Here's a press release we issued a few minutes ago:
A medical worker who pretended to be a doctor and submitted millions of dollars in bogus bills to insurance companies has been sentenced to a year in jail and $472,458 in restitution.
Kenneth R. Welling, 45, of Lake Forest Park, was sentenced Aug. 24 in King County Superior Court. He pleaded guilty to seven felony counts of theft in June.
“We found numerous cases in which Welling billed for surgeries that never happened,” said state Insurance Commissioner Mike Kreidler. Kreidler’s office was tipped off to the scam when a patient complained, saying that Welling had tried to bill her insurer $89,000 for six surgeries that never took place.
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. 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.”
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Monday, August 31, 2015
Interesting story about how the Apollo 11 astronauts got life insurance
NPR has posted an interesting story about how the Apollo 11 astronauts sort of self-insured their lives when they headed for the moon.
Rather than try to get conventional life insurance, the three astronauts spent their spare moments during their month of pre-launch quarantine signing autographed envelopes, according to NPR's Chana Joffe-Walt. That way, if they died on their lunar adventure, their families could sell the autographs, which today command up to $30,000 at auction.
To make the autographs more valuable, each was on an envelope that a friend would have postmarked on key days, like the launch date and the date they landed on the moon. Writes Joffe-Walt:
Rather than try to get conventional life insurance, the three astronauts spent their spare moments during their month of pre-launch quarantine signing autographed envelopes, according to NPR's Chana Joffe-Walt. That way, if they died on their lunar adventure, their families could sell the autographs, which today command up to $30,000 at auction.
To make the autographs more valuable, each was on an envelope that a friend would have postmarked on key days, like the launch date and the date they landed on the moon. Writes Joffe-Walt:
It was life insurance in the form of autographs.
"If they did not return from the moon, their families could sell them — to not just fund their day-to-day lives, but also fund their kids' college education and other life needs," (space historian Robert) Pearlman said.
The life insurance autographs were not needed. Armstrong and Aldrin walked on the moon and came home safely. They signed probably tens of thousands more autographs for free.
Sunday, August 30, 2015
Kreidler achieves settlement with health insurers - approves 10 more Exchange plans
Insurance Commissioner Mike Kreidler has reached settlements with Community Health Plan of Washington and Kaiser Foundation Health Plan of the Northwest and approved their 10 plans for sale in Washington’s Health Benefit Exchange, the Washington Healthplanfinder.
“We had 31 health plans approved by the Exchange’s deadline. Washington consumers now have an additional 10 quality plans to choose from,” Kreidler said. “We took the initial deadline seriously, but we also followed our own legal process and it worked. The Exchange cannot delay any further. It must take action and approve these plans by Sept. 5.”
Saturday, August 29, 2015
Sept. 13 hearing set re: Sagicor Life's acquisition of PEMCO Life
Insurance Commissioner Mike Kreidler has scheduled a hearing for Sept. 13 at 10 a.m. at his Tumwater, Wash. office to consider approval of Sagicor Life Insurance Company's request to acquire Washington-based PEMCO Life Insurance Company.
Sagicor Life is proposing to acquire all outstanding stock of PEMCO Life Insurance Company, and is also proposing to merge PEMCO Life with and into Sagicor Life at a later date after receiving approval of the acquisition.
PEMCO Life Insurance Company, which has been a Washington-based insurer since 1963, provides life and disability products to approximately 15 thousand Washington individual and group policyholders, and is wholly owned by its parent company, PEMCO Mutual Insurance Company. PEMCO Mutual Insurance Company is a mutual property and casualty insurer located in Seattle, WA and is licensed in Idaho, Oregon, and Washington.
Sagicor Life is a Texas-based insurer licensed in Texas to offer accident, health and life insurance and has been authorized to conduct life and disability insurance in Washington since 1961. Sagicor Life operates primarily in the US and is wholly-owned by Sagicor Financial Corporation. Sagicor Financial Corp. is a Barbados corporation which operates internationally in various European and Caribbean countries, and is publicly traded on the Barbados, Trinidad and Tobago, and London Stock Exchanges. Sagicor Financial Corp. had $142.6 million in US revenue in 2011, $1.35 billion in total revenue (both US and international) and 632,123 individual life policies in-force overall. As of December 31, 2011, Sagicor Financial Corp.’s consolidated stockholders’ equity was $797.5 million.
For more information, including how to submit letters of support or objection, please see the hearing notice.
Sagicor Life is proposing to acquire all outstanding stock of PEMCO Life Insurance Company, and is also proposing to merge PEMCO Life with and into Sagicor Life at a later date after receiving approval of the acquisition.
PEMCO Life Insurance Company, which has been a Washington-based insurer since 1963, provides life and disability products to approximately 15 thousand Washington individual and group policyholders, and is wholly owned by its parent company, PEMCO Mutual Insurance Company. PEMCO Mutual Insurance Company is a mutual property and casualty insurer located in Seattle, WA and is licensed in Idaho, Oregon, and Washington.
Sagicor Life is a Texas-based insurer licensed in Texas to offer accident, health and life insurance and has been authorized to conduct life and disability insurance in Washington since 1961. Sagicor Life operates primarily in the US and is wholly-owned by Sagicor Financial Corporation. Sagicor Financial Corp. is a Barbados corporation which operates internationally in various European and Caribbean countries, and is publicly traded on the Barbados, Trinidad and Tobago, and London Stock Exchanges. Sagicor Financial Corp. had $142.6 million in US revenue in 2011, $1.35 billion in total revenue (both US and international) and 632,123 individual life policies in-force overall. As of December 31, 2011, Sagicor Financial Corp.’s consolidated stockholders’ equity was $797.5 million.
For more information, including how to submit letters of support or objection, please see the hearing notice.
Dispute Resolution System Review Is Seeking Submissions From Stakeholders
On August 23, 2013 Ontario Minister of Finance Charles Sousa announced that he had appointed the Honourable J. Douglas Cunningham, former Associate Chief Justice of the Ontario Superior Court of Justice, to conduct the review of Ontario’s dispute resolution system.
