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Sunday, June 28, 2015
Kreidler: The insurance industry faces an unprecedented risk from climate change
Commissioner Kreidler has been involved in climate change and insurance issues for years now. Currently, he chairs the National Association of Insurance Commissioner's Climate Change and Global Warming Working Group. Read his take in Climate Action on the unique opportunity the insurance industry has to prepare for the changes to our climate.
What was at stake in the ruling for Washington state
Earlier this month, we put out a report detailing what was at stake for Washington state -- down to the county level -- if the Affordable Care Act was thrown out by the Supreme Court.
The upshot was that more than 800,000 Washingtonians stand to get coverage through the Medicaid expansion OR to get subsidies to help them and their families pay for private insurance.
In addition, the report details the reforms, most of them largely unnoticed by the average person, that have already taken effect. Among these: Young adults can now stay on their parents' health coverage up to age 26, kids can't be denied insurance because they're sick, small businesses get tax rebates if they provide health coverage for workers, no caps on lifetime benefits, etc.
The most significant reforms will take place in 2014, including the state's new health care exchange, an online marketplace to shop for and compare insurance -- as well as a way for lower- and middle-income families to get substantial help paying for it.
The full report is at http://www.insurance.wa.gov/legislative/reports/Whats-at-stake.pdf.
The upshot was that more than 800,000 Washingtonians stand to get coverage through the Medicaid expansion OR to get subsidies to help them and their families pay for private insurance.
In addition, the report details the reforms, most of them largely unnoticed by the average person, that have already taken effect. Among these: Young adults can now stay on their parents' health coverage up to age 26, kids can't be denied insurance because they're sick, small businesses get tax rebates if they provide health coverage for workers, no caps on lifetime benefits, etc.
The most significant reforms will take place in 2014, including the state's new health care exchange, an online marketplace to shop for and compare insurance -- as well as a way for lower- and middle-income families to get substantial help paying for it.
The full report is at http://www.insurance.wa.gov/legislative/reports/Whats-at-stake.pdf.
Kreidler reaction to Supreme Court upholding health care reform law
OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler expressed great relief with the U.S. Supreme Court’s decision upholding the Affordable Care Act and said Washington state is now well ahead of most states in reforming its health care system.
Many reforms are currently in place, but key benefits and programs take effect in 2014, including Washington’s new Health Exchange, federal subsidies to help 477,000 people afford health insurance, an expansion of Medicaid for 328,000 poor childless adults and the ban on insurance companies from denying people coverage if they’re sick.
“I’m very pleased the Supreme Court chose to uphold the Affordable Care Act,” said Kreidler. “We’ve been busy for two years now implementing the reforms and have made great progress, but there’s a lot left to do before 2014. With the court decision out of the way, we can continue our focus on where it should be – bringing relief to families struggling to find quality, affordable health insurance.”
The millions of Washington state consumers benefitting from the Affordable Care Act’s early reforms include:
Washington state also leveraged millions in federal funds available under the Affordable Care Act to create:
“The Affordable Care Act is not perfect, but it moves us in the right direction and is the only meaningful reform that’s passed in decades,” said Kreidler. “The debate was clearly contentious, and I’m grateful to have it behind us. But, now it’s time to focus on the work ahead – more than a million uninsured people in our state are counting on us.”
- More than 2.4 million people who no longer face lifetime caps on their health benefits.
- More than 52,000 young adults up to age 26 who have stayed on their parents’ health plans.
- More than 1.2 million people who now have coverage for preventive care with no co-pays or deductibles.
- More than 60,000 people in Medicare who have saved hundreds on their prescription drugs.
- Public access to health insurance rate requests.
- A new marketplace in Washington state for health insurance in 2014 – called an exchange – where people can shop for health plans, compare their options and apply for subsidies.
- A temporary health insurance program (PCIP-WA) for people with pre-existing health conditions.
Saturday, June 27, 2015
Total loss claims for customized vehicles
There are a lot of car buffs among us who like to customize their vehicles with a new set of wheels and tires, a custom paint job or a high-end sound system. While that money may be an investment in the resale value of your car, it may not transfer to the value of your car in the event of a total loss.
If you are in an auto accident, your insurance company will determine if it will cost more to repair your vehicle than it is worth. If that's the case, it will declare the vehicle a total loss and report it to the state Department of Licensing.
The insurance company will try to establish a fair market value for your vehicle by locating comparable vehicles in where you live and park your vehicle. Even if your car has been customized or has added features, the value of the car may not be as high as you expect it will be in comparison to the cars around you.
Read about what happens if your vehicle is a total loss.
If you are in an auto accident, your insurance company will determine if it will cost more to repair your vehicle than it is worth. If that's the case, it will declare the vehicle a total loss and report it to the state Department of Licensing.
The insurance company will try to establish a fair market value for your vehicle by locating comparable vehicles in where you live and park your vehicle. Even if your car has been customized or has added features, the value of the car may not be as high as you expect it will be in comparison to the cars around you.
Read about what happens if your vehicle is a total loss.
I forgot to pay my auto insurance - is there a grace period?
Sorry to deliver the bad news, but if you forget to pay your auto insurance, you really could be canceled. There is no grace period. Call your company or agent right away to make sure you're covered.
Here's a couple more common questions we get:
I was in an accident and the other insurance company won't pay my ongoing medical bills. What can I do?
Unfortunately, when you're dealing with someone else's insurance company, they usually will not pay your ongoing medical costs. Only when you're done with your treatments will they consider settling your claim. If you have personal injury protection (PIP), you should contact your own insurance company to let them know about the accident and your injuries.
I was in an accident and the other person's insurance company says I have to get my car repaired. Is that true?
The insurance company is obligated to pay you for the loss. You have the right to decide to cash out your claim rather than have your vehicle repaired. But keep in mind that if you cash out your claim, the company may not consider any additional damage that you discover later. Also, the company will only pay the very least it can to repair your vehicle. So, if you have three estimates they'll only pay for the lowest cost one. Most companies will base your settlement on their own inspection and estimate.
Here's a couple more common questions we get:
I was in an accident and the other insurance company won't pay my ongoing medical bills. What can I do?
Unfortunately, when you're dealing with someone else's insurance company, they usually will not pay your ongoing medical costs. Only when you're done with your treatments will they consider settling your claim. If you have personal injury protection (PIP), you should contact your own insurance company to let them know about the accident and your injuries.
I was in an accident and the other person's insurance company says I have to get my car repaired. Is that true?
The insurance company is obligated to pay you for the loss. You have the right to decide to cash out your claim rather than have your vehicle repaired. But keep in mind that if you cash out your claim, the company may not consider any additional damage that you discover later. Also, the company will only pay the very least it can to repair your vehicle. So, if you have three estimates they'll only pay for the lowest cost one. Most companies will base your settlement on their own inspection and estimate.
Insurance News - Thursday, June 27, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, June 27, 2013:
- The Manitoba government will introduce new consumer protection rules for vehicle repair shops effective July 1.
- A U.S. analysts suggests that claims processing in the American P&C industry is inefficient and the industry could reduce claims costs by $36 billion. Claims operations are still extremely labour-intensive, heavily paper-based, and data-rich but information-poor.
- Social media is here to stay so the P&C insurance industry might as well learn to use it. I've noticed that many insurers are now on Twitter.
- Is it really that easy to hack a car and cause a crash?
Trial Lawyers Quit FSCO Advisory Committee - Is That A Good Thing?
The Toronto Star reported last week that a group of prominent personal injury lawyers has resigned en masse from an informal legal advisory committee on auto insurance reform in Ontario. The protest action by the trial lawyers was in response to the release by the Ontario Minister of Finance of a report from the Superintendent of Financial Services on recommended changes to the SABS definition of "catastrophic impairment."
The contentious nature of the proposals is the Superintendent’s recommendation to preclude allowing the combination of psychological and physical impacts when determining if someone qualifies as having suffered a catastrophic impairment, in constrast to the Ontario Court of Appeal which recently said it combining should be allowed.
