossible to actually get through to the 404Care.gov site.

Not to mention, under what scenario will these victims would-be customers be eligible to sign up? The Initial Open Enrollment Period is over, and the next one is many months away. Under what pretext, pray tell, will these folks claim a Special Open Enrollment Period?

Inquiring minds want to know....

Vanilla is Vanilla

My kids love our favorite local ice cream joint. The soft serve isn't what draws them though. It is the fact that they have so many different choices of sundaes and toppings. From a "Mud Sundae" with crushed Oreos, hot fudge, and gummy worms to the quart sized "hot fudge cake" there is something for everyone.

All of that is about to change. Later this week legislation is being introduced on the Affordable Ice Cream Act (AICA). You see, the cost for these heavenly sundaes has been rising lately and the government feels that they need to step in and change the way people purchase the product and make it more affordable for everyone.

In order to make it affordable the government is setting standards for what is available. You will now only be able to choose from chocolate, vanilla, strawberry, and twist. If you are under the age of 12 you can get Neapolitan. The only variation of ingredients can be in the fat content of the dairy products you use. No longer will you be able to have any toppings and all serving sizes will be measured to the ounce. Because of this, every ice cream shop in town would now be the same. Prices will be close and the only difference will be in taste.

Everyone must purchase ice cream or they will pay a penalty. The only people who can qualify for an exemption are those who can prove that they are lactose sensitive (yes, there is a difference from lactose intolerant).

For the sake of "professional development" I told my boys about this crazy new law yesterday afternoon. The reaction from them was priceless. The older two didn't believe it and actually made fun of the thought that anyone would eliminate toppings. The four year old wasn't happy. He really believed that he wouldn't be able to get a twist with sprinkles and smiley face.

The next time you step up to order a Topsy Tervy - or my personal favorite the Buckeye Sundae - think about Obamacare. Because in the health insurance world pretty soon the most creative option left will be the basic cone with twist ice cream.

Plan cancelled! Understanding The Full Ramifications of "If You LikeYour Current Plan"

I've written extensively on the broken promise of "if you like your plan you can keep it" yet over and over again it keeps surfacing throughout media outlets. The most recent edition comes to us from a study done by Benjamin Sommers at Health Affairs. In his findings he shares that churn, turnover in the insurance market, is so high that policy cancellations "aren't out of the norm" for people who purchase individual health insurance.

There is no doubt that turnover occurs in this segment of the market. Most of these people are in between jobs and use individual products as a bridge back to employer coverage. Based on Sommers' data in 2012 there were 10.8 million people in the individual insurance market. 6.2 million leave this form of insurance annually. So we all need to calm down about the insurance cancellations as it only impacts 4.6 million people. That's his logic and, as many liberal media outlets are reporting, is the whole argument.

But. It's. Not.

Those of us who understand insurance markets know that this is much more widespread than what is being reported. The individual market isn't alone. It also hits small employer sponsored insurance plans which represent more than 23 million people. Every small employer will lose their current plan (unless grandfathered) over the next two years. This is guaranteed because of the strict requirements under Obamacare. These requirements include a provision called Actuarial Value (AV). AV is the amount of the average claims an insurance plan must pay under a policy. If a plan falls outside of one of the four narrow bands it must be eliminated.

Which brings us to another key problem - less choice. Government believes they know what is better for you than you do. By restricting the AV bands (Bronze, Silver, Gold, Platinum) they are eliminating a large number of insurance choices. What was available in 2013 is no longer the case in 2014. This chart explains how choice is restricted and where plans are being cancelled.

In 2013 employers and individuals could purchase insurance from insurers that had any AV. Every dot represents an insurance plan. You will see very good plans to very poor plans. Now that 2014 is here insurers must conform to the four narrow bands of AV. What this does is eliminate all of the red insurance plans. For many small employers they are having very comprehensive plans cancelled and are being forced to either better or lesser plans.

This is how Obamacare works. Insurance companies are forced to cancel plans outside of the four metallic bands which eliminates consumer choice. It also hinders an insurance company's ability to price products at various levels and suppresses creative plan designs.