Mr. Cunningham is seeking stakeholder perspectives on the Ontario auto insurance dispute resolution system and the Ministry of Finance has posted on their website an invitation to stakeholder so make submissions.
Written submissions can be sent to the Ministry of Finance on or before September 20, 2013.
Mr. Cunningham is expected to deliver an interim report to the Minister of Finance in October 2013, and a final report in February 2014.
Mr. Cunningham is seeking stakeholder perspectives on the Ontario auto insurance dispute resolution system and the Ministry of Finance has posted on their website an invitation to stakeholder so make submissions.
Written submissions can be sent to the Ministry of Finance on or before September 20, 2013.
Mr. Cunningham is expected to deliver an interim report to the Minister of Finance in October 2013, and a final report in February 2014.
Insurance News - Wednesday, August 29, 2012
Deloitte Report Estimates U.S. P & C Insurance Fraud At $30 Billion
A recent report, A Call to Action: Identifying Strategies to Win the War Against Insurance Claims Fraud, released by Deloitte says auto insurance and workers’ compensation are the two biggest sources of an estimated $30 million in insurance fraud.
With losses mounting from fraudulent claims, fraud management has moved higher on the agenda of senior management. Many companies have taken steps to improve their ability to identify and address fraudulent claims, but these efforts have typically been fragmented. Effectively addressing claims fraud rests on four pillars of an integrated fraud management program:
Deloitte has also reported on the cost of auto insurance fraud in Ontario. Information about that report can be found here.
Falling On Ice Outside A Vehicle Is Not An Accident Under The SABS
A woman who slipped on ice after exiting her car is not eligible for auto accident benefits in Ontario because the incident does not constitute an “accident” under insurance regulations, a director’s delegate of the Financial Services Commission of Ontario (FSCO) recently ruled.
A recent report, A Call to Action: Identifying Strategies to Win the War Against Insurance Claims Fraud, released by Deloitte says auto insurance and workers’ compensation are the two biggest sources of an estimated $30 million in insurance fraud.
With losses mounting from fraudulent claims, fraud management has moved higher on the agenda of senior management. Many companies have taken steps to improve their ability to identify and address fraudulent claims, but these efforts have typically been fragmented. Effectively addressing claims fraud rests on four pillars of an integrated fraud management program:
- Develop a fraud management strategy
- Align the operating model
- Improve information quality
- Leverage advanced technology tools and analytics
Deloitte has also reported on the cost of auto insurance fraud in Ontario. Information about that report can be found here.
Falling On Ice Outside A Vehicle Is Not An Accident Under The SABS
A woman who slipped on ice after exiting her car is not eligible for auto accident benefits in Ontario because the incident does not constitute an “accident” under insurance regulations, a director’s delegate of the Financial Services Commission of Ontario (FSCO) recently ruled.
In Wawanesa Mutual Insurance and Webb, Daphna Webb was injured when she parked in a residential neighbourhood. After parking at a pedestrian access point along a snowy street, she exited the driver side and walked around the front of her car. Webb slipped and fell on ice, breaking four bones in her foot.
The burden of proof rested with Ms. Webb to show on a balance of probabilities that she was injured as a result of an accident pursuant to subsection 2(1) of the SABS. The arbitrator found in her decision dated May 12, 2011, that Ms. Webb satisfied her burden.
Disembarking from a motor vehicle is a normal activity required by the use or operation of a motor vehicle. The key question to be answered was whether Ms. Webb's injury was "directly" caused by the use or operation of her motor vehicle.
Wawanesa submitted that the access point constituted a different geography and was an intervening event. Once Ms. Webb had exited her vehicle and walked to the front of her vehicle, the disembarkation had concluded as she stepped onto the access point and, accordingly, she was no longer engaged in the ordinary activities to which an automobile is put. The arbitrator disagreed on this point.
The director's delegate disagreed with the arbitrator. He indicated that Ms. Webb was not in the process of actually disembarking from the vehicle when the incident took place. She was not intending to momentarily return to her vehicle so no auto contributed physically to her injuries.
Insurance tips: What to know before renting your home/boat/etc.
We get a number of calls from folks who rent out their homes, vacation cabins, vacant lakefront sites, boats, RVs, motorcycles, etc. to others every once in a while. They want to know if that affects their insurance.
It very well could. Here's why: When property is rented, that's considered a business activity. And that can affect any existing coverage for property damage and liability protection.
There may also be coverage limitations or exclusions built into the policy that activated by your renting the property.
We recommend that you talk to your agent or the insurer before you rent, so you're not left personally responsible for property damage costs or legal costs in a lawsuit stemming from renting the property.
It very well could. Here's why: When property is rented, that's considered a business activity. And that can affect any existing coverage for property damage and liability protection.
There may also be coverage limitations or exclusions built into the policy that activated by your renting the property.
We recommend that you talk to your agent or the insurer before you rent, so you're not left personally responsible for property damage costs or legal costs in a lawsuit stemming from renting the property.
Insurance News - Thursday, August 29, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, August 29, 2013:
- The courts are turning their attention to the dangers of texting and driving. A New Jersey appeals court ruled that a person could have a legal duty to avoid texting with someone who is driving.
- Only five remaining U.S. states have no prohibition whatsoever on texting while driving.
- Auto insurers shouldn't just focus on claims fraud. The latest trend in the U.S. is underwriting fraud by applicants who conceal or misrepresent information.
- Insurers love to insurer safe drivers. So what is the safest city in America to drive in? Fort Collins, Colorado according to Allstate claims data.
- Get ready to hand over control over the steering wheel because Nissan is planning to introduce their first self-driving cars by 2020.
- FSCO officially eliminated their mediation backlog as of August 19th but now they will have to focus on a build up of arbitration applications.
Friday, August 28, 2015
90 health plans approved for next year's Exchange - find one in your area
Health plans and their rates for next year's Exchange, Washington Healthplanfinder were approved by our office and certified by the Exchange board this week.