The contentious nature of the proposals is the Superintendent’s recommendation to preclude allowing the combination of psychological and physical impacts when determining if someone qualifies as having suffered a catastrophic impairment, in constrast to the Ontario Court of Appeal which recently said it combining should be allowed.
The lawyers contend that the number of accident victims that will meet the catastrophic impairment threshold will fall. I think that is likely undisputable. Unfortunately there isn't sufficient data to make a determination on the numbers. Other changes could possibly increase the number of catastrophic determinations but again there is no way of confirming the numbers.
The group of personal injury lawyers, who include Richard Halpern, partner at Thomson Rogers, Roger Oatley of Oatley Vigmond Personal Injury Lawyers LLP, Nigel Gilby, partner at Lerners LLP and Stephen Firestone of Lackman Firestone, resigned because their recommendations on catastrophic impairment were ignored.
The Legal Advisory Committee was one of several advisory groups set up by the Superintendent to continue the dialogue with stakeholders during the development and implementation of the 2010 auto insurance reforms. These advisory committees were not created as policy or decision making groups and I believe those participating understand that. That doesn't make the process a sham. Nonetheless, there is always an expectation that discussions with senior public servants will influence policy makers. When they don't it invariable leads to frustration.
In my 20 plus years in government, I have conducted many stakeholder consultations and outreach. It is a considerable challenge to manage expectations. My advice to groups has always been to continue dialoguing. Ongoing participation is not a sign of acceptance of the policy direction.
No doubt the trial lawyers feel that their time on the committee is a waste of time and that lobbying efforts should be concentrated elsewhere. My view is that you have a role in ensuring transparency and accountability by continuing to participate.
Friday, June 26, 2015
Queen's Park Update
A surprise majority for the Liberals in the recent election is expected to set a different tone in Queen's Park after almost 3 years of minority government. A minority government is all about survival, there is no long-term planning. The Liberals could not focus on deficit reduction, job creation, pensions or stabilizing the auto insurance product without the confidence of having the support of the Legislature.
Despite campaigning under an activist agenda, the Liberals are now signalling that they are serious about deficit reduction. Deb Matthews has been appointed President/Chair of Treasury Board/Management Board which traditionally has been a responsibility of the Ministry of Finance. Treasury Board is not well known outside of government but it is a powerful central agency that manages the fiscal plan of the government including all government spending and approving labour agreements. A very powerful body.
Charles Sousa continues as Minister of Finance and appears to still be responsible for the auto insurance file. His Deputy, Steve Orsini has been promoted to Secretary of Cabinet which is head of the Ontario Public Service. His appointment is intended to also signal that the Liberals are serious about deficit reduction. He replaces Peter Wallace also preceded Orsini as Deputy Minister of Finance.
There has been some restructuring in the Ministry of Finance. The Insurance and Cooperatives Policy Unit (which includes auto insurance policy) and the Deposit Taking Institutions Unit of the Industrial and Financial Services Branch will be reconstituted as the Financial Institutions Policy Branch. They will continue to be led by Alvaro del Castillo. Tthe Financial Institutions Policy Branch will join the Securities Reform Division (SRD) reporting to Assistant Deputy Minister Frank Allen who replaces Pat Deutscher. To better reflect its broader mandate the SRD will be renamed the Financial Services Policy Division.
Next week, new MPPs will return to Queen's Park to elect a new Speaker of the Legislature (July 2), hear a new Speech from the Throne (July 3), then debate a re-introduced provincial budget on July 14. It is expected that shortly after that the Legislature will recess for the summer. That might mean that the reintroduction of industry supported bills such as Bills 171 and 189 might have to wait until the fall.
Despite campaigning under an activist agenda, the Liberals are now signalling that they are serious about deficit reduction. Deb Matthews has been appointed President/Chair of Treasury Board/Management Board which traditionally has been a responsibility of the Ministry of Finance. Treasury Board is not well known outside of government but it is a powerful central agency that manages the fiscal plan of the government including all government spending and approving labour agreements. A very powerful body.
Charles Sousa continues as Minister of Finance and appears to still be responsible for the auto insurance file. His Deputy, Steve Orsini has been promoted to Secretary of Cabinet which is head of the Ontario Public Service. His appointment is intended to also signal that the Liberals are serious about deficit reduction. He replaces Peter Wallace also preceded Orsini as Deputy Minister of Finance.
There has been some restructuring in the Ministry of Finance. The Insurance and Cooperatives Policy Unit (which includes auto insurance policy) and the Deposit Taking Institutions Unit of the Industrial and Financial Services Branch will be reconstituted as the Financial Institutions Policy Branch. They will continue to be led by Alvaro del Castillo. Tthe Financial Institutions Policy Branch will join the Securities Reform Division (SRD) reporting to Assistant Deputy Minister Frank Allen who replaces Pat Deutscher. To better reflect its broader mandate the SRD will be renamed the Financial Services Policy Division.
Next week, new MPPs will return to Queen's Park to elect a new Speaker of the Legislature (July 2), hear a new Speech from the Throne (July 3), then debate a re-introduced provincial budget on July 14. It is expected that shortly after that the Legislature will recess for the summer. That might mean that the reintroduction of industry supported bills such as Bills 171 and 189 might have to wait until the fall.
How long is this claim going to take?
Consumers who call our hotline often ask us how long insurance companies can take to settle their claims. Waiting for a decision on an insurance claim can be frustrating when you are trying to get on with your life.
Insurers have 30 days from the time they receive a claim to complete their investigation and make a coverage decision, unless it is unreasonable to get it done in that timeframe. Depending on the circumstances, some claims may require more time. Insurers are required to perform reasonable investigations of claims, which often includes activities like scheduling interviews with other parties, obtaining police or engineering reports and site inspections that can extend the investigation time beyond 30 days.
If you are dealing with your own insurance company, your policy may require you to provide statements of the circumstances of the loss, fill out proof-of-loss forms, obtain estimates or supply police reports or medical information. You can speed the process by keeping records, including purchase receipts, maintaining an inventory of your possessions, staying in contact with your adjuster, and being available to assist the adjuster if they need your input.
Finalizing a claim, including the paperwork and arranging for payments, commonly takes longer than 30 days. Complicated claims can take months to resolve. Whether you are dealing with your own insurer or someone else’s insurer, we recommend that you take an active part in the process, ask questions and provide requested information to help process your claim.
If you feel you have been treated unfairly or have questions about insurance in Washington state, contact our consumer advocates online or at 1-800-562-6900.
Insurers have 30 days from the time they receive a claim to complete their investigation and make a coverage decision, unless it is unreasonable to get it done in that timeframe. Depending on the circumstances, some claims may require more time. Insurers are required to perform reasonable investigations of claims, which often includes activities like scheduling interviews with other parties, obtaining police or engineering reports and site inspections that can extend the investigation time beyond 30 days.
If you are dealing with your own insurance company, your policy may require you to provide statements of the circumstances of the loss, fill out proof-of-loss forms, obtain estimates or supply police reports or medical information. You can speed the process by keeping records, including purchase receipts, maintaining an inventory of your possessions, staying in contact with your adjuster, and being available to assist the adjuster if they need your input.
Finalizing a claim, including the paperwork and arranging for payments, commonly takes longer than 30 days. Complicated claims can take months to resolve. Whether you are dealing with your own insurer or someone else’s insurer, we recommend that you take an active part in the process, ask questions and provide requested information to help process your claim.
If you feel you have been treated unfairly or have questions about insurance in Washington state, contact our consumer advocates online or at 1-800-562-6900.
Cease and desist order issued against Lenovo
Insurance Commissioner Mike Kreidler has issued a cease-and-desist order against computer maker Lenovo, barring the company from continuing to sell illegal service contracts in Washington state.
From May 2008 to May 2012, Lenovo (United States) Inc. is believed to have sold $153,415 worth of service contracts in the state. The plans, which covered repair or replacement of damaged Lenovo products, can only be sold to Washington residents by a licensed insurer or a registered service contract provider. Lenovo is neither.
Kreidler also ordered the company to mail a copy of the cease-and-desist order to all its Washington customers within 10 days.
Nothing in the order prevents the company from fulfilling the terms of the service contracts or from issuing a refund, if requested.
