(Un)common Sense

You know those warning labels on things like hair dryers? The ones that tell you not to use the hair dryer while you are in the tub or shower?

Or don't stick a fork in the toaster to get your piece of bread?

You would think these things are common sense. Why would you need to tell someone they shouldn't use a hair dryer while standing (or sitting) in water, or that you should not stick a metal fork in an electric toaster while it it turned on?

So why do navigators need to be told the following?

“Do not leave documents that contain PII [Personally Identifiable Information] or tax return information on printers and fax machines.”

“When faxing PII or tax return information, double-check that the recipient’s fax number is correct and that someone is able to pick up the faxed information immediately.”

ATR

Common sense, right?

Apparently not.

And these are the folks the government is hiring (and training) to help you get an Obamacare subsidy.

An ObamaTax Exchange Prediction (1,000 Words)

Seattle insurance producer loses license

The OIC revoked the license of Christopher S. Gloria, 39, of Seattle effect Sept. 26. Gloria was licensed as a Washington state insurance producer and was initially licensed in July 2012. We revoked his license for misrepresentation and fraudulent activity in his dealings with a Washington couple. 

In March 2013, the couple met with Gloria to find out if they could find equal or better whole life insurance for a lower premium than they had on their existing policy. They told Gloria they didn’t want to give up their existing policy, they simply wanted some comparison quotes. Gloria gave the couple documents to sign, which he said were necessary to obtain a quote, but in fact allowed him to replace their existing policies with new ones, underwritten by a different insurance company. Gloria also requested a voided check, which the couple gave him.  

Once the couple realized that their old policies had been replaced with new ones, they instructed Gloria that they wanted their old policies restored. From March through September 2013, the couple repeatedly contacted Gloria and he repeatedly told them it was in the works, even when the old company told the couple their policies were still not reinstated. 

Gloria is not allowed to sell insurance in Washington state or to Washington consumers. He has 90 days to appeal the revocation of his license. You can read the OIC order revoking his license here. 

If you feel you have been treated unfairly or have questions about insurance in Washington state, contact our consumer advocates online or by phone at 1-800-562-6900.

• Related info: Read the OIC’s consumer’s guide to life insurance. 

 

 

Insurance News - Tuesday, September 30, 2014

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

• An engineer has developed a system that uses a small black box, plugged in under a car’s steering column, to block incoming and outgoing texts and prevent phone calls from reaching the driver.
• A Kansas City hospital allegedly didn’t file health insurance claims for some patients injured in auto accidents, which allowed it to avoid the deep discounts typically required by health insurers. It could then seek more money for its medical services, mainly from auto insurance settlements.
• Audi of America became the first company to receive an official California DMV permit to test driver-less vehicles on the state’s public roads, followed by competing automaker Mercedes-Benz and Internet giant Google.
• Is using a smartwatch behind the wheel a ticketable offence under the country's distracted driving laws?  Both MTO and the OPP are unsure.
• Typical insurance policies won't cover people participating in the "sharing economy" by renting out their their car for a driving service, Oregon's insurance commissioner warns.

Breaking: Actual ObamaTax Rates (Tar Heel State edition)

A friend of mine, who lives in the Wilmington area, just received his 2014 "renewal" from Blue Cross/Shield, as well as a copy of the internal rate sheets for their new "metal" plans.

As one might expect, although he likes his current (HSA) insurance plan, he can't keep it. And contra the President's other explicit promise, his rates didn't go down "3000%"

His current premium, good through the end of 2013, is $212 per month with a $5,000 deductible (and no co-insurance). His renewal has mapped ("transitioned") him to a Bronze plan with a $5,500 deductible (and no co-insurance) with a monthly (non-subsidized) premium of $493, more than double his current premium, plus 10% more out-of-pocket.

Now, he could opt for a so-called "Catastrophic" plan (which, due to his age, would require a hardship exemption for eligibility) with a $6,350 deductible (and again, no co-insurance) for $387 per month. That's a 35% increase in premiums and a little over 25% greater out-of-pocket.