Consumers shopping inside the Exchange will have 10 companies and 90 plans to choose from, depending on where they live. Not all plans are available in every county, but most people will have more choices and minimal rate changes.
Additional insurers and plans for sale outside of the Exchange are still under review. There may be more plans for sale outside of the Exchange, but premium subsidies are not available.
Open enrollment for inside and outside of the Exchange starts Nov. 15 and runs through Feb. 15, 2015.
Check out the map below to see the 2015 plans and rates available in your county.
Consumers shopping inside the Exchange will have 10 companies and 90 plans to choose from, depending on where they live. Not all plans are available in every county, but most people will have more choices and minimal rate changes.
Additional insurers and plans for sale outside of the Exchange are still under review. There may be more plans for sale outside of the Exchange, but premium subsidies are not available.
Open enrollment for inside and outside of the Exchange starts Nov. 15 and runs through Feb. 15, 2015.
Check out the map below to see the 2015 plans and rates available in your county.
Insurance News - Thursday, August 28, 2014
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, August 28, 2014:
- Google has recently admitted that its driverless cars are designed to intentionally break the speed limit by up to 10 miles-per-hour.
- A study suggests digital display advertising is nine times better at creating immediate brand awareness for auto and life insurance providers than a commercial on TV.
- A new California rule says that driverless cars are only legal on public roads if a driver is able to take “immediate physical control,” which means that Google is going to have to make a couple of small adjustments to the cars: fitting that missing steering-wheel and pedals.
- A vehicle-to-vehicle transmitter for only $350 could mean the end of car collisions.
- Ottawa police union claims the collision reporting centres give impaired drivers time to sober up.
- Fast-moving technology runs into slow-moving regulators as U.S. Federal regulators are stalled the approval of driverless cars.
Thursday, August 27, 2015
FSCO Lowers ROE Benchmark to 11%
When approving filed auto insurance rates from individual insurance companies FSCO has allowed a reasonable rate of return. In his 2011 Annual Report, the Auditor General of Ontario discussed the changed economic environment since 1996 when the return on equity (ROE) benchmark was last updated and recommended that it be reviewed. The Ontario Government endorsed the recommendation in the 2012 Ontario Budget.
FSCO selected two consultants (Dr. Fred Lazar and Dr. Eli Prisman of York University) to conduct the ROE review for automobile insurance. The ROE review included consultation with stakeholders and is now complete and is posted on the FSCO website.
FSCO uses an after-tax , return on equity ( “ ROE ”) benchmark in the rate review process for rate filings by auto insurance companies in the province. The benchmark was initially established at 12.5% in 1988. In 1996 the ROE benchmark was reduced to 12%. The ROE benchmark is one of many variables used in the rate review process .
Three other provinces (Nova Scotia , New Brunswick and Newfoundland and Labrador) use an ROE benchmark ranging from 10% to 12%.FSCO selected two consultants (Dr. Fred Lazar and Dr. Eli Prisman of York University) to conduct the ROE review for automobile insurance. The ROE review included consultation with stakeholders and is now complete and is posted on the FSCO website.
FSCO uses an after-tax , return on equity ( “ ROE ”) benchmark in the rate review process for rate filings by auto insurance companies in the province. The benchmark was initially established at 12.5% in 1988. In 1996 the ROE benchmark was reduced to 12%. The ROE benchmark is one of many variables used in the rate review process .
In carrying out their review of FSCO’s ROE benchmark the consultants examined various approaches and settled on the Capital Asset Pricing Model (CAPM) , which is a widely accepted methodology for estimating a company’s cost of equity capital
The consultants concluded that the current cost of capital for insurers is below FSCO’s current 12% after-tax ROE benchmark. They noted , however, that the current risk-free rate is abnormally low as the Bank of Canada deals with the aftermath of the 2015-9 economic and financial crisis and likely underestimates what the risk-free rate might be under more normal economic conditions.
Consequently, the consultants concluded that it would be inappropriate to apply the CAPM simplistically, noting that if it had been applied continuously from 1995 with appropriate risk-free rates and market risk premiums, the resulting ROE would have moved sharply from year to year, in some cases changing by more than 150 basis points. To address the volatility in the application of the CAPM model, the consultants proposed moving to a 5 or 10-year rolling average for the ROE benchmark, utilizing the CAPM results calculated in the report
If a 10-year rolling average were used to determine the ROE benchmark, for 2013 the benchmark would be between 11.20% and 11.28%. If a 5-year rolling average were used , the benchmark for 2013 would be between 10.40% and 10.56%.
As a result, FSCO has determined that it will now be using an 11% ROE as a benchmark for Automobile Insurance rate filings, effective immediately.
Temporary special enrollment for those stuck in Exchange plans begins today
A temporary special enrollment period begins today for those consumers who have experienced difficulties with enrollment in health plans on the Washington Healthplanfinder.
Insurance Commissioner Mike Kreidler authorized the special enrollment period this week as another option to those who feel they might need more help. This voluntary special enrollment period starts Aug. 27 and runs through Nov. 14, 2014. Only people who attest to having enrollment, billing, or payment issues with an Exchange plan may change plans during this time.
If you’re considering this option, you should be aware of all of the details involved, including the fact that you could lose a current premium subsidy. Special enrollment may not be the best choice for everyone. But as the commissioner notes, “Hopefully, it will bring relief to some.”
A list of answers to questions about this temporary special enrollment is available on our website.
Do I have "minimal essential" insurance coverage?
As part of health care reform, starting in January 2014 most Americans will need to have “minimum essential” health insurance coverage or face a tax penalty.
We've gotten a number of calls from consumers wondering if their current health coverage qualifies. (In particular, a number of people who get their medical care through the Veterans Administration have called to check.)