The company’s unauthorized sale of service contracts was initially disclosed by Lenovo itself when it applied for registration as a service contract provider in April 2011. At that point, the company said, it had already sold 855 contracts for $90,630.
When Kreidler’s staff reviewing the application sought more information, the company failed to respond, and later withdrew its application (December 2011). Lenovo later said it had sold a total of 1,327 contracts worth $153,415 to Washingtonians (May 2012).
The company has a right to demand a hearing. The order takes effect immediately.
From May 2008 to May 2012, Lenovo (United States) Inc. is believed to have sold $153,415 worth of service contracts in the state. The plans, which covered repair or replacement of damaged Lenovo products, can only be sold to Washington residents by a licensed insurer or a registered service contract provider. Lenovo is neither.
Kreidler also ordered the company to mail a copy of the cease-and-desist order to all its Washington customers within 10 days.
Nothing in the order prevents the company from fulfilling the terms of the service contracts or from issuing a refund, if requested.
The company’s unauthorized sale of service contracts was initially disclosed by Lenovo itself when it applied for registration as a service contract provider in April 2011. At that point, the company said, it had already sold 855 contracts for $90,630.
When Kreidler’s staff reviewing the application sought more information, the company failed to respond, and later withdrew its application (December 2011). Lenovo later said it had sold a total of 1,327 contracts worth $153,415 to Washingtonians (May 2012).
The company has a right to demand a hearing. The order takes effect immediately.
Questions about health reform? Check out www.healthcare.gov
For those of you who've followed the Affordable Care Act since it's passage, you've probably spent considerable time at the federal government site: www.healthcare.gov. Well, it just got a whole new look. They've streamlined the information and given it more of a consumer focus. We like it - a lot. Check it out for yourself. There's even specific information for people who already have health insurance. And even a live chat option 24/7 if you want your question answered right away.
Thursday, June 25, 2015
Treatment/Assessment Plan Numbers to Become Mandatory on HCAI Invoices
On November 8, 2011, the Superintendent released a bulletin (A-07/11) outlining changes to the HCAI Guideline to address abusive billing practices including frequent invoices, duplicate invoices, "double dipping" and invoicing for non-approved goods and services .
At the time the Superintendent committed to further changes to the Standard Invoice (OCF-21) that would provide that the “Plan Number” on the form would become a mandatory field. This is the unique number generated by the HCAI system when the Treatment and Assessment Plan (OCF-18) or Treatment Confirmtion Form (OCF-23) to which the OCF-21 refers is submitted, and will enable insurers to properly reconcile invoices.
These changes have now been made and announced by the Superintendent in a recent bulletin (A-02/12). The updated HCAI system will become available at 8 a.m. EDT on July 3, 2012. At that point, HCAI will begin enforcing the new rules for OCF-21 submissions.
If there is no Plan Number because of a valid business scenario (e.g., the insurer has waived the requirement for an OCF-18 or OCF-23 as applicable) the word “exempt” must be inserted in the Plan Number field and details of the circumstances must be provided in the “Other Information” section of the OCF-21.
FSCO will in the near future be issuing an amended OCF-21 form to address information gaps a regarding Minor Injury Guideline (MIG) claims. These changes will be effective for use on and after November 1, 2012 and will contain the following changes:
At the time the Superintendent committed to further changes to the Standard Invoice (OCF-21) that would provide that the “Plan Number” on the form would become a mandatory field. This is the unique number generated by the HCAI system when the Treatment and Assessment Plan (OCF-18) or Treatment Confirmtion Form (OCF-23) to which the OCF-21 refers is submitted, and will enable insurers to properly reconcile invoices.
These changes have now been made and announced by the Superintendent in a recent bulletin (A-02/12). The updated HCAI system will become available at 8 a.m. EDT on July 3, 2012. At that point, HCAI will begin enforcing the new rules for OCF-21 submissions.
If there is no Plan Number because of a valid business scenario (e.g., the insurer has waived the requirement for an OCF-18 or OCF-23 as applicable) the word “exempt” must be inserted in the Plan Number field and details of the circumstances must be provided in the “Other Information” section of the OCF-21.
FSCO will in the near future be issuing an amended OCF-21 form to address information gaps a regarding Minor Injury Guideline (MIG) claims. These changes will be effective for use on and after November 1, 2012 and will contain the following changes:
- The amended OCF-21C form will include two new mandatory additional data fields in which the date that the MIG treatment Block commenced and the profession(s) of the health care provider(s) who provided the treatment are to be identified. In addition, use of the OCF-21C will become mandatory for billing all amounts applicable under the MIG. The OCF-21B and OCF-18 will no longer be approved for use with MIG codes.
- The amended OCF-21 form will also reflect the requirement, already noted above, that completion of the “Plan Number” field in the manner specified in the Guideline is mandatory effective July 1, 2012.
- In addition, the OCF-21 will be amended to raise the awareness of those individuals signing the form of their responsibility and accountability in doing so.
Insurance News - Tuesday, June 25, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday, June 25, 2013:
- To combat distracted driving, Manitoba has announced it will assess drivers 2 demerit points if caught using hand-held electronics.
- Some legal advice from the UK for insurers on the use of telematics.
- The City of Toronto has announced that it is launching a review of the tow truck industry. Supposedly they are looking at everything from fees to body shop recommendations to insurance scams.
- An interesting Toronto Star article entitled: Big Data: the good, the bad and the ugly.
- A strong first quarter of 2013 for U.S. p&c insurers with an ROE approaching 10%. Here is an analysis on the results.
- The U.S. Supreme Court could indirectly reduce rates for same-sex drivers if they rule bans on same-sex marriage are unconstitutional.
Wednesday, June 24, 2015
What is Obamacare?
The United States is midway through its first year of health benefits under the Affordable Care Act (ACA), which was passed by Congress in March 2010 to reform the nation's health care system. The Affordable Care Act is the short name for the official act, called the Patient Protection and Affordable Care Act and often referred to in the media as Obamacare.
There has been much confusion about the ACA and Obamacare since those terms joined our national lexicon. Late night show host Jimmy Kimmel illustrated that last fall when he interviewed people "man on the street" style about how they felt about the ACA versus Obamacare.
Regardless what your personal opinion is about the ACA, the act is complex and far-reaching. It seems no matter how much you know about the ACA, there is always more to learn. Journalist Sarah Kliff with Vox, an online media outlet, posted an interactive overview of all things ACA from a national perspective.
Take a look at Everything you need to know about Obamacare.
Other resources:
There has been much confusion about the ACA and Obamacare since those terms joined our national lexicon. Late night show host Jimmy Kimmel illustrated that last fall when he interviewed people "man on the street" style about how they felt about the ACA versus Obamacare.
Regardless what your personal opinion is about the ACA, the act is complex and far-reaching. It seems no matter how much you know about the ACA, there is always more to learn. Journalist Sarah Kliff with Vox, an online media outlet, posted an interactive overview of all things ACA from a national perspective.
Take a look at Everything you need to know about Obamacare.
Other resources:
- People cannot currently enroll in health care unless they qualify for a special enrollment. Open enrollment starts on Nov. 15.
- You can access Washington's health exchange at www.wahealthplanfinder.org.
Sunday, June 21, 2015
Theft charges for medical worker who submitted $4 million in bogus bills, sometimes claiming to be a doc
We're going to post a news release soon about this case:
A medical worker submitted at least $4.1 million in bogus bills to insurers, sometimes while falsely claiming to be a doctor or physician’s assistant, has pleaded guilty to theft.
Kenneth R. Welling, 45, of Lake Forest Park, pleaded guilty Thursday in King County Superior Court. The charges -- all of which are felonies -- include one count of first-degree theft and six counts of second-degree theft.
“This was a pretty audacious scam,” said state Insurance Commissioner Mike Kreidler. “We were tipped off to it when a patient contacted us, saying that Welling billed her insurer $89,000 for six surgeries that never happened.”
Welling is a registered surgical technologist and sole proprietor of Shoreline, Wash.-based Alpine Surgical Services. His license allows him to perform tasks like preparing supplies and instruments, passing them to the surgeon and preparing basic sterile packs and trays. But after patients had procedures done, he would often submit large bills with codes listing himself as a doctor or physician’s assistant. He is neither.