The results are less plans, less variation in plan design, less variation in premiums, and less innovation in plan administration. Worse yet, the formula used to determine the four metallic bands will change every year. So, even if you like your new Obamacare plan don't count on keeping it.

Ontario Standing Committee to Review Auto Insurance

On April 16, 2012 the Standing Committee of General Government of the Ontario Legislature approved a motion presented by NDP MPP Rosario Marchese to conduct a review of the Ontario auto insurance system. The motion passed because the Liberal minority government also is a minority on standing committee because representation reflects the size of caucus in the Legislature.

As result of the motion the standing committee intends to initiate a fair and balanced study into a range of auto insurance industry practices and trends with the purpose of developing recommendations on how to make insurance rates more affordable, and that the committee report its findings to the House. The study shall include witnesses to be called upon to assist the committee and shall include, but not be limited to:

• the current overall profitability of the property and casualty industry, with an analysis of current and future trends in both investment and underwriting income;
• the profitability of auto insurance underwriting in Ontario and costs related to Ontario underwriting, with particular emphasis on profits in the post-September 30, 2010, era where the statutory accident benefits were amended;
• assessing the adequacy of med-rehab treatment as per the capped minor injury guideline;
• the relationship between insurance underwriters and their sales representatives and/or the role independent brokers of insurance play in the industry. This would include an in-depth look at the extent to which brokers that portray themselves as independent of insurers really are independent;
• the impact of fraud in the insurance industry and how that impacts insurance rates;
• assessment of the adequacy of the current definition of “catastrophic injury”;
• ongoing and future trends in claims fraud as well as the impact of recent anti-fraud initiatives in combating such activity;
• the appropriateness of the 12% return-on-equity rate and the approvals mechanisms related to the ROE rate;
• reviewing the auto insurance dispute resolution system; and
• reviewing risk assessment factors of drivers and the corresponding rates assigned to particular drivers, as well as the eligibility and classification factors that currently determine individual, corporate and fleet coverage.

So what does this all mean? Well many of the issues to be reviewed have in fact been previously announced as part of the Government's Budget or commitments made by FSCO in the proposed Statement of Priorities. For example the Government established a Auto Insurance Anti-Fraud Task Force last summer and will be making recommendations later this year. The Financial Services Commission of Ontario (FSCO) set up a medical panel to conduct a review of the definition of catastrophic impairment last year and the Government recently announced that it is planning to move ahead to amendment regulations to implement the panel's recommendations. Some of these initiatives including the review of the minor injury guideline and the 12% ROE rate are subject to FSCO Requests for Proposals and it is expected that the successful consultants will be announced shortly.

It is likely not helpful for the insurance industry or consumers to have parallel reviews taking place with two sets of recommendations. In fact many of the changes coming out of these reviews will not require legislation and likely never come before the Legislature. Cabinet has the authority to create and amend regulations specified in statute.

We have a minority government so it's not business as usual. Opposition parties are looking to flex their muscles and push their own agendas.

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

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

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

Among the remaining challenges noted in the report:

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

 

My Karma Ran Over My Dogma

In case you needed a laugh:

"General Electric is telling its investors that Obamacare is to blame for recent losses in the company’s health care division"

GE, you may recall, was an early, vociferous proponent of the ObamaTax. It now cites the very real problem of market uncertainty resulting from a law both carelessly and cavalierly written and enforced.

There's a word for this....

Insurance and fallen trees

Q: Will my insurance pay to repair my neighbor's home if my tree falls on his home?

A: It may not have to. Typically, a homeowner's own insurance coverage pays for such damage, unless you were negligent and your negligence caused the tree to fall.

Say the tree was obviously diseased or damaged and posed a clear risk to your neighbor's home, for example. In such cases, you could be found negligent and your insurer would cover the claim.


Note: This is one of a series of common -- or in some cases, particularly unusual -- questions received by our consumer advocacy staff, who answer questions from consumers.