In many cases, the answer is yes. Many existing plans qualify as minimal essential health insurance coverage. Here are some examples:
• Medicare Part A
• Health programs administered by Washington state (such as Medicaid or the Children’s Health Insurance Program)
• TriCare
• Coverage through the Veteran’s Administration
• Coverage from an employer, regardless of whether the employer is a government agency, a private-sector employer, or an Indian tribe.
• A individual plan (i.e. a plan that you buy on your own directly from a health insurance company).
We've gotten a number of calls from consumers wondering if their current health coverage qualifies. (In particular, a number of people who get their medical care through the Veterans Administration have called to check.)
In many cases, the answer is yes. Many existing plans qualify as minimal essential health insurance coverage. Here are some examples:
• Medicare Part A
• Health programs administered by Washington state (such as Medicaid or the Children’s Health Insurance Program)
• TriCare
• Coverage through the Veteran’s Administration
• Coverage from an employer, regardless of whether the employer is a government agency, a private-sector employer, or an Indian tribe.
• A individual plan (i.e. a plan that you buy on your own directly from a health insurance company).
HCAI Data: Most Early Treatment Is Provided By Chiropractors and Physiotherapists
The IBC has now published the standard HCAI reports for the first half of 2014. The document provides over 75 pages of aggregate data collected by HCAI going back to 2011. HCAI was made mandatory on February 1, 2011.
The standard reports are published on an “accident half year” basis. In accident half year statistics, the experience of all claims with accident dates in the same accident half year is grouped together. The accident half years are defined as calendar half years, with January to June being the first half and July to December being the second half for each of the stated years.
The chart below sets out the treatment reported on the HCAI system by healthcare profession. It shows that the majority of claimants see a chiropractor or physiotherapist which is expected since the majority claims are strains and sprains. But as the claims develop, claimants are seeing additional healthcare professionals. In the most recent accident half year (first half of 2014) claimants saw an average of 1.5 professionals. For the second half of 12013, claimants saw an average of 2.1 professionals and in the first half of that year 2.4 professionals.
The largest increases in interventions for older claims relate to physicians and psychologists. Because the data includes both treatment intervention and assessments, this is expected outcome. Older claims are more likely to undergo an independent medical assessment or a psychological assessment. There appears to be minimal growth in chiropractic and physiotherapy interventions over time.
The standard reports are published on an “accident half year” basis. In accident half year statistics, the experience of all claims with accident dates in the same accident half year is grouped together. The accident half years are defined as calendar half years, with January to June being the first half and July to December being the second half for each of the stated years.
The chart below sets out the treatment reported on the HCAI system by healthcare profession. It shows that the majority of claimants see a chiropractor or physiotherapist which is expected since the majority claims are strains and sprains. But as the claims develop, claimants are seeing additional healthcare professionals. In the most recent accident half year (first half of 2014) claimants saw an average of 1.5 professionals. For the second half of 12013, claimants saw an average of 2.1 professionals and in the first half of that year 2.4 professionals.
The largest increases in interventions for older claims relate to physicians and psychologists. Because the data includes both treatment intervention and assessments, this is expected outcome. Older claims are more likely to undergo an independent medical assessment or a psychological assessment. There appears to be minimal growth in chiropractic and physiotherapy interventions over time.
Wednesday, August 26, 2015
Insurance News - Monday, August 26, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Monday, August 26, 2013:
- Another U.S state (Illinois) allows drivers to use phones as proof of auto insurance coverage but still no initiative in Canada.
- Illinois also now has higher minimum coverage for third party liability. The new amounts are $25,000 for injury or death of one person (up from $20,000) and $50,000 for injury or death of two or more people. Still one of the lowest in terms of TPL coverage.
- According to a LexisNexis Insurance Telematics study 36% of consumers would switch auto insurers to receive usage-based insurance discount.
- Do people with luxury cars drive differently? Apparently they do.
- Posting on Facebook about driving drunk got a teen arrested when he bragged about hitting another car.
Talk to your agent or broker about coverage for college students
Many college students are heading back to college or starting their college careers this time of year. In addition to outfitting students with laptops and dorm room supplies, parents may want to think about whether their students are covered by the right insurance policies. Insuring possessions
For students who live in a dorm, typically the parents’ homeowner policy will cover the student’s personal belongings while they are away. The same is true for college students who live at home. Some policies may have a dollar limit for off-premises personal property, so check with your agent or broker to find out what your policy covers.
If the student is renting an apartment or house, it’s worth looking into renter’s insurance. If you have a roommate, read our blog post from earlier this month: Living with someone? You may need your own policy to protect your belongings.
Auto insurance
Auto insurance policies typically don’t change once a driver goes to college, but it can’t hurt to check with your agent or broker if the car will be driven in another state for an extended period of time or, conversely, if the car will stay home while the student is in school and isn’t likely to be driven. You can also ask about any discounts they may have available for good grades or good driving records.
Health insurance
Under the Affordable Care Act, parents can keep children on their health insurance policies until age 26. Read more about health care reform for families.
Tuesday, August 25, 2015
HCAI Data: Most MIG Claimants Continue to Receive Some Treatment After Completing MIG Treatment
The IBC has now published the standard HCAI reports for the first half of 2014. The document provides over 75 pages of aggregate data collected by HCAI going back to 2011. HCAI was made mandatory on February 1, 2011.
The standard reports are published on an “accident half year” basis. In accident half year statistics, the experience of all claims with accident dates in the same accident half year is grouped together. The accident half years are defined as calendar half years, with January to June being the first half and July to December being the second half for each of the stated years.
The chart below provides some insight into what might be happening to MIG claims over time. Although as many as 75% of claims are classified as strains and sprain and should fall under the minor injury definition, only a fraction of those claims receive MIG treatment only. A majority of those claims actually receive treatment within the MIG and additional treatment outside the MIG, likely when the MIG funding is used up. However, that is not to day that they are actually "escaping" the minor injury definition and cap. The average cost of treatment for strains and sprains is under $3,000.