Kreidler’s investigators also found numerous instances in which Welling billed for surgeries that never happened. Sometimes he would include post-operative reports, listing himself as the surgeon.
No evidence was found to indicate that Welling was playing an improper role in actual medical care. The fraud involved billing.
“As far as we could tell, the only time he pretended to be a doctor was when he submitted bills,” said Kreidler.
In one woman’s case, Welling billed $140,323 as assisting surgeon for nine surgeries that never took place. Over a five-year period, he billed another woman’s insurer 107 times for 51 different surgeries, listing himself as the primary doctor. Hospital records show she’d only had surgery twice.
From 2004 through 2011, according to medical records obtained by Kreidler’s Special Investigations Unit, Welling billed five insurance companies at least $4.1 million for services he did not provide. He was paid $461,000.
“Part of the reason he got away with this for so long is that he’d rarely challenge an insurer who paid little or nothing,” said Kreidler. “He’d just send them the bills and hope they’d pay.”
The investigation also showed that some patients were complaining to their insurers.
“I am angry!” one woman wrote to her insurance company in 2011. “Here is yet another fraudulent claim. Can’t you people help me to stop this? I never had surgery on Aug. 27, 2009. I never met or had anything to do with Ken Welling.”
A sentencing date is expected to be scheduled soon.
A medical worker submitted at least $4.1 million in bogus bills to insurers, sometimes while falsely claiming to be a doctor or physician’s assistant, has pleaded guilty to theft.
Kenneth R. Welling, 45, of Lake Forest Park, pleaded guilty Thursday in King County Superior Court. The charges -- all of which are felonies -- include one count of first-degree theft and six counts of second-degree theft.
“This was a pretty audacious scam,” said state Insurance Commissioner Mike Kreidler. “We were tipped off to it when a patient contacted us, saying that Welling billed her insurer $89,000 for six surgeries that never happened.”
Welling is a registered surgical technologist and sole proprietor of Shoreline, Wash.-based Alpine Surgical Services. His license allows him to perform tasks like preparing supplies and instruments, passing them to the surgeon and preparing basic sterile packs and trays. But after patients had procedures done, he would often submit large bills with codes listing himself as a doctor or physician’s assistant. He is neither.
Kreidler’s investigators also found numerous instances in which Welling billed for surgeries that never happened. Sometimes he would include post-operative reports, listing himself as the surgeon.
No evidence was found to indicate that Welling was playing an improper role in actual medical care. The fraud involved billing.
“As far as we could tell, the only time he pretended to be a doctor was when he submitted bills,” said Kreidler.
In one woman’s case, Welling billed $140,323 as assisting surgeon for nine surgeries that never took place. Over a five-year period, he billed another woman’s insurer 107 times for 51 different surgeries, listing himself as the primary doctor. Hospital records show she’d only had surgery twice.
From 2004 through 2011, according to medical records obtained by Kreidler’s Special Investigations Unit, Welling billed five insurance companies at least $4.1 million for services he did not provide. He was paid $461,000.
“Part of the reason he got away with this for so long is that he’d rarely challenge an insurer who paid little or nothing,” said Kreidler. “He’d just send them the bills and hope they’d pay.”
The investigation also showed that some patients were complaining to their insurers.
“I am angry!” one woman wrote to her insurance company in 2011. “Here is yet another fraudulent claim. Can’t you people help me to stop this? I never had surgery on Aug. 27, 2009. I never met or had anything to do with Ken Welling.”
A sentencing date is expected to be scheduled soon.
Insurance News - Friday, June 21, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Friday, June 21, 2013:
- A spike in personal injury claims in Alberta has sparked applications for a 13.5% hike in auto insurance rates and renewed calls for reforms to plug 'loopholes.'
- A FSCO arbitrator has determined the now obsolete stoppage of weekly benefits form (OCF-17) to be invalid. This continues a tread of FSCO arbitrators invalidating Superintendent approved forms.
- The AAA Foundation for Traffic Safety has released a study on cognitive distractions in the car indicating voice-to-text e-mail is as significant distraction as cell phone use.
- Affiliated Brokers Exchange Ltd. has teamed up with Insurance Technology Solutions Inc. to offer a new policy administration system that allows for paperless policy issuance, among other capabilities.
- NAIC reports that more than 40% of teen auto deaths occur between 9 p.m. and 6 a.m. and for teens the relative risk of fatal crash increases as the number of passengers increases.
- There is a month left to comment on a CCIR paper dealing with e-commerce in insurance products.
- The Property Casualty Insurers Association of America has produced a map of states (25) that allow electronic proof of insurance using a smartphone or tablet.
Saturday, June 20, 2015
Rate Evasion Is The Latest Type of Fraud To Hit The GTA
Registering and insuring your vehicle using your parent's address in a neighbouring city might seem like a clever way to save money on your auto insurance rates.
Doing so can save hundreds of dollars. Using an online quoting system, I found that a 30 year old man, driving a 10 year old Toyota with no tickets or accidents would pay $1,998 if he lived in North York. Change the address to one in Barrie and the rate drops to $1,489. That's a $500 difference.
While fibbing on an address may seem harmless enough, it's a practice known as rate evasion, and it's considered a form of insurance fraud.
With rate evasion, people claim to live in another city or that their car is garaged there, in order to pay lower insurance rates. If you say you live in Barrie but actually live in Toronto, you're posing a risk in Toronto but you're not paying for that risk. Toronto residents whose vehicles are registered in the right location end up covering some of your share of the costs by paying higher auto insurance rates.
Rate evasion occurs in regions with high auto insurance rates. It's difficult to detect in the GTA since vehicle plates do not reveal where your car is registered. In some urban areas in the U.S. it is a little more obvious. In certain areas of New Jersey, especially northern, urban areas, and the southern part of the state bordering Pennsylvania, it's not uncommon to see plenty of cars with out-of-state license plates regularly parked in people's driveways and on residential streets. Recently I was involved in a minor collision and the other driver provided me with his driver's licence, vehicle registration and insurance card. Each document had a different address. It made me just a little suspicious.
Auto insurance is a pooling system where everyone pays premiums and the pool of funds are used by an insurer to pay claims to those who have accidents. Everyone is rated based on their risk profile which includes where you live. To certain extent there is always going to be some form of cross-subsidization based on the rules an insurer follows. For example, an insurer cannot determine premiums based on whether the policyholder has access to collateral benefits from a workplace (e.g., supplementary health benefits). Those with access to collateral benefits are going to claim less than those without yet they may be rated the same, all things being equal.
When consumers try to beat the system by registering their vehicle at a false address, they are being cross-subsidized by other policyholders. The difference is they are operating outside of the rules and the law. Therefore, it's fraud. Still, high premiums in the GTA will continue to tempt some drivers.
Doing so can save hundreds of dollars. Using an online quoting system, I found that a 30 year old man, driving a 10 year old Toyota with no tickets or accidents would pay $1,998 if he lived in North York. Change the address to one in Barrie and the rate drops to $1,489. That's a $500 difference.
While fibbing on an address may seem harmless enough, it's a practice known as rate evasion, and it's considered a form of insurance fraud.
With rate evasion, people claim to live in another city or that their car is garaged there, in order to pay lower insurance rates. If you say you live in Barrie but actually live in Toronto, you're posing a risk in Toronto but you're not paying for that risk. Toronto residents whose vehicles are registered in the right location end up covering some of your share of the costs by paying higher auto insurance rates.
Rate evasion occurs in regions with high auto insurance rates. It's difficult to detect in the GTA since vehicle plates do not reveal where your car is registered. In some urban areas in the U.S. it is a little more obvious. In certain areas of New Jersey, especially northern, urban areas, and the southern part of the state bordering Pennsylvania, it's not uncommon to see plenty of cars with out-of-state license plates regularly parked in people's driveways and on residential streets. Recently I was involved in a minor collision and the other driver provided me with his driver's licence, vehicle registration and insurance card. Each document had a different address. It made me just a little suspicious.