Got a question or insurance problem of your own? If you live in Washington, feel free to give us a call, toll-free at 1-800-562-6900. We'll do our best to help. (And if you live in another state or territory, here's a handy map that lists the contact info for your local insurance regulatory office.)

Insurance News - Thursday, April 25, 2013

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, April 25, 2013:

• Driverless vehicles would be a windfall for households and businesses that acquire them but would probably increase traffic and nationwide fuel usage.
• The U.S. government is urging car makers to curb web apps and electronic gadgets to reduce distracted driving. 
• HowU.S. government Distracted-Driving Guidelines will shape your next smartphone.
• Proposed Texas law would bar uninsured drivers from collecting non-economic damages when they are injured in a crash.
• Why are Ontario Conservatives eager for an election? It's because they have a near-10% lead over the Liberals and NDP.  So don't be surprised when the NDP decide to support the Liberal budget next week, their supporters fear a majority Conservative government.
• Is auto insurance an election-worthy issue outside of Brampton?

Another auto insurance private member's bill introduced in Ontario

On April 23, 2012 York West MPP Mario Sergio introduced New Drivers' Insurance Rate Reduction Act , 2012 (Bill 71), which is intended to lower rates for new drivers.

MPP Sergio previously introduced Bill 43 which deals with allowable elements of a risk classification system. Bill 43 has not proceeded beyond first reading in he Legislature. Both these bill are private members' bills and historically very few of these bill are passed.

Bill 71 requires a risk classification system used by an insurer to determine rates for automobile insurance to provide for lower rates for new drivers by crediting new drivers with additional years of driving experience. All new drivers get credit for 3 years driving experience and those that have completed a driver education course at a recognized school get credit for 6 years driving experience.

A new driver is disqualified from receiving additional years of credit in a number of circumstances, including

(a) if he or she has been found to be more than 25 per cent at fault in an accident;

(b) if his or her licence has been suspended for non-payment of a fine (excluding parking tickets); or

(c) if he or she has been convicted of,

(i) a provincial offence related to driving,

(ii) a Criminal Code offence related to driving, or

(iii) an offence under in another jurisdiction in North America for similar offence.

The bill can be found here.

Deadline? WHAT Deadline?

Only in DC could this concept make any sense:

"The Obama administration said Thursday that sick patients in the temporary, federal [PCIP] program now will have until June 30 to select an exchange health plan."

Let's consider this for a moment, shall we?

We've always considered the PCIP (Pre-Existing Condition Insurance Plan) as one of the very few (if not the sole) good things about the ObamaTax. It allowed those with severe and/or chronic conditions to purchase reasonably effective, reasonably priced health insurance, and covered their pre-existing conditions from the get-go. Unfortunately, it was designed with a built-in "sunset clause" that (ostensibly) closed down the program on January 1, based on the (naive) idea that it would no longer be necessary.

At that, the reports of its demise were somewhat exaggerated, as the phase-out was pushed back to the end of March.

And even that was pushed back in a last-minute, under-the-radar announcement that "Enrollees in the federally-run [PCIP], who have not yet found new health insurance coverage through the Marketplace, can purchase an additional month of PCIP coverage through April 30, 2014, while they continue their search."

All well and good (one supposes), but now we learn that, again with little fanfare, the program has been extended an additional 2 months.

Which raises some questions:

First, why would we believe that even the new-and-improved June 30th deadline will be enforced?

Second, and perhaps more critically, just how is this extension being funded? The money originally set aside for it is long-since spent, and I've seen no Congressional activity authorizing additional funding.

Finally, if the ObamaTax folks can't get even those who value such coverage to sign up, why would they believe that healthy folks would be interested in an ObamaPlan?

Implementing a 15% Reduction In Auto Insurance Premiums

The NDP put forward their motion on March 27th calling upon the government “to direct FSCO (the Financial Services Commission of Ontario) to gradually reduce average, industry-wide, private passenger auto insurance premiums by 15%.”  Just what Ms. Wynne subsequently agreed to do is still a bit vague, and although the motion is non-binding, it does seem certain that some form of autom insurance premium roll-back will be enforced, either legislatively or through FSCO policy over the coming months.  