One must be careful interpreting this data. One might want to conclude that the number of claims receiving only MIG treatment has been increased over time based on the chart below since each accident half year, fewer claims are receiving both MIG and non-MIG treatment. However, the newer claims are likely still open and many of those in the MIG only category move over time into the MIG and non-MIG category. When you compare data from previous reports you begin to understand how the data continues to develop. I had previously reported that for the first half of 2013, 48.3% of strains and sprains received MIG treatment only and just 23.2% received both MIG and non-MIG treatment. The most recent report indicates that only 26.7% of these injuries have only received MIG treatment and now 53.8% received both MIG and non-MIG treatment. These numbers will continue to develop further.
The standard reports are published on an “accident half year” basis. In accident half year statistics, the experience of all claims with accident dates in the same accident half year is grouped together. The accident half years are defined as calendar half years, with January to June being the first half and July to December being the second half for each of the stated years.
The chart below provides some insight into what might be happening to MIG claims over time. Although as many as 75% of claims are classified as strains and sprain and should fall under the minor injury definition, only a fraction of those claims receive MIG treatment only. A majority of those claims actually receive treatment within the MIG and additional treatment outside the MIG, likely when the MIG funding is used up. However, that is not to day that they are actually "escaping" the minor injury definition and cap. The average cost of treatment for strains and sprains is under $3,000.
One must be careful interpreting this data. One might want to conclude that the number of claims receiving only MIG treatment has been increased over time based on the chart below since each accident half year, fewer claims are receiving both MIG and non-MIG treatment. However, the newer claims are likely still open and many of those in the MIG only category move over time into the MIG and non-MIG category. When you compare data from previous reports you begin to understand how the data continues to develop. I had previously reported that for the first half of 2013, 48.3% of strains and sprains received MIG treatment only and just 23.2% received both MIG and non-MIG treatment. The most recent report indicates that only 26.7% of these injuries have only received MIG treatment and now 53.8% received both MIG and non-MIG treatment. These numbers will continue to develop further.
Monday, August 24, 2015
Insurance News - Saturday, August 24, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Saturday, August 24, 2013:
- A Cornell University study based on interviews of industry members suggesting that prior approval of auto rates does not benefit consumers. Although most experts agree that promoting the affordability and availability of auto insurance are appropriate objectives for regulators, they express strong disagreement with many of the tools commonly used by regulators.
- Bad news for older truck drivers; it seems that employees age 55 or older who drive as part of their jobs are more likely to be killed in accidents than younger colleagues because of declining cognition and greater susceptibility to injury.
- Mixed reviews on the government's strategy to reduce auto insurance rates as consumers will need to wait 2 years (or longer depending on when their policy is up for renewal) to see the full 15% reduction.
- As well, the amendments to the Automobile Insurance Rate Stabilization Act, 2003 were proclaimed in force effective August 16, 2013.
- Driver surprised to learn her auto insurer has launched a lawsuit without her knowledge. Her insurer has used section 24 of the Repair and Storage Liens Act to resolve a dispute over storage costs.
- Newly licensed teens often drive older vehicles short of safety features that might lessen injuries in the event of a crash.
Sunday, August 23, 2015
New online tool shows you what individual health insurance costs next year in WA
We've built a new online tool to help you find out what health care plans will cost next year. Simply click on the map -- premiums vary by where you live -- and it will tell you which insurance carriers are offering coverage in your area. You can click on each company to see its rates, which vary based on your age.
A couple of caveats: These rates are mainly for the individual market, meaning people who have to buy insurance for themselves, and don't get it through an employer, Medicare, etc.
Also, the rates do factor in the subsidies that will be available to some people. Those subsidies will reduce the cost of coverage substantially for many people. You can estimate how much you'll pay, with subsidies taken into account, by using this online calculator from the Washington HealthPlanFinder.
Lastly, the list of health plans is likely to grow over the next couple of months. We are still reviewing plans, for example, for multiple insurance carriers that have filed to sell coverage outside the state exchange. And some plans that were rejected for the Exchange have filed appeals. So stay tuned.
“Hole-in-Won” Golf tournament insurer charged with felonies after not paying up
OLYMPIA, Wash. _ A Connecticut businessman who specializes in insurance for golf tournament hole-in-one prizes has been charged with multiple felonies after repeatedly failing to pay up.
Kevin Kolenda, of Norwalk, Conn., was charged Wednesday in King County Superior Court with five counts of transacting insurance without a license, a class B felony. His arraignment is slated for Sept. 5.
Kolenda, 54, ignored a previous cease-and-desist order and a $125,000 fine from state Insurance Commissioner Mike Kreidler.
“We’ve been warning the public about Mr. Kolenda’s scam for years,” said Kreidler, whose Special Investigations Unit did the investigation that led to the charges. “He has a long history of selling illegal insurance, refusing to pay prize winners, and thumbing his nose at regulators.”
In some cases, charities have had to come up with the prize money. In others, the prize winners agreed to forego a prize.
Kolenda in 1995 started a business called Golf Marketing, working out of a home his parents owned in Norwalk. Since then, the business’ name has changed several times, including: Golf Marketing Worldwide LLC, Golf Marketing Inc., Hole-in-Won.com, and currently Hole-in-Won.com Worldwide. The company also has a regional office in Rye, N.Y.
Kolenda has repeatedly failed to pay winning golfers in Washington. Among them:
• In 2003, Kolenda illegally sold insurance for a tournament in Bremerton. But when a golfer got a hole in one and tried to claim the $10,000 prize, Kolenda wouldn’t pay.
• In 2004, Kolenda sold insurance for a Vancouver tournament. Again, a golfer got a hole in one. Kolenda refused to pay the $50,000 prize. After a hearing at which Kolenda failed to appear, he was ordered in 2008 to pay a $125,000 fine. He never did.
• In 2010, Kolenda sold coverage to pay $25,000 for a hole in one during a golf tournament in Snohomish. A player got a hole in one. His golf partners signed notarized forms attesting to the hole in one. The prize remains unpaid, despite numerous calls and emails from the partners and tournament officials.