Fortunately, my friend's a non-smoker, else he could plan on adding an additional 20% to those "bargain" rates.

The ObamaTax in action.

ObamaTax Exchange Jitters - Part 1

Over the weekend, co-blogger Patrick sent me the link to an online "database" that purported to have the rates for various QHP's (Qualified Health Plans) as they'll appear on the Exchanges. Only problem was, the "data" was simply a recap of how many plans and carriers would be participating in a given state. But I wasn't all that surprised since I'd just seen this little gem from an agent in the Old Line State:

So tomorrow I’m supposed to be able to start enrolling people in the great and glorious future of health insurance. No doubt figuring that it would be helpful for me to know what plans are available to enroll people in before that date, this past weekend Maryland Health Connection emailed me a handy little quick reference guide to available plans. 876 pages of coverage grids, yay! I’ve been paging through it, and it’s really back to the future time, these are, with 2 exceptions so far*, old fashioned Major Medical (MM) plans.

Let me explain: Traditionally, a MM plan is a simple thing; you have a deductible of whatever, you pay for all your medical treatments until you spend that much, then the insurance kicks in. In recent years, most major carriers have modified MM plans so that some/much/most outpatient treatment was not subject to the deductible, but just required a copay. It works pretty well, if something major happens (i.e. hospitalization, surgery) there’s a deductible to meet but it’s not so bad because the bill’s huge, but in most normal years thing like docs, Rx, ER just require a copay. People are NOT going to be happy going back to the old model. EVERYTHING except preventive care is now subject to the deductible. It could work if the cost came down significantly, back to where it used to be, but we already know it’s going up.

And that’s the other thing. There are no prices attached to these plans. I’m supposed to start enrolling people tomorrow, wonder if I’ll have it by then? Without some idea of costs, I have no way to judge whether these are “good” insurance plans or not. They could be, if they are cheap enough. (Hell if they’re cheap enough, it would be dragging insurance back to what it’s supposed to be instead of being prepaid medical) I’m not holding my breath, however, and I’ll tell you something else: People who have been covered by comprehensive work plans that require little out of pocket from them at the point of service are going to scream bloody murder.

Also along the same everything-old-is-new-again lines, HMOs are back with a vengeance. Pre-approvals and referrals are the new black.

* UHC has managed to retain a smidgeon of outpatient coverage not subject to the deductible, but it’s not even close to what their plans cover now. Also, what I can only call “super insurance” is available; BCBS has one plan where you pay nothing for health care, no deductible, no copay, no coinsurance, nada. Network limited, but your annual out of pocket max is $0. I really, really want to know what that one costs.

Thanks, WD!

Stay tuned for Part 2 - the other shoe drops.

On ObamaCare Messaging and Strategy

It's no secret that, like most Americans, we're no fans of Obamacare. So it's frustrating to see the political party that did not ram it down our throats being so weak-kneed in its opposition as it's being rolled out.

The latest tactic would delay the Exchanges for a year. How stupid is this? The administration is already accusing the Republicans of everything short of murdering people by not wanting them to have insurance. The one aspect of Obamacare that gets positive polling is people getting covered. Delaying that a year would be terrible press going into an election year, press the Media will heap on them gleefully. In the end they aren’t going to win that fight.

So what should they do? I have some suggestions:

1 - Waive the individual mandate for 1 year after the employer mandate is enforced

2 - Allow exchange subsidies but fund it with;

    a. Elimination of government contribution to Congress and staff premiums

    b. Force executive & Judicial branch and all staff to buy their coverage through the exchange with no subsidy from the tax payors

    c. Require passage of Keystone pipeline immediately with small small tax on oil passing through it earmarked for exchange subsidies

    d. Eliminate PCORI and allocate all collected money to exchange subsidies

Now instead of Republicans not wanting people to have insurance it will be on the administration to give up graft or shut down the government. None of the items are meaningful to the public; the majority of people would argue they should be sacrificed to fund the subsidies.