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

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

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

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

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

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

Cavalcade of Risk #207: Call for submissions

Rebecca Shafer hosts next week's Cav. Entries are due by Monday (the 28th).

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.

Again???

You'd think that this would have been fixed...

Embarrassment of (Link) Riches

■ Say it ain't so! Seems that the Silver State's Health Exchange has a few problems, not the least of which is that it's intent on hiding its problems:

"Confidential documents which appear to be from a Nevada Health Link employee may reveal huge problems within the state health exchange."

See - I told you so!

And what, exactly, are these problems? Well, to start with, there's the case of Lawrence Basich. Regular readers may recall Mr B as the gentleman who's been trying - unsuccessfully - to sign up for an ObamaPlan since last Fall. Turns out, he (and upwards of 10,000 others in similar circumstances), may have been the victim of the Exchange itself, which was apparently miscalculating subsidies and premiums.

The scary part is that administrators apparently knew of these problems and, rather than fix them, chose to hide them.

But according to their state's senior Senator, they're all lying.

■ We've written pretty extensively on the Death Panel IPAB controversy, but as FoIB Holly R tips us, that may not be the worst of it:

"The Center for Medicare and Medicaid Innovation has flown below the political radar. That's due to its seemingly innocuous mission: promoting new and more efficient "payment systems" and "models of care."

As Bob pointed out almost two years ago, the CMMI may sound anodyne - it is anything but:

"Obamacare’s Center for Medicare and Medicaid Innovation will conduct payment and delivery reform demonstrations with a goal of changing Medicare from fee-for-service to “capitated” or salaried payments. Unlike a pluralistic system of competitive plans, Medicare patients will have little or no control over whether or not they will be subject to these changes."

Shorter version: bye-bye, Grandma.

■ Up is down and left is right:

"Actuary Jac Joubert, along with a pair of Oliver Wyman analysts, say a big new federal risk-management program could pay carriers too much for covering consumers with health problems and too little for covering low-risk people."

That's the take-away from a study of how the ObamaTax is faring thus far. Ms Shecantbeserious (well, for now) and her minions are using a "risk adjustment model" originally designed for  Medicare Advantage plans, which are vastly different than ObamaTax-compliant major medical policies.

The result: decreased profit margins and a faltering - or even failing - carrier.

Perhaps Ms Kathy sees this as a feature, not a bug?

Consumer tip: Don’t toss notices from your lenders

If you get a notice in the mail from one of your lenders – whether it be auto, boat, home or any other item you are paying for with a loan – make sure you read it. Lenders can require you to prove the item they’ve paid for is insured against damage or loss with an auto, homeowner or other applicable policy.

If you fail to prove the item is insured, the lender has the right to apply its own insurance policy, called “force placed” or “vendor’s single interest (VSI),” to your loan. The policy doesn’t protect you against property loss or liability—its sole function is to pay the lender the loan balance if you default on the loan. These policies are very expensive, they are added to your loan balance and you pay interest on them. One consumer was charged $2,680 for a policy on a $15,000 loan—that’s nearly 18 percent of the loan, not counting the interest the consumer paid.

The good news is that lenders typically allow you to drop the policy once you prove you have your own insurance on the item.

Don’t get stuck with a huge insurance cost that could have been prevented. When you get notices in the mail from a lender, read them. 

If you have questions, contact our consumer advocates at 1-800-562-6900 or through our website.

Standing Committee on General Government - April 17, 2013 - Automobile insurance review

I've provided some highlight of the first day of hearings last week on auto insurance by the Standing Committee on General Government.  Full transcripts are available here.