Similar allegations have been made against Mr. Kolenda and/or his business in numerous other states, including Montana, Ohio, Georgia, California, New York, Hawaii, Alabama, Massachusetts, Florida, Connecticut and North Carolina.
Kevin Kolenda, of Norwalk, Conn., was charged Wednesday in King County Superior Court with five counts of transacting insurance without a license, a class B felony. His arraignment is slated for Sept. 5.
Kolenda, 54, ignored a previous cease-and-desist order and a $125,000 fine from state Insurance Commissioner Mike Kreidler.
“We’ve been warning the public about Mr. Kolenda’s scam for years,” said Kreidler, whose Special Investigations Unit did the investigation that led to the charges. “He has a long history of selling illegal insurance, refusing to pay prize winners, and thumbing his nose at regulators.”
In some cases, charities have had to come up with the prize money. In others, the prize winners agreed to forego a prize.
Kolenda in 1995 started a business called Golf Marketing, working out of a home his parents owned in Norwalk. Since then, the business’ name has changed several times, including: Golf Marketing Worldwide LLC, Golf Marketing Inc., Hole-in-Won.com, and currently Hole-in-Won.com Worldwide. The company also has a regional office in Rye, N.Y.
Kolenda has repeatedly failed to pay winning golfers in Washington. Among them:
• In 2003, Kolenda illegally sold insurance for a tournament in Bremerton. But when a golfer got a hole in one and tried to claim the $10,000 prize, Kolenda wouldn’t pay.
• In 2004, Kolenda sold insurance for a Vancouver tournament. Again, a golfer got a hole in one. Kolenda refused to pay the $50,000 prize. After a hearing at which Kolenda failed to appear, he was ordered in 2008 to pay a $125,000 fine. He never did.
• In 2010, Kolenda sold coverage to pay $25,000 for a hole in one during a golf tournament in Snohomish. A player got a hole in one. His golf partners signed notarized forms attesting to the hole in one. The prize remains unpaid, despite numerous calls and emails from the partners and tournament officials.
Similar allegations have been made against Mr. Kolenda and/or his business in numerous other states, including Montana, Ohio, Georgia, California, New York, Hawaii, Alabama, Massachusetts, Florida, Connecticut and North Carolina.
Ontario Government Moves Forward On Its Rate Reduction Strategy
This week the amendments to the Automobile Insurance Rate Stabilization Act, 2003 (AIRSA) were proclaimed in force effective August 16, 2013.
In addition, the government filed an Industry-Wide Rate Reduction Target Regulation which calls for an average rate reduction of 15% by August 15, 2015. The government is also aiming to make an average 8% rate reduction by August 15, 2014. It will also expect a report in January 2014 from FSCO to show an approved rate reduction of 3% to 5%.
This was followed by FSCO releasing a bulletin that begins the process for insurers in Ontario to refile their auto insurance rates.
Also announced today was the appointment of Douglas Cunningham also has been appointed to lead a review of Ontario’s auto insurance dispute resolution system and make recommendations on transforming the current system. Mr. Cunningham is a former Associate Chief Justice of the Ontario Superior Court of Justice.
In addition, the government filed an Industry-Wide Rate Reduction Target Regulation which calls for an average rate reduction of 15% by August 15, 2015. The government is also aiming to make an average 8% rate reduction by August 15, 2014. It will also expect a report in January 2014 from FSCO to show an approved rate reduction of 3% to 5%.
This was followed by FSCO releasing a bulletin that begins the process for insurers in Ontario to refile their auto insurance rates.
Also announced today was the appointment of Douglas Cunningham also has been appointed to lead a review of Ontario’s auto insurance dispute resolution system and make recommendations on transforming the current system. Mr. Cunningham is a former Associate Chief Justice of the Ontario Superior Court of Justice.
Saturday, August 22, 2015
An open letter from Mike Kreidler about insurance plans filed for Washington's exchange
An open letter from Insurance Commissioner Mike Kreidler
In January, the biggest changes under health care reform – or “Obamacare” – will take effect. Many health plans, which now have to comply with federal standards, will be significantly better. And hundreds of thousands of low- and middle-income Washingtonians will qualify for subsidies to help pay for coverage.
This fall, Washington’s new Health Benefit Exchange will open for business, giving consumers an easy way to compare health plans, sign up, and see if they qualify for the subsidies.
Many kinds of insurance policies, before they can be sold, must be reviewed and approved by my office. This is a very important consumer protection, designed to ensure that prices are fair and that insurers can deliver on their promises.
I’m pleased to report that based on state and federal law, we were able to approve 31 health insurance plans, from four carriers, for the Exchange. People shopping on the Exchange will have broad choice and significantly better coverage, starting Jan. 1, 2014.
Unfortunately, we had to reject applications from five other insurance carriers. These were not decisions I made lightly. I am a strong supporter of competition and consumer choice, and a longtime supporter of health care reform.
As the state’s insurance regulator, however, I have a duty to protect consumers and to hold all insurers to the same standards. There were substantial problems in the plans we rejected.
Health insurers must have adequate networks of doctors and other health care providers. And there were major problems with the networks of most of the rejected plans. One didn’t offer any pediatric hospital.
Another had no approved retail pharmacy. Certain plans didn’t have adequate access to transplant surgeons, or to HIV/AIDS specialists.
One network would have required people to drive more than 45 miles to see a cardiologist, and more than 120 miles to see a gastroenterologist. That would be like living in Tacoma but having to see a doctor in Bellingham.
These were not minor technicalities. They were major problems.
Some people have pointed out that three of the carriers whose plans were rejected are currently serving people on Medicaid. They worry that people whose incomes rise, making them ineligible for Medicaid, will have difficulty moving to a regular commercial plan, or would lose important continuity of care offered by the community clinics. Many of these community clinics offer important services, such as language assistance or transportation.
Rest assured: The plans I approved for the Exchange include a substantial number of community clinics throughout the state. In many cases, Medicaid patients who want to remain with the same clinic will be able to.