Auto insurance is a pooling system where everyone pays premiums and the pool of funds are used by an insurer to pay claims to those who have accidents. Everyone is rated based on their risk profile which includes where you live. To certain extent there is always going to be some form of cross-subsidization based on the rules an insurer follows. For example, an insurer cannot determine premiums based on whether the policyholder has access to collateral benefits from a workplace (e.g., supplementary health benefits). Those with access to collateral benefits are going to claim less than those without yet they may be rated the same, all things being equal.
When consumers try to beat the system by registering their vehicle at a false address, they are being cross-subsidized by other policyholders. The difference is they are operating outside of the rules and the law. Therefore, it's fraud. Still, high premiums in the GTA will continue to tempt some drivers.
Kreidler statement on Regence's proposed 14.7 percent rate hike
Regence BlueShield, one of Washington state's largest health insurers, is proposing an average 14.7 percent hike in premiums for its customers who buy coverage on their own.
Even with that increase, the company says it would also face a loss of $4.5 million from its surplus, which currently exceeds $1 billion.
Here's state Insurance Commissioner Mike Kreidler's statement on the proposal:
“We’ve just received this request. It will undergo a rigorous review by our actuaries.
“Regence contends that even with this increase, it would lose $4.5 million from the company’s surplus. To put that in perspective, that’s less than half of 1 percent of the company’s $1 billion surplus.
“In fact, Regence could continue to lose $4.5 million annually for the next 220 years and it would still have a surplus.
“A similar request by a sister company, Regence BlueCross BlueShield of Oregon, sought a 6.4 percent increase, starting August 1, 2012. But after our review and objections, it withdrew the request today. Any future rate request will face the same thorough scrutiny.”
Even with that increase, the company says it would also face a loss of $4.5 million from its surplus, which currently exceeds $1 billion.
Here's state Insurance Commissioner Mike Kreidler's statement on the proposal:
“We’ve just received this request. It will undergo a rigorous review by our actuaries.
“Regence contends that even with this increase, it would lose $4.5 million from the company’s surplus. To put that in perspective, that’s less than half of 1 percent of the company’s $1 billion surplus.
“In fact, Regence could continue to lose $4.5 million annually for the next 220 years and it would still have a surplus.
“A similar request by a sister company, Regence BlueCross BlueShield of Oregon, sought a 6.4 percent increase, starting August 1, 2012. But after our review and objections, it withdrew the request today. Any future rate request will face the same thorough scrutiny.”
Insurance News - Thursday, June 20, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, June 20, 2013:
- Canadian privacy advocates express alarm over the use of telematic devices after FSCO approves Desjardins pay-as-as-drive program. However, the program has been praised by Ontario Privacy Commissioner Ann Cavoukian for the steps taken to protect privacy.
- This Florida case covers the classic insurance fraud from that state including staged accidents and the purchase of information on legitimate accident victims from bribed hospital staff.
- Isn't it gratifying when those arrogant fraudsters that brag about it on Twitter and Facebook discover insurers now check social media?
- A United Kingdom study suggests up to 60% of whiplash claims are either exaggerated or fraudulent.
- Consumer Federation of America reports that California is only state where auto insurance rates fell over two decades through 2010. The group attributes the decline to a law that gave regulators more control over rates.
- A spike in personal injury claims has sparked applications for a 13.5% hike in Alberta auto insurance rates and calls for new reforms.
Spokane man's own smartphone is a witness against him in insurance-fraud case
Last summer, a Spokane man named Bryan Gilbert Robb filed an insurance claim, saying that his home had been burglarized. The police report listed an $800 loss.
Robb's claim, however, totaled $26,569, most of it from computers, games and DVDs. He included several photographs of the items that he said had been stolen.
Digital cameras and smartphones typically record the date and time that an image is taken, with what device, etc. This information, which is embedded in the photo file, is called metadata.
The problem: The metadata for 7 of the 9 photos submitted by Robb showed that the images were taken after the burglary date.
Robb's company, Assurant, denied the claim and turned it over to our Special Investigations Unit, which found a very similar 2004 burglary claim at Mr. Robb's previous address. That claim reported the loss of almost identical computers, a game console and DVDs.
Robb was charged June 14 in Spokane County Superior Court with one count of felony insurance fraud and one count of second-degree attempted theft. Arraignment is set for July 1.
To report insurance fraud or insurance scams here in Washington state, here's how to reach us.
Robb's claim, however, totaled $26,569, most of it from computers, games and DVDs. He included several photographs of the items that he said had been stolen.
Digital cameras and smartphones typically record the date and time that an image is taken, with what device, etc. This information, which is embedded in the photo file, is called metadata.
The problem: The metadata for 7 of the 9 photos submitted by Robb showed that the images were taken after the burglary date.
Robb's company, Assurant, denied the claim and turned it over to our Special Investigations Unit, which found a very similar 2004 burglary claim at Mr. Robb's previous address. That claim reported the loss of almost identical computers, a game console and DVDs.
Robb was charged June 14 in Spokane County Superior Court with one count of felony insurance fraud and one count of second-degree attempted theft. Arraignment is set for July 1.
To report insurance fraud or insurance scams here in Washington state, here's how to reach us.
Insurance News - Thursday, June 20, 2012
New System To Verify Alabama Auto Insurance Coverage
About 22 percent of Alabama’s drivers don’t have liability insurance, but a new online system could change that starting next year.The system will allow officials who issue license plates to immediately verify the insurance status of the vehicle’s owner. If insurance can’t be verified, proof of insurance will have to be presented before a tag is issued.
The new system was necessitated by the passage of the Alabama Mandatory Liability Insurance Law, which State Sen. Arthur Orr, R-Decatur, helped sponsor during the 2011 session.
read more...
The new Alabama system is similar to the Unisured Vehicle Project (UVP) in Ontario. The UVP is an initiative that is led by the Ministry of Transportation of Ontario that will provide an electronic means of determining whether a vehicle carries mandatory insurance coverage at the time their license plates are being renewed. The vehicle identification number and mandatory coverage status of each insured vehicle are maintained in a database by Insurance Bureau of Canada on behalf of the insurance industry.
read more...
Driverless Cars Inching Closer To Reality
Last month, Google received permission to test driverless vehicles in Nevada. The state set regulations for the companies before issuing the permit, but before we get to those, there are some obvious concerns that other motorists have about the new technology.
The California Senate has approved legislation that would have the California Highway Patrol develop standards and performance requirements for "autonomous" vehicles to be licensed for testing and operation on public roads.
Building autonomous vehicles that don't cause accidents is a difficult but crucial challenge. It's not enough to be as safe as the human driver. We need to be crashless," said John Maddox, an associate administrator at the National Highway Traffic Safety Administration (NHTSA) and keynote speaker at the Driverless Car Summit in Detroit.
read more...
Sebastian Thrun helped build Google's amazing driverless car, powered by a very personal quest to save lives and reduce traffic accidents.
Driverless car driving through heavy city traffic.
Insurance News - Friday, June 20, 2014
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Friday, June 20, 2014:
- IBC will be lobbying for more auto insurance reforms in in Ontario now that there is a majority government.
- Why it's so easy to steal from insurance companies – and what to do about it.
- Should Canada revisit credit rating for auto underwriting?
- Auto insurance claims drop with Honda collision warning system - a taste of what driverless cars can offer.
- So what happens when two self-driving cars are at an intersection and their clocks tell them both they arrived first?
- FSCO has revised the Standard Benefit Statement that insurers must send to claimants every 2 months beginning Sept 1.
Friday, June 19, 2015
Allianz Life Insurance fined $150,000
Washington State Insurance Commissioner Mike Kreidler has fined an insurance company $150,000 after its agents sold unapproved annuities.
Allianz Life Insurance Company of North America has agreed to pay the fine.
Several Allianz Life agents have been fined, suspended or have lost their insurance licenses in recent years for selling unapproved annuities to Washingtonians. In some cases, the customers were flown to Idaho; in others, the agents falsely claimed that the forms had been signed in Idaho or Florida. Kreidler’s office had been raising concerns with the company about these problems since at least 2007.