Collision Industry Information Assistance

John Norris

• Repair shops who become preferred providers of insurance companies are expected to provide labour cost discounts and purchase parts from suppliers selected by insurers and who pay the insurer a fee. Local suppliers are often not used which delays repairs.
• Shops often have no choice but to become preferred providers because of the volume of business that comes from insurance companies.
• Companies that rent repair estimating systems to shop sell the data collected to insurers who use it to identify policyholders who have not reported accidents.  The policyholder is rebilled to reflect a higher risk.
• Cash settlements for physical damage claims are not always used to repair vehicles which means unsafe vehicles are on the road.
• Supports self-regulation of the towing industry.
• Repair shops can also identify fraudulent claims if there was an entity to which they could be reported.

FAIR, the Association of Victims for Accident Insurance Reform

Rhona DesRoches

Tammy Kirkwood

Greg Smith

• Believe that dishonest or corrupt vendors of auto insurer medico-legal assessments or IMEs ought to suffer the same fate as dishonest treatment providers.
• Do not see any difference between opportunistic fraud in the form of falsely inflating the value of a claim by exaggerating injuries and impairments, and the opportunism of falsely deflating the value of a claim by dishonestly trivializing and minimizing serious injuries.
• Propose a three-strikes rule, where if an IME provider has three negative comments about the quality of their reports from arbitrators or judges, they would be denied the ability to continue to provide reports.

Insurance News - Wednesday, April 24, 2013

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Wednesday, April 24, 2013:

• Survey shows a prospective customer's age is not always a good way of predicting whether they want to get insurance quotes online. 
• Some courts are now applying a higher level of judicial scrutiny to the role of expert witnesses, particularly in cases involving medical diagnoses. Claims examiners and insurers need to be cautious when retaining experts and make sure that their processes will stand up to review.
• Property and casualty insurers looking to maintain and enhance profitability in 2013 and beyond are advised to adopt a more consumer-centric business model.
• Sentry Insurance announces the release of a mobile version of its risk management solution, Sentry Insight Mobile, which provides a customer-focused way for businesses to receive claims information on any smart phone. 
• A new study from researchers at the Texas Transportation Institute at Texas A&M University found that sending text messages via voice while driving is just as dangerous as texting with fingers.

Job opening: senior market analyst

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

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

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

Insurance News - Thursday April 24, 2014

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday April 24, 2014:

• According to analysis of consumers getting online quotes by Kanetix those using online quoting services are now older and using mobile devices.
• The IBC is making the rounds talking up Bill 171 to MPPs but are they listening?
• Of course MPPs are more focused on a spring election.  Speaking of which the projected outcome will likely satisfy no one. The Liberals would likely win 43 seats with 41 seats going to the Conservatives and 23 setas going to the NDP.
• As data about drivers proliferates, auto insurers look to adjust rates. Opposition to using socio-economic factors heats up in the U.S.

Meanwhile, on This Side of the Pond . . .

Henry likes to write about the MVNHS (Most Vaunted National Health Service). Mike brings us tales about health care  in the Sceptered Isle.  

As it turns out, they don't have to travel that far to find stories about government run health care.

At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.

The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.

CNN

Treatment at V.A. facilities has been a dirty secret for some time. Just a few years ago the Walter Reed scandal made the news.

Now this.

The secret waiting list sounds like Schindler's List, except much more ominous.

The VA requires its hospitals to provide care to patients in a timely manner, typically within 14 to 30 days, Foote said.

According to Foote, the elaborate scheme in Phoenix involved shredding evidence to hide the long list of veterans waiting for appointments and care. Officials at the VA, Foote says, instructed their staff to not actually make doctor's appointments for veterans within the computer system.

Instead, Foote says, when a veteran comes in seeking an appointment, "they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there's no record that you were ever here," he said.

Data manipulation by the government? 

That's a first . . .

Foote says the Phoenix wait times reported back to Washington were entirely fictitious. "So then when they did that, they would report to Washington, 'Oh yeah. We're makin' our appointments within -- within 10 days, within the 14-day frame,' when in reality it had been six, nine, in some cases 21 months," he said.

What is the impact on the health of our veterans?

Teddy says his Brooklyn-raised father was so proud of his military service that he would go nowhere but the VA for treatment. On September 28, 2013, with blood in his urine and a history of cancer, Teddy and his wife, Sally, rushed his father to the Phoenix VA emergency room, where he was examined and sent home to wait.