The Affordable Care Act requires all carriers participating in the Exchange to contract with an adequate number of “Essential Community Providers,” or ECPs. These are defined as health care providers that serve high-risk, special needs and underserved individuals. Many Sea Mar clinics, for example, have contracts with the commercial carriers who were approved for the Exchange.
My staff and I worked very hard to try to get all carriers and all plans across the finish line in time. We had dozens of meetings, and 14 webinars to try to walk them through the process. I called one CEO after another, laying out the key issues and timelines. On the final night, July 31, we had staff waiting at their desks until midnight, in order to give the companies every possible minute to succeed.
But some carriers – particularly those new to the commercial insurance market -- simply couldn’t meet the standards this time.
We knew this first big year of health reform implementation would be a bumpy ride, and it has been. But I remain optimistic about the future. We will continue to work with all carriers to help them get ready for the next year, when I fully expect more insurers to succeed.
In the meantime, consumers have a broad number of choices. The insurance is meaningful, the networks robust, the subsidies significant. Again, the process has been bumpy. But it’s a very promising start.
This fall, Washington’s new Health Benefit Exchange will open for business, giving consumers an easy way to compare health plans, sign up, and see if they qualify for the subsidies.
Many kinds of insurance policies, before they can be sold, must be reviewed and approved by my office. This is a very important consumer protection, designed to ensure that prices are fair and that insurers can deliver on their promises.
I’m pleased to report that based on state and federal law, we were able to approve 31 health insurance plans, from four carriers, for the Exchange. People shopping on the Exchange will have broad choice and significantly better coverage, starting Jan. 1, 2014.
Unfortunately, we had to reject applications from five other insurance carriers. These were not decisions I made lightly. I am a strong supporter of competition and consumer choice, and a longtime supporter of health care reform.
As the state’s insurance regulator, however, I have a duty to protect consumers and to hold all insurers to the same standards. There were substantial problems in the plans we rejected.
Health insurers must have adequate networks of doctors and other health care providers. And there were major problems with the networks of most of the rejected plans. One didn’t offer any pediatric hospital.
Another had no approved retail pharmacy. Certain plans didn’t have adequate access to transplant surgeons, or to HIV/AIDS specialists.
One network would have required people to drive more than 45 miles to see a cardiologist, and more than 120 miles to see a gastroenterologist. That would be like living in Tacoma but having to see a doctor in Bellingham.
These were not minor technicalities. They were major problems.
Some people have pointed out that three of the carriers whose plans were rejected are currently serving people on Medicaid. They worry that people whose incomes rise, making them ineligible for Medicaid, will have difficulty moving to a regular commercial plan, or would lose important continuity of care offered by the community clinics. Many of these community clinics offer important services, such as language assistance or transportation.
Rest assured: The plans I approved for the Exchange include a substantial number of community clinics throughout the state. In many cases, Medicaid patients who want to remain with the same clinic will be able to.
The Affordable Care Act requires all carriers participating in the Exchange to contract with an adequate number of “Essential Community Providers,” or ECPs. These are defined as health care providers that serve high-risk, special needs and underserved individuals. Many Sea Mar clinics, for example, have contracts with the commercial carriers who were approved for the Exchange.
My staff and I worked very hard to try to get all carriers and all plans across the finish line in time. We had dozens of meetings, and 14 webinars to try to walk them through the process. I called one CEO after another, laying out the key issues and timelines. On the final night, July 31, we had staff waiting at their desks until midnight, in order to give the companies every possible minute to succeed.
But some carriers – particularly those new to the commercial insurance market -- simply couldn’t meet the standards this time.
We knew this first big year of health reform implementation would be a bumpy ride, and it has been. But I remain optimistic about the future. We will continue to work with all carriers to help them get ready for the next year, when I fully expect more insurers to succeed.
In the meantime, consumers have a broad number of choices. The insurance is meaningful, the networks robust, the subsidies significant. Again, the process has been bumpy. But it’s a very promising start.
Mike Kreidler
Insurance Commissioner
OIC seeks Senior Financial Analyst to monitor companies
We are hiring a Senior Financial Analyst (Financial Examiner 4) in our Tumwater office to help us monitor the financial health of insurance companies. This position is in our Company Supervision divison and is responsible for monitoring the financial condition of insurers and other entities and taking timely action to help these organizations' financial health so they can fulfill their obligations to consumers. This position also supervises three financial examiners and fills in as acting Chief Financial Analyst, when necessary.
This position is open until filled. Read more or apply at careers.wa.gov.
This position is open until filled. Read more or apply at careers.wa.gov.
"Auto accidents have decreased. Why did my insurance rates go up?"
Q: I read that auto accidents in Washington state have decreased, as have accident-related deaths. But my insurance premium just went up 15 percent. What's going on?
A: As Washington state's insurance regulator, we do our best to hold down insurance costs. But there are things other than accident rates that can affect your auto insurance premiums. Theft rates, auto glass costs, health care costs (for injuries in a crash) can all play a role. So can the fact that modern vehicles, with more airbags, high-strength steel and sophisticated safety features can be more expensive to repair.
Rates are driven by insurers' actual claim payments, administration costs and the company's cost and loss projections for the near future.
A: As Washington state's insurance regulator, we do our best to hold down insurance costs. But there are things other than accident rates that can affect your auto insurance premiums. Theft rates, auto glass costs, health care costs (for injuries in a crash) can all play a role. So can the fact that modern vehicles, with more airbags, high-strength steel and sophisticated safety features can be more expensive to repair.
Rates are driven by insurers' actual claim payments, administration costs and the company's cost and loss projections for the near future.
Insurance News - Thursday, August 22, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, August 22, 2013:
- California could be the 5th U.S. state to allow e-delivery of insurance documents. A state Senate bill would allow policy renewals to be sent electronically to policyholders’ computers, tablets and mobile devices.
- Eventually insurers will need to move beyond discounts to attract consumers to user based insurance. After all not every driver can be given a discount once UBI becomes mainstream.