ObamaTax Eve: MVNHS© and CanadaCare© edition

While legacy media reports that the ObamaTax rolls out tomorrow aren't quite accurate (various portions have been implemented over the past 3 1/2+ years), the opening of the Exchanges is certainly a high- (or low-, depending on one's perspective) watermark. And so in that spirit, let's see what our Friends Across the Pond© and Neighbors to the North© have wrought, in order to better understand the future of health "care" in America.

■ Reader Peter K tips us to this little gem from Merry Olde England:

"A teenage girl died after doctors failed to carry out basic checks that may have revealed she was suffering from life-threatening brain damage"

15-year-old Amie Miller had been suffering from headaches and nausea, and couldn't even open her eyes. Some very simple tests might have revealed the extent of the damage, and saved her life.

But that's not the best part. This is:

It took 5 years for the Royal Rocket Surgeons to figure this out.

■ It's probably a good thing that little Amie didn't smoke, or things could have gone even worse:

"Patients are being denied minor treatments because they smoke ... a healthy middle-aged man was told he could not have a ten-minute operation to cut a small benign growth off the side of his  head, because of his habit."

One might endeavor to argue that smokers who develop lung-cancer ought to pay some penalty at claim time. But the Much Vaunted (and Totally Compassionate) National Health System© has begun denying actual care for non-smoking-related health problems to those who choose to light up.

Death Panels IPAB at its finest.

■ Meanwhile, our Neighbors to the North© prove that, when it comes to denying care to those most in need, they're no slouches, either:

"The daughter of a 67-year-old woman is planning to sue Pierre-Boucher Hospital in Longueuil [in Quebec] after her mother spent 13 hours in the emergency room without being seen by a doctor."

The good news is that Mom's health care was "free."

The bad news is that Mom's free health care killed her.

The ObamaTax Exchanges (are scheduled to) open tomorrow.

Five things you should know about flood insurance

1) Your homeowners policy doesn't cover floods. Flood damage is not a covered peril on standard homeowners policies and most commercial policies, although many people assume that it is. That can be a costly assumption.

2) You can get an estimate of your property's flood risk online with a "one-step flood risk profile."

3) You may have to have flood coverage. Mortgage lenders often require flood coverage if a home is located in a flood-prone area (also known as a "special flood hazard area.")

4) Most people buy flood coverage through the government. Flood insurance is widely available through the National Flood Insurance Program, which is run by the Federal Emergency Management Agency, or FEMA. There are limits, however, on how much damage they'll cover. Many local agents sell NFIP policies.

5) Rates may be going up. In July 2012, Congress passed the Biggert-Waters Flood Insurance Reform Act, which will change the way the National Flood Insurance Program is run. Among those changes: premiums will increase for some policyholders. That's being done to make the program more financially stable.

Obamacare and Mega Blue

The Obama administration plans on Monday to announce scores of new health insurance options to be offered to consumers around the country by the Blue Cross and Blue Shield Association and the United States Office of Personnel Management, the agency that arranges health benefits for federal employees, according to administration officials.

The options are part of a multistate insurance program that Congress authorized in 2010 to increase options for consumers shopping in the online insurance markets scheduled to open on Tuesday.

Congress conceived multistate plans as an alternative to a pure government-run insurance program — the “public option” championed by liberal Democrats and opposed by Republicans in 2015-10.

NY Times

And this is good because . . . .?

The federal government negotiated the benefits and premiums for the Blue Cross and Blue Shield products, so this plan carries a federal seal of approval.

But how is this good for consumers?

Supporters of the multistate plans authorized by Congress say the plans will increase competition in local health insurance markets, many of which are dominated by one or two carriers. 

Introducing a "super plan", issued by ONE carrier, will increase competition in markets dominated by one or two carriers.