"They wrote on his chart that it was urgent," said Sally, her father-in-law's main caretaker. The family has obtained the chart from the VA that clearly states the "urgency" as "one week" for Breen to see a primary care doctor or at least a urologist, for the concerns about the blood in the urine.

"And they sent him home," says Teddy, incredulously.

Seems we have our own version of the Liverpool Care Pathway right here in the U.S.

So what happened with 71 year old Navy veteran Thomas Breen? 

When no one called from the V.A. about his follow up appointment family members made several inquiries.

"Well, you know, we have other patients that are critical as well," Sally says she was told. "It's a seven-month waiting list. And you're gonna have to have patience."

Sally says she kept calling, day after day, from late September to October. She kept up the calls through November. But then she no longer had reason to call.

Thomas Breen died on November 30. The death certificate shows that he died from Stage 4 bladder cancer. Months after the initial visit, Sally says she finally did get a call.

"They called me December 6. He's dead already."

The V.A. saga that started on Sept. 28, marked as "urgent", ended for Mr. Breen on November 30.

One can argue that Mr. Breen's stage 4 bladder cancer was too advanced, treatment would not have saved him.

Yes, you could say that. But you miss the point.

No one deserves this kind of neglect.

Especially our veterans.

Health Wonk Review: ACA "Improvement" edition is up

Louise Norris always does a great job hosting, but this week's edition is arguably her finest work. It's full of great posts and helpful context, just a really terrific job. Definitely worth clicking over to read the latest and greatest on ObamaCare.

Standing Committee on General Government - April 15, 2013 - Automobile insurance review

I've provided some highlight of the first day of hearings last week on auto insurance by the Standing Committee on General Government.  Full transcripts are available here.

Financial Services Commission of Ontario

Philip Howell

Tom Golfetto

• With respect to the mediation backlog, all files will be assigned to a mediator by year-end which will eliminate the backlog
• The average accident benefit claim costs are higher in Ontario because maximum benefit levels for comparable accident benefit coverages in other provinces are less generous or unavailable.
• There’s absolutely no question that there is some rate reduction room in the system. It varies quite a lot by company.
• If every company had to cut rates by 15% next year without any corresponding reduction in costs, there would be many companies that would be effectively put out of business or would at least have to go to their investors and ask for a significant infusion of capital in order to remain in business.
• Clarified that the 2010 reforms produced $2 billion in reduced claims cost but not $2 billion in additional profits.

Insurance Bureau of Canada

Ralph Palumbo

Barb Taylor

Joe Cheng

Neil Parkinson

Pete Karageorgos

• Two actuarial reports commissioned by the IBC show that the proposed 15% premium reduction would basically exceed any profits the industry had made and put the industry in a loss situation.
• Claim costs were lower fully by $1.6 billion just on a straightforward calendar-year-to-calendar-year basis between full year 2010 to 2012.
• Underwriting losses were substantially reduced, but not eliminated, to $655 million in 2012 and when you allocate investment income to it, the industry has achieved a small and positive return for 2012: about 3.3%. Effectively, it was break even in 2011 according to KPMG.
• GISA data cannot be used to measure profitability.
• There is an explanation for the difference in claims costs from 2011 and 2012.  JSCP indicates and increase of $300 million and KPMG indicates of drop of $198 million.  JSCP’s calculation is principally driven off premiums and KPMG is driven off capital and claims reserves. So there is a difference in investment income; there are some other differences in allocation and estimates.

 

Independent Brokers Association of Ontario

Rick Orr

Randy Carroll

• Concerned that a 15% rate reduction would make the industry unprofitable and impact on availability similar to what was going on prior to 2010.  Drivers would be forced into the Facility Association.
• Rates have not been coming down because of uncertainty in the market due to lack of progress around changes to the definition of catastrophic impairment and the mediation backlog.  Uncertainty has now increased because of the proposed 15% rate reduction.
• There is a growing risk if the insurance companies continue to buy brokerages and remove the independents from the market.