- Insurers looking for ways to stand out in terms of the kind of billing experiences they are providing policyholders using technology such as portals, websites and mobile apps. More and more consumers prefer online payment systems.
- Georgia is most expensive state to own a car and Oregon the least expensive. Although insurance costs are part of the difference, the gap is largely unrelated to car ownership but rather state taxes.
- Ontario court rules in favour of the government thereby allowing new regulations governing physiotherapy for seniors to take effect immediately. The government claimed the existing system delivered by for-profit clinics was being abused.
- Study suggests gender differences in Post Traumatic Stress account for why women are more at risk after a motor vehicle accident.
- Finally, a Minnesota man has lost his driver's licence for driving too slow.
Friday, August 21, 2015
Cost of raising children may factor into life insurance decisions
This week, the U.S. Department of Agriculture reported that a child born in 2013 will cost $245,340 to raise to the age of 18. That does not include the cost of a college education, or any other expenses if the child lives at home after age 17. The largest expense of raising a child is housing, followed by child care, education and food.
What, you ask, does the cost of raising children have to do with insurance? If you have children under the age of 18 and you are considering purchasing or modifying a life insurance policy for yourself or your spouse, the cost of raising and educating children is one factor you may want to weigh. When you purchase life insurance, you should consider expenses your family will need to pay for when you are gone and how the loss of your salary will affect their ability to do that. We recommend you talk to your financial planner, insurance agent or broker when you are making decisions about life insurance. You can also read more about life insurance on our website.
Are you curious about how much you may spend on raising your child? The USDA has a Cost of Raising a Child Calculator.
Thursday, August 20, 2015
Driverless Cars Will Create Cities with No Parking Lots, Congestion, Collisions...and No Car Insurance
Cars changed the world and our cities in the 20th Century by freeing people of the limitations of their geography. People now have the freedom to live, work, shop and travel almost anywhere they want. The car industry has caused suburbs to grow, and made the development of road and highway systems necessary. Cars also made possible the development of shopping malls, roadside businesses, supermarkets, motels and hotels, intercity travel, the taxi industry, and of course auto insurance. Of course along with the positive contributions of cars, there have been negative implications - car accidents are a leading cause of death and injury in the world. Cars have also created traffic congestion and contributed to air and noise pollution.
As people became more dependent on cars, those without access to cars have come less independent as they struggle to live, work and shop in cities where everything is spread out over large geographic areas. Our cities and society are about to undergo another dramatic change as we move closer to the introduction of driverless cars. Driverless will be here soon. Google is testing a fleet of driverless cars in the United States and Britain recently announced it will begin a trial on public roads next year. The Ontario Ministry of Transportation is consulting on a pilot project to test driverless cars so we may soo see driverless cars on Ontario roads. Many of the negative aspects of cars will soon vanish as robot cars will take us wherever we want with less cost, stress and risk. Car ownership will no longer be necessary and our cities and suburbs will be transformed again.
So what will this future world look like? It may be hard to believe but no one will own a car. Let’s take a look at John and his family. John steps out of the shower and after drying off picks up his smartphone and orders transportation for his family for the day. John needs to be picked up for work at 8:15 and brought home at the end of the day. His wife, Gloria needs a ride to work at 8:40 and on the way will drop off her two sons, Brad and Glenn, at school. She will need a ride home at 4:30 with a stop at the supermarket. After school Brad will need a ride to hockey practice and Glenn will be dropped off at a friend’s house. The cars are provided by RoboTrans which operates a fleet of driverless cars that are on the road 24 hours a day.
At 8:15 John steps out of the house and a car is waiting in front. John’s home has no garage or driveway and neither do his neighbours in this relatively new suburb which makes the neighbourhood esthetically more appealing and cheaper to build. John reviews his presentation that he will be making this morning in the car which zips through traffic at brisk pace. Rush hour as we know it will no longer exists. A road full of driverless cars moves at constant speeds and distances between cars allowing the road to accommodate more volume at greater speeds. The commute always takes 18 minutes and when the car pulls up in front of his office, John steps out and heads inside. The trip is automatically charged to his credit card and the car pulls away and smoothly gets back into traffic to head off to pick up the next customer or to the city’s periphery where it awaits being wirelessly called back. At the end of the month, John, Gloria and the kids have planned a driving holiday to the East Coast. The family has already booked all the hotels and vehicles for the trip. Not having to drive the long distance will mean that John will arrive fresh and ready to enjoy his holiday.
Downtown will look quite different with no cars parked on the streets. For one thing, traffic will be lighter without thousands of cars circling around looking for parking spots. There won’t be any parking lots or gas stations. All that ugly space will be gone, which will free up commercial real estate downtown and reduce property values. As a result living and working downtown will become cheaper. There will still be gas stations and RoboTrans will likely own its own located in industrial neighbourhoods for refueling its fleet. There will be no taxis on the road because RoboTrans provides the same service but without a driver and at a much lower cost. The UPS driver will likely also disappear.
So why won’t I be owning or leasing a car in the future? Let’s say I drive my car on average 2 hours each day. That’s about 8% of the day. The remaining 92% of the time it sits on my driveway or a parking lot. If I share a vehicle with others then my cost per trip will drop significantly. My home and property taxes will drop because my home will need a small lot when I no longer require a garage. I also will no longer need to have a driver’s licence or learn to drive. When I become old and infirm, it won’t be necessary to give up driving or my independence.
There will no longer be road collisions and be no need to purchase car insurance. That complex and costly system for insuring drivers and vehicles disappears. Most collision repair shops, towing operators and private rehabilitation providers will disappear as well. Personal injury lawyers will see case loads fall significantly. Just imagine a world where there are virtually no injuries and deaths from car crashes, better mobility for people who can't drive now, more efficient use of resources, and healthier, more vibrant cities. We will finally stop obsessing about cars and focus on people and making our cities more livable.
Just as Henry Ford revolutionized society when he introduced the Model T over a hundred years ago, Google will take us to the next frontier when driverless cars hit the road in the next few years.