Really?

Insurance News - Saturday, September 28, 2013

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Saturday, September 28, 2013:

• NDP claims Liberals have backtracked on a promise to lower the profit benchmark to 9% (FSCO has set it at 11%) and now the government will have problems reducing rates by 15. 
• Court of Appeals of Ontario confirms that it’s illegal to hold a cellphone while driving even if it’s not transmitting and no matter how briefly it’s in a driver’s hand.
• WiFi-enabled vehicles are coming to Canada.  So being able to better access the Internet on smartphones, tablets and laptops in cars is a good thing?
• Auto insurers with a "wait and see" strategy for usage-based insurance could end up underpricing bad risks that UBI insurers will avoid.
• More evidence that self-driving cars are on the way: Nissan’s self-driving car, the LEAF, has been granted a license for public roads in Japan.
• Michigan House of Representatives bill would introduce electronic proof of insurance as a mechanism to combat fraudulent insurance slips.

Golf insurer in CT arrested for selling illegal insurance in WA

A Connecticut businessman who specializes in insurance for golf tournament hole-in-one prizes has been arrested in his home state after failing to appear for a felony arraignment in Seattle earlier this month.

Kevin Kolenda, 54, was arrested Wednesday in his hometown of Norwalk, Conn. He faces five counts of transacting insurance without a license, a class B felony.

"We've been warning the public about Mr. Kolenda's scam for years," Insurance Commissioner Mike Kreidler said in a recent press release. "He has a long history of selling illegal insurance, refusing to pay prize winners, and thumbing his nose at regulators."

Kolenda was supposed to appear in court Sept. 5 for arraignment on those charges, but he failed to appear. So the judge issued a bench warrant for his arrest.

Kolenda has ignored a previous cease and desist order from our office, as well as a $125,000 fine.

Update (9/28/2012): Added King5 video at top of post.

Why did you make my auto/homeowners insurance rates go up?

Q: My auto and homeowners insurance rates went up, and my agent and insurer said that it's because Washington state required them to charge more. Did you require this?

A: We get this question fairly often. While we do review rates for many kinds of insurance, no, we did not tell your auto/homeowners/etc. insurer to raise its rates. It's up to insurers to decide when, or if, they will submit proposals to us to increase or decrease rates. (In some cases, notably health coverage, insurers often reduce benefits in order to moderate rates hikes.)

Again: While we may review the rates, the insurance company is the one proposing any changes.

There are many insurers selling auto and homeowners policies in Washington. If your insurer is raising rates too high, maybe it's time to shop around. Need help? Here are some tips when shopping for auto coverage, and here are some tips when shopping for homeowners coverage.

Cavalcade of Risk #193: Call for Submissions (And A Special Note)

Dennis Wall hosts next week's Cav, and he's chosen to build it around a rather interesting (and provocative) theme:

The Rich Get Richer from the Great Recession, The Unemployed Stopped Looking.

So, please try to submit a post that fits this theme (of course, non-themed posts are also welcome).

Submissions are due by Monday the 30th.

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like unless directly theme-related). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Cute vs Real

This is how Ms Shecantbeserious sees the ObamaTax:

And this is reality, barking back at her:

[HatTip: Ace of Spades]

ObamaTax Exchange Crunch-Time edition

Poor Ms Kathy: the clock keeps on tickin', and her pet project keeps getting a lickin'.

To wit:

■ Capital City itself

"The ObamaCare exchange serving Washington, D.C. is delaying important parts of its operations less than a week before it is scheduled to open for enrollment"

Not only won't potential enrollees be unable to calculate their subsidies (if any), but they can't even determine whether or not they're eligible for Medicaid.

■ Colorado

"Colorado exchange managers revealed Monday ... that customers who want tax credits to make health insurance more affordable will have to call for help, rather than navigating the multi-million dollar computer system on their own."