Ontario Trial Lawyers Association

Andrew Murray

John Karapita

• Should consider using profits to provide better protection to accident victims. The minor injury cap should be increased from $3,500 but if the money in the system is used to reducing premiums then it won’t happen.
• Dispute resolution can be sped up if you improve the ability to fail those mediations where it’s clearly obvious that the dispute is so large or the gap is so wide that it’s not amenable to a mediated resolution.
• Should consider hiring some of the outsourced mediators if they’re working well, to clear through the backlog, and then, having tackled the backlog, keep them on to stay ahead of the wave.
• Provide greater flexibility for those cases where the mediation is not well suited to actually resolving the file with a lump-sum settlement.

Canadian Automobile Association

Elliott Silverstein

Matthew Turack

• From an auto insurance perspective, regulation of the towing industry will not only help further the industry’s image; it will help prevent the tow truck industry from being used by other industries where fraud is already prevalent. Through regulation, the industry would also include a code of conduct, safety standards, training and proper oversight, not to mention consumer protection as well.
• CAA has conducted a pilot of a telematics product and surveyed its participants with an overwhelmingly positive response. The results showed that of those surveyed, 43% would consider enrolling in a telematics-driven product if they received a discount on their auto insurance. Also important to highlight is that 11% of those surveyed would enrol in a telematics program without any incentives or discounts whatsoever.
• We have seen an impact since the reforms in 2010 on the accident benefits side of the business, as well, we’ve also seen a shift, and continue to reserve as such, to the bodily injury side, from accident benefits claims to bodily injury claims.
• If we took a 15% rate reduction in a one-year period of time, it would put us into a negative underwriting profit position and it would mean that we would have very small, if any, returns from the insurance company.

Ontario Rehab Alliance

Laurie Davis

Patricia Howell

Nick Gurevich

Justine Hamilton

• The quantum of benefits seems to be too low. At $3,500, our current system offers the lowest level of protection in Canada to about 80% of all victims who, since the 2010 reforms, are deemed to have sustained a minor injury.
• Would like to see a licensing process for health care facilities that focuses on owns the business that provides the service, because the providers are largely regulated.
• Would like a person to be designated as a clinical director within a practice, and that has to be a regulated provider.
• The $2,000 assessment cap creates a situation where low cost assessments are overcompensated and complex assessments are undercompensated.
• Concerned that when the Task Force recommendations get implemented, additional barriers to access treatment are created because the early recommendations that have been implemented seem to be headed in that direction.

We knew it! Actuary named best job of 2013.

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

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

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

Alphabet Soup News

From our friends at FlexBank:

■ "The IRS announced [last October] the ability to permit employees to carryover up to $500 of an unused health FSA balance. IRS Notice 2015-71 now offers an employer the option to amend their Section 125 plan to allow up to $500 of unused funds remaining at the end of a plan year to be carried forward into the following plan year."

This is significant because these plans have traditionally been "use it or lost it," and now participants may have the opportunity to roll-over unused dollars.

 ■ "The IRS released a memorandum on March 28, 2014 that confirms that employees participating in a general purpose health FSA, and who have carryover from a prior year, cannot contribute to an HSA for the entire following year."

General Purpose Flex Spending Accounts are those which cover any so-called 213(d) expenses (a laundry list of eligible expenses) as opposed to a Limited Purpose FSA which covers only those specifically stated in the plan document. This is significant because it may severely limit one's participation in a Health Savings Account.

 ■ "Section 125 Plans (also known as a Cafeteria Plan or Premium Only Plan (POP), must follow the general principle that employees' pre-tax elections are irrevocable for the plan year, except under certain conditions"

Generally speaking, you only get to change your "cafeteria plan" choices once a year - at Open Enrollment. But there are exceptions to these rules, although they're quite limited. These would include a "Change in Status" (eg marriage, adoption, etc), as well as a few others. The fine folks at FlexBank offer you this link for an overview of the permitted election changes.