As required by law, Allianz Life reported the agents to Kreidler’s office and offered refunds to the affected customers. In April 2012, the company implemented procedures designed to prevent illegal cross-state insurance sales.
“I’m glad to see that the company’s taking efforts to rein in this ongoing problem,” said Kreidler. “I understand the pressure to make sales, but agents and companies selling to Washingtonians have to use products that are approved here.”
For more, please see the press release.
Allianz Life Insurance Company of North America has agreed to pay the fine.
Several Allianz Life agents have been fined, suspended or have lost their insurance licenses in recent years for selling unapproved annuities to Washingtonians. In some cases, the customers were flown to Idaho; in others, the agents falsely claimed that the forms had been signed in Idaho or Florida. Kreidler’s office had been raising concerns with the company about these problems since at least 2007.
As required by law, Allianz Life reported the agents to Kreidler’s office and offered refunds to the affected customers. In April 2012, the company implemented procedures designed to prevent illegal cross-state insurance sales.
“I’m glad to see that the company’s taking efforts to rein in this ongoing problem,” said Kreidler. “I understand the pressure to make sales, but agents and companies selling to Washingtonians have to use products that are approved here.”
For more, please see the press release.
Thursday, June 18, 2015
Insurance News - Wednesday, June 18, 2014
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Wednesday, June 18, 2014:
- Ontario Court of Appeal finds insurer must indemnify and and defend woman who let her driver's licence expire.
- The WSIB has been relying more on surveillance to investigate questionable claims.
- Government prepares regulations to enable large-scale testing of self-driving cars on Dutch roads.
- Driverless cars are going to change just about everything.
- Other than Ekos, why did none of the polls pick up on a Liberal majority?
Wednesday, June 17, 2015
Spokane man sentenced for insurance fraud and attempted theft
Four years after filing a bogus insurance insurance claim that tried to turn $4,000 in storm damage into a $200,000 payment, a Spokane man has been sentenced to 240 hours of community service, 15 days of electronic home monitoring and more than $7,000 in fines.
Keith R. Scribner, seen in the surveillance photo above, was sentenced Friday in Spokane County Superior Court on felony charges of insurance fraud and attempted theft.
The case stemmed from a claim filed in late July 2009 by Scribner's mother, Marilyn Warsinske. She said a patio roof at a home she'd purchased had collapsed due to the weight of snow some 6 months earlier. The policy covered "like kind and quality" replacement. Her son, she told the company, would handle the claim.
Scribner told the insurance company that patio cover was an extensive structure, spanning the entire length of the patio and wrapping around the home's chimney. Claims officials, inspecting the site, wondered why was there no flashing or holes in the masonry. Scribner said that house painters must have made repairs.
He sent the insurance company three bids to replace the cover based on his description. The bids ranged from $195,586 to $213,815.
Claims officials asked Scribner for any photos of the roof prior to the damage or after it collapsed. Perhaps some were taken during a home appraisal prior to the purchase, they suggested. Scribner said there were no photos and was no appraisal.
But a claims handler discovered an aerial photo of the home on a real estate website. It showed a much smaller patio cover than Scribner claimed.
The company launched a fraud investigation and notified Insurance Commissioner Mike Kreidler's anti-fraud Special Investigations Unit.
As it turned out, there had been a home appraisal, the investigators discovered. In fact, Keith Scribner met with the appraiser. And the appraisal included photos of the patio cover. A real estate agent interviewed by investigators described the cover as being "small and nothing special or significant."
The home's previous owner also provided photographs of the structure. It was originally canvas. When that because troublesome to remove each year, the homeowner bought a polycarbonate cover. Cost: About $300.
An architect told a state fraud investigator that he'd met with Scribner in 2008 -- months before the snow collapse -- to discuss plans to replace the deck cover with new, larger one.
A local company, provided with measurements and photographs of the original structure, drew up replacement bids at the request of a state fraud investigator. The bids: $3,913 and $4,782.
Sunday, June 14, 2015
What the Liberal Majority Government Means For Ontario Auto Insurance
The Liberal platform for auto insurance was essentially set out in the 2014 Spring Budget which never proceeded beyond first reading before the election was called. Now that the Liberals have a majority, it is expected that they will proceed with those commitments. It also means the NDP will no longer be able to influence government policy.
In the Spring, the Liberals indicates that the rate reduction strategy is on target and average rates will be 8% lower by August 2014 and 15% lower by August 2015. However, the Budget document does not point to any specific initiative that will specifically work towards achieving those targets. Average rates are down 5.6% as of the end of the first quarter of 2014.
The Liberals will have a challenge bringing down rates further without a few significant systemic changes. More and more it appears costs have been rising over past few quarters so it should be interesting to see the second half data for 2013. Rising costs can be attributed to a number of factors including:
The Premier has committed to bringing back the Legislature on July 2 to re-introduce the Budget Bill following a Throne Speech. The Budget Bill itself had no auto insurance provisions.
Instead, legislative amendments to the Insurance Act were part of Bill 171, the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014 which was introduced in March 2014. The Bill included legislative amendments for the transformation of the dispute resolution system, and further action to crack down on fraud and abuse, as well as other cost-saving measures. The government was to take further steps on developing a dedicated investigation and prosecution office on serious fraud, with an initial focus on auto insurance fraud. The development of this fraud office would be based on the Auto Insurance Anti-Fraud Task Force’s principle that fraudsters should be vigorously pursued and prosecuted where evidence warrants.
There is no timetable for re-introducing Bill 171. There were some strong objections expressed over several provisions in the Bill - barring access to the courts for accident benefit disputes and reducing the prejudgment interest rate. It will be interesting to see if there are any changes should the Bill be re-introduced.
The Liberals had also introduced legislation to regulate the towing industry that never passed. Bill 189, the Roadside Assistance Protection Act would require towing and storage providers to publish their rates, provide an itemized invoices, accept payment by credit card if requested and to disclose to the consumer any interest a towing and storage provider may have in a location or facility to which a vehicle may be towed for repair or storage. If passed into law, Bill 189 would also stipulate the consumers be given access to towed vehicles in order to remove personal property.
FSCO has been proceeding with the licensing of treatment and assessment facilities on the auto insurance sector. The licence application process opened up on June 1. Facilities will have to be licensed on December 1 in order to submit invoices through HCAI. Application fees were also recently announced.
Perhaps even some outstanding issues, such as the definition of catastrophic impairment and a new minor injury treatment protocol will finally be addressed.
In the Spring, the Liberals indicates that the rate reduction strategy is on target and average rates will be 8% lower by August 2014 and 15% lower by August 2015. However, the Budget document does not point to any specific initiative that will specifically work towards achieving those targets. Average rates are down 5.6% as of the end of the first quarter of 2014.
The Liberals will have a challenge bringing down rates further without a few significant systemic changes. More and more it appears costs have been rising over past few quarters so it should be interesting to see the second half data for 2013. Rising costs can be attributed to a number of factors including:
- a severe winter
- higher claims volumes
- the backlog of decisions awaiting arbitration
- deterioration of reforms as parties begin to discover how to work the system
- claims staff "fatigue"
- residual fraud
The Premier has committed to bringing back the Legislature on July 2 to re-introduce the Budget Bill following a Throne Speech. The Budget Bill itself had no auto insurance provisions.
Instead, legislative amendments to the Insurance Act were part of Bill 171, the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014 which was introduced in March 2014. The Bill included legislative amendments for the transformation of the dispute resolution system, and further action to crack down on fraud and abuse, as well as other cost-saving measures. The government was to take further steps on developing a dedicated investigation and prosecution office on serious fraud, with an initial focus on auto insurance fraud. The development of this fraud office would be based on the Auto Insurance Anti-Fraud Task Force’s principle that fraudsters should be vigorously pursued and prosecuted where evidence warrants.
There is no timetable for re-introducing Bill 171. There were some strong objections expressed over several provisions in the Bill - barring access to the courts for accident benefit disputes and reducing the prejudgment interest rate. It will be interesting to see if there are any changes should the Bill be re-introduced.