I'm sure that'll go over big with the 20-somethings that hold the key to the whole train-wreck's "success."

■ Utah

"Obamacare’s insurance marketplace was supposed to have “no wrong door ... Consumers will need to find the right door ... or they will possibly face delays in obtaining coverage"

The whole "No Wrong Door" meme was heavily promoted in the Exchange Certification training. Why am I not surprised that it's DOA?

■ Oregon

When it rains, it pours:

"Oregon ... won’t meet all the requirements for its health-insurance exchange when the online marketplace opens Oct. 1 ... For at least two weeks, people using Cover Oregon won’t be able to complete their purchase without help from a certified insurance broker or community group"

Feature or bug? What difference, at this point, does it make?

2012 Canadian Auto Insurance Statisfaction Study

This week the J.D. Power and Associates released its 2012 Canadian Auto Insurance Satisfaction Study^SM.  The study, now in its fifth year, measures insurance customers' experiences with their primary insurer. Customer satisfaction is measured across five factors: interaction; price; policy offerings; billing and payment; and claims. Insurers are ranked in three regions: Western (British Columbia; Alberta; Saskatchewan; and Manitoba); Ontario/Atlantic; and Quebec.

Customer satisfaction in the Ontario/Atlantic region has increased by 11 points from 2011, primarily due to an increase in satisfaction with insurer policy offerings (+17 points). Policy offering satisfaction is most often influenced by the quality of discounts offered. In fact, 60 per cent of customers in this region received multiple (three or more) discounts on their policy, a six-percentage-point increase from 2011. Nearly 30 per cent (29%) of customers reported an insurer-initiated rate increase in 2012, representing a four-percentage-point decrease from 2011.

Obviously a big factor has been more stable premiums which continually has a significant impact on overall customer satisfaction.  However, J.D. Power and Associates pointed out that there was increases in satisfaction in nearly every factor across the board.

 Below is customer satisfaction in Atlantic/Ontario region broken down by insurer.

A Gentle Reminder...

For HHS Secretary Shecantbeserous:

COUNTDOWN CLOCKS

This word "start" - I dunna think it means what you think it means:

"In response, Joel Ario, a former HHS official who oversaw health exchange matters at the agency, told The Washington Post’s Sarah Kliff that “nobody is going to say we’re not starting on October 1, but in some situations, you may see a redefinition of what ‘start’ means.”

Insurance News - Thursday, September 26, 2013

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, September 26, 2013:

• Allstate introduces new mobile app that lets some customers settle auto claims by submitting photos of their damaged vehicle using a smartphone.
• Woman struck by car, lands on hood - ruled an 'occupant' of the car by Ohio appeals court in favouring victim.
• With insurers not able to use gender in calculating premiums under new European Union regulations, the use of telematics to determine premiums to become critical.
• Ontario now allowing drivers to renew licences online ­- will be able to use their existing licence photos for an additional five-year renewal cycle, meaning they will only need to renew in person every ten years.
• New York launching "Texting Zones" along New York State Thruway and Highways for drivers to pull over and use their cell phones.

Open enrollment for children ends Oct. 31

Do you need health insurance for your child? Open enrollment for individual health insurance for children is now underway. From Sept. 15-Oct. 31 you can buy an individual plan for your child or add them to your plan with out having to fill out a health questionnaire.

Under health reform, health plans can no longer deny children coverage if they have a pre-existing medical condition, but they can create open enrollment periods. Washington state has two annual enrollment periods: March 15-April 30 and Sept. 15-Oct. 31.

If you need coverage now, don't wait. You have until the end of Oct., but the sooner you enroll, the faster you'll get coverage.

The next open enrollment starts March 15. Here's a list of plans in the individual market by county and what to do if you miss the enrollment period.

Visit OIC at the Small Business Fair in Renton this Saturday

The Office of the Insurance Commissioner will be available to answer your insurance questions at the Washington Small Business Fair this Saturday in Renton. 