The Liberals had also introduced legislation to regulate the towing industry that never passed. Bill 189, the Roadside Assistance Protection Act would require towing and storage providers to publish their rates, provide an itemized invoices, accept payment by credit card if requested and to disclose to the consumer any interest a towing and storage provider may have in a location or facility to which a vehicle may be towed for repair or storage. If passed into law, Bill 189 would also stipulate the consumers be given access to towed vehicles in order to remove personal property.
FSCO has been proceeding with the licensing of treatment and assessment facilities on the auto insurance sector. The licence application process opened up on June 1. Facilities will have to be licensed on December 1 in order to submit invoices through HCAI. Application fees were also recently announced.
Perhaps even some outstanding issues, such as the definition of catastrophic impairment and a new minor injury treatment protocol will finally be addressed.
New report cites increased flood risk in coming decades
FEMA on Wednesday released a report on flood risk and the potential impact of climate change, particularly sea level rises.
The upshot: the report said that areas considered flood-prone could substantially increase, particularly here in the Pacific Northwest, by the end of this century. The impact on federal flood insurance -- the National Flood Insurance Program -- would be profound, with substantial increases in both cost and the number of policies.
Mother Jones magazine summarized the report here.
The upshot: the report said that areas considered flood-prone could substantially increase, particularly here in the Pacific Northwest, by the end of this century. The impact on federal flood insurance -- the National Flood Insurance Program -- would be profound, with substantial increases in both cost and the number of policies.
Mother Jones magazine summarized the report here.
Saturday, June 13, 2015
Insurance tips: Credit scores and insurance scores
Many insurers use a credit-based "insurance score" as a factor -- a major factor, often -- in setting your rates. It's a quick way of quoting you a price, and insurers maintain that there's a correlation between these credit-based scores and a person's claims history.
Washington state limits how insurers can use these scores, and Commissioner Kreidler has repeatedly pushed for legislation to ban their use completely.
In Washington, insurers cannot hold the following things against you:
What goes into an insurance score? Here's the breakdown of a score from FICO, one of the biggest companies generating these scores for insurers:
• Payment History (40%) – How well you have made payments on your outstanding debt in the past
• Outstanding Debt (30%) – How much debt you currently have
• Credit History Length (15%) – How long you have had a line of credit
• Pursuit of New Credit (10%) – If you have applied for new lines of credit recently
• Credit Mix (5%) – The types of credit you have (credit card, mortgage, auto loans, etc.)
How can you improve your score? The same way you'd improve your credit score: make payments (bills, taxes, fines, etc.) on time. Keep credit card balances as low as possible. Think carefully before opening new lines of credit, such as a department store charge card, just to get a discount.
You can check your credit reports from the three nationwide consumer credit reporting companies annually at http://www.annualcreditreport.com/. If you find errors, contact the credit reporting company to have them corrected.
Washington state limits how insurers can use these scores, and Commissioner Kreidler has repeatedly pushed for legislation to ban their use completely.
In Washington, insurers cannot hold the following things against you:
- The number of credit inquiries
- Collection accounts identified as medical bills
- A loan if it's the initial purchase or finance of a vehicle or home.
What goes into an insurance score? Here's the breakdown of a score from FICO, one of the biggest companies generating these scores for insurers:
• Payment History (40%) – How well you have made payments on your outstanding debt in the past
• Outstanding Debt (30%) – How much debt you currently have
• Credit History Length (15%) – How long you have had a line of credit
• Pursuit of New Credit (10%) – If you have applied for new lines of credit recently
• Credit Mix (5%) – The types of credit you have (credit card, mortgage, auto loans, etc.)
How can you improve your score? The same way you'd improve your credit score: make payments (bills, taxes, fines, etc.) on time. Keep credit card balances as low as possible. Think carefully before opening new lines of credit, such as a department store charge card, just to get a discount.
You can check your credit reports from the three nationwide consumer credit reporting companies annually at http://www.annualcreditreport.com/. If you find errors, contact the credit reporting company to have them corrected.
Wildfires and homeowners insurance: Five things you need to know
As wildfire season approaches, here are five important things to know about fire danger and your homeowners insurance:
1) Homeowners insurance generally covers all fires, including wildfires, unless the policyholder intentionally set the fire. Outbuildings and unattached structures are also generally covered.
2) If possible, review your policy to make sure you have enough coverage. Things like fine art and jewelry may have limited coverage under a standard policy. But you can buy special coverage that gives you more protection. Here's information to help determine how much
3) Prepare a household inventory, which will help a lot if you have to file a claim. You can do it with these easy-to-use paper forms, or you can try free iPhone/iPad or Android apps that do the same thing.
4) You can help protect a rural home and limit the danger by clearing a natural firebreak between your home and surrounding trees, brush and uncut fields. The Federal Emergency Management Agency has much more information on how to protect yourself and your home, before, during and even after a wildfire.
5) Have an emergency kit and a family communication plan. Know where your valuable papers (including insurance policy and contact info), mementos and anything you can't live without are, so that you can evacuate with them if needed. Here's a list of recommended emergency supplies. And if you're advised to evacuate, do so immediately. Don't be the person in the photo above.
Heads up: New travel insurance license rules in WA
New rules are taking effect July 1 for travel insurance licensing in Washington state. Here's a summary, albeit one that's pretty heavy on insurance-ese:
- Under the new rules, any individual or business entity that will sell, solicit, or negotiate travel insurance must have the travel line of authority specifically listed on their Washington state insurance producer license.
Got questions? We've prepared an FAQ page on this topic, and if that doesn't help, you'll find contact info (email and phone) at the bottom of the FAQ page.
- There is one exception to this new requirement. If a licensed business entity (agency) wants to transact travel insurance business, it must a) have a producer license with the travel line of authority and b) have a designated responsible licensed person for the agency who has a producer license with the travel line of authority.
Friday, June 12, 2015
Superintendent's Report on the Definition of Catastrophic Impairment in the SABS
The Minister of Finance has now released the Superintendent's Report on the Definition of Catastrophic Impairment in the Statutory Accident Benefits Schedule. The Superintendent's report recommends changes to the SABS definition that reflect the two reports submitted by the Catastrophic Impairment Expert Panel as well as consultations conducted last year by FSCO.
The recommended changes if implemented would update the catastrophic impairment definition to reflect current scientific knowledge. The chart below describes the current test and the proposed test for each impairment group covered by the definition as well as the evidence used by the Expert Panel to support the recommended changes.
In addition to changes to the definition, the Superintendent recommends the payment of interim benefits to some claimants awaiting catastrophic impairment designation and automatic designation to other claimants. Only some of the Expert Panel's recommendations regarding the qualifications of catastrophic impairment assessors has been accepted by the Superintendent.
The most contentious recommendation deals with the combining of physical and psychiatric impairments. The Superintendent agrees with the recommendation originally made by the Expert Panel that these impairments not be combined which reverses the direction provided in the 2004 court case, Desbiens v. Mordini. The Superintendent also recommended that the catastrophic impairment definition not allow pain to be quantified as a separate impairment which would exclude chronic pain and fibromyalgia as catastrophic impairments.
The recommended changes if implemented would update the catastrophic impairment definition to reflect current scientific knowledge. The chart below describes the current test and the proposed test for each impairment group covered by the definition as well as the evidence used by the Expert Panel to support the recommended changes.
In addition to changes to the definition, the Superintendent recommends the payment of interim benefits to some claimants awaiting catastrophic impairment designation and automatic designation to other claimants. Only some of the Expert Panel's recommendations regarding the qualifications of catastrophic impairment assessors has been accepted by the Superintendent.
The most contentious recommendation deals with the combining of physical and psychiatric impairments. The Superintendent agrees with the recommendation originally made by the Expert Panel that these impairments not be combined which reverses the direction provided in the 2004 court case, Desbiens v. Mordini. The Superintendent also recommended that the catastrophic impairment definition not allow pain to be quantified as a separate impairment which would exclude chronic pain and fibromyalgia as catastrophic impairments.
Impairment | Current Test | Proposed Test | Evidence |
paraplegia and tetraplegia (quadriplegia) | none | American Spinal Injury Association classification of spinal cord injuries | standard in medical practices literature suggests classification system is valid and reliable |
amputations | none | none | clinical and scientific judgment of Expert Panel members |
burn and crush injuries to limbs | not covered in SABS | Spinal Cord Independence Measure | clinical and scientific judgment of Expert Panel members The scientific evidence supports the validity and reliability of the SCIM |
blindness | none | Legal blindness | |
traumatic brain injuries in adults | Glasgow Coma Scale Glasgow Outcome Scale | Extended Glasgow Outcome Scale | strong psychometric properties and reliable when used with a structured interview and standard scoring algorithm |
other physical impairments | whole body impairment rating using American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition | whole body impairment rating using American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition, Chapters 3-13 | very little scientific literature supporting use for determining catastrophic impairment but Expert Panel found no alternative rating system |
psychiatric impairments | class of mental or behavioural disorder using American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition, Chapter 14 | Global Assessment of Functioning Scale | literature suggests scale has adequate reliability and validity |
combining physical and non-physical impairments | none but the courts have assigning whole body impairment scores to impairments under Chapter 14 of AMA Guides to allow combining with scores under Chapters 3-13 | no combining | no scientific literature to support combining physical and non-physical impairment ratings The physical and mental/behavioural impairement rating chapters were not developed to be combined |
traumatic brain injuries in children | none | King’s Outcome Scale for Children Head Injury | little scientific evidence to support so Expert Panel recommended a study be conducted |
Insurance News - June 12, 2014
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, June 12, 2014:
- What do politics have to do with Ontario auto insurance rates anyway?
- The Ontario election is too close to predict but that doesn't stop people from predicting. Go out and vote.
- Self-driving cars along with car sharing schemes could take up to 80% of traffic off the roads of congested cities.
- A fake city built at the University of Michigan is to be used to test self-driving cars.
- The legal costs to the telematics industry of handling subpoenas and other information requests will quickly rise.
- Auto risk management - how 'telematics' is revolutionizing insurance.
Thursday, June 11, 2015
Insurance and vintage or antique cars
Q: I'm rebuilding my antique car and my grandfather's one-seater vintage biplane in my garage. Will my homeowners policy cover all the parts if they are stolen?
A: Probably not. Most homeowners policies exclude autos, aircraft, other motorized vehicles and their parts. You might have coverage for, say, a riding lawn mower or golf cart, but you'd be wise to talk to your agent and insurer about separate coverage that may be available for the parts during the rebuild process and after completion. Most antique cars and planes can be covered on specialized policies designed for their generally limited and unique use.
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.)
A: Probably not. Most homeowners policies exclude autos, aircraft, other motorized vehicles and their parts. You might have coverage for, say, a riding lawn mower or golf cart, but you'd be wise to talk to your agent and insurer about separate coverage that may be available for the parts during the rebuild process and after completion. Most antique cars and planes can be covered on specialized policies designed for their generally limited and unique use.
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 - Monday, June 11, 2012
Assault Victim May Qualifies for SABS Because of Psychological Trauma
The plaintiff was physically assaulted by several unidentified assailants while parked at a gas station sorting his money. He escaped by putting his car in gear and driving away. He believed he may have run over one of his assailants in the course of fleeing. He claimed he sustained psychological and physical injuries as a result of the incident.
This case is revolves on the meaning of subsection 2(1) of the SABS, which defines an "accident" as “an incident in which the use or operation of an automobile directly causes an impairment”. The motion judge granted a declaration that the plaintiff was involved in an “accident” within the meaning of the SABS. The insurer appealed.
The Court of Appeal allowed the appeal with respect to the physical injuries, holding that the physical assault did not constitute an “accident”. The Court held that a trial was required to determine whether the psychological injuries were caused by the ordinary use of a motor vehicle.
With respect to the psychological injuries, the Court held that running someone over could be considered a normal incident of the risk created by the use or operation of a vehicle.
read more...
Louisiana Cracks Down on Uninsured Drivers
A new law has passed in Louisiana, giving the state’s law enforcement expanded authority over vehicles that may not be insured.The legislation, House Bill 1053, was signed into law this week by Governor Bobby Jindal. State officials believe the new law will help law enforcement ensure that drivers are protected while taking to the state’s roadways.
2. Chevrolet Colorado Crew Cab
3. Mazda CX-7
4. Mazda CX-9
5. Nissan Pathfinder
6. Jeep Wrangler
7. Suzuki SX4
read more...
The plaintiff was physically assaulted by several unidentified assailants while parked at a gas station sorting his money. He escaped by putting his car in gear and driving away. He believed he may have run over one of his assailants in the course of fleeing. He claimed he sustained psychological and physical injuries as a result of the incident.
This case is revolves on the meaning of subsection 2(1) of the SABS, which defines an "accident" as “an incident in which the use or operation of an automobile directly causes an impairment”. The motion judge granted a declaration that the plaintiff was involved in an “accident” within the meaning of the SABS. The insurer appealed.
The Court of Appeal allowed the appeal with respect to the physical injuries, holding that the physical assault did not constitute an “accident”. The Court held that a trial was required to determine whether the psychological injuries were caused by the ordinary use of a motor vehicle.
With respect to the psychological injuries, the Court held that running someone over could be considered a normal incident of the risk created by the use or operation of a vehicle.
read more...
Louisiana Cracks Down on Uninsured Drivers
A new law has passed in Louisiana, giving the state’s law enforcement expanded authority over vehicles that may not be insured.The legislation, House Bill 1053, was signed into law this week by Governor Bobby Jindal. State officials believe the new law will help law enforcement ensure that drivers are protected while taking to the state’s roadways.
According to the new auto insurance law, officers will now be able to tow vehicles if drivers cannot show proof of insurance coverage on their first offense. State officials suggests that more than 850,000 vehicles are currently uninsured in Louisiana, many of which are likely to have been targeted by citation in the past but were allowed to stay on the road due to faulty laws.
Top 7 Most Dangerous Cars in America
The Insurance Institute for Highway Safety recently performed crash tests and rated the cars in four separate categories. 24/7 Wall St. analyzed the ratings and ranked the seven most dangerous cars in the country.
1. Dodge Ram 15002. Chevrolet Colorado Crew Cab
3. Mazda CX-7
4. Mazda CX-9
5. Nissan Pathfinder
6. Jeep Wrangler
7. Suzuki SX4
read more...
Wednesday, June 10, 2015
Eastern Washington at risk for wildfires with dry conditions
The Office of the Washington State Climatologist report for May says that while Western Washington was wetter than normal, the lack of low-elevation precipitation in Eastern Washington has warranted drought concerns in some areas. The U.S. Department of Agriculture has designated Benton, Franklin, Chelan, Lincoln, and Walla Walla counties as natural disaster areas due to the dry conditions. According to the state Department of Natural Resources, a red flag warning has been issued for Chelan and Douglas counties, meaning there’s a higher chance of wildfires in those areas.
Here are some tips for people who live in areas that are prone to wildfire:
- Check your policy to make sure damage from wildfires is covered. Some policies include some coverage for emergency shelter, such as a hotel, if a home is uninhabitable.
- Review your policy to make sure you have enough coverage. Things like fine art, jewelry and computer equipment may have limited coverage under a standard policy. But you can buy special coverage that gives you more protection for those types of items, called a rider. Contact your insurance agent or broker to ask about supplemental policies.
- Catalog your home’s belongings in case you need to make an insurance claim. The National Association of Insurance Commissioners has a printable home inventory checklist or you can try free iPhone/iPad or Android apps.
- Read some tips to prepare and protect your home.
- You can help protect a rural home and limit the danger by clearing a natural fire break between your home and surrounding trees, brush and uncut fields. The Federal Emergency Management Agency has information on how to protect yourself and your home before, during and even after a wildfire.
- Have an emergency kit and a family communication plan. Know the location of your valuable papers, including insurance policy and contact information, mementos and anything you can't live without, so you can evacuate with them, if needed.
- Here's a list of recommended emergency supplies to keep on hand in the case of an evacuation.
- Don’t forget about planning for your pets. Ready.gov has tips for pet owners.
- The Washington Department of Natural Resources has the most recent fire information available on its website and through the @waDNR_fire Twitter feed.