We can answer your questions about: 

• How to get health insurance, either as an individual or as a small business.
• Benefits that health plans must cover under the Affordable Care Act. 
• Options for small businesses that want to provide health plans for employees.
• Other types of insurance that small businesses may want to consider.

The fair is free, with plenty of free parking and no advance registration necessary.

There will free seminars that cover important, up-to-date topics for all stages of business ownership. Savvy business experts share their knowledge and real-life experiences with you. 

Attendees will be able to connect with 30 federal, state and local government agencies, and business and trade associations.  

Here are the details:

• Saturday, Sept. 27 from 8 a.m. to 3:30 p.m.
• Renton Technical College, 3000 NE 4th Street, Renton.
• www.bizfair.org

We're looking for a communications and social media manager

Please help us spread the word - do you know a communications expert who's looking for a new challenge? We're currently recruiting for a Public Affairs Communications and Social Media Manager.

This position reports to the Deputy Commissioner for Public Affairs and manages select agency-wide public affairs strategies and communication projects. It also oversees the agency's social media efforts, represents the agency as senior writer and editor on legislatively required reports and high-profile projects for the commissioner and is primary spokesperson for news media and stakeholder groups on agency administrative, civil and criminal enforcement actions.

Here's the full job announcement. Please share with anyone you think might be interested.

We're taking applications through Oct.8.

Are Non-Driving Rating Factors Unfairly Weighted in Auto Rates?

Rating factors that have little to do with an individual’s driving abilities appear to have considerable bearing on the price consumers pay for auto insurance, a report from Consumer Federation of America (CFA) asserts.

CFA also says the rating factors in question discriminate against low- and middle-income drivers.

The CFA released its third report this year examining the affordability of auto insurance and its impact on moderate income individuals’ mobility and access to better paying jobs.

In this latest report, the consumer-advocacy group examined how non-driving rating factors can affect the cost of auto insurance, increasing the price of coverage by as much as 50 percent or more depending upon location and insurer.

The report examined the price of minimum-liability insurance for a 30-year old woman working as a bank teller, with a clean driving record, high school education, and insurance coverage that lapsed 15 days ago. Quotes were sought from the websites of the five largest U.S. insurers in Baltimore, Miami, Louisville, Houston and Los Angeles. A quote was obtained for the individual under the standard information provided. Then new quotes were obtained adding five different rating factors:
• Married.
• Homeowner.
• Professional.
• No break in coverage.
• Higher-income zip code.

With each factor, the price of insurance declined, and when all five rating factors were added to the quote, the change in price was as high as 73 percent.

In Ontario, only marital status and some lapses in coverage are rating factors.  As well, territorial rating is permissible but not at the postal code level.

The report also includes a survey of 1010 adult Americans performed by CFA and ORC International asking what they thought about the use of specific factors to set auto insurance premiums (see chart below).

In response, Willem Rijksen, a spokesman for the American Insurance Association points out that the use of these factors, such as credit-based insurance scoring, location of the vehicle, driver experience, and traffic citations, helps insurers to more accurately price risk.  Neil Aldridge, senior vice president for state and policy affair for the  National Association of Mutual Insurance Companies commented that rating factors should not be “regulated by popularity,” adding, that “is not exactly a precise way to measure risk.”

read more here...

CFA report is here...

How to contact Washington's Health Benefits Exchange

Earlier this month, the Washington Healthplanfinder (our state's health insurance exchange) opened its toll-free hotline to start answering questions about health coverage options, how to access financial help and what you need to know about the Exchange's enrollment process. The phone number is 1-855-923-4633 or TTY/TDD 1-855-627-9604. They're available from 7:30 a.m. to 8 p.m., Monday through Friday.

The Healthplanfinder can also help you find other people -- a broker in your local community, say, or a nearby in-person assister -- to help you through the process. Click on the link or image above to find out more.

Life insurance explainer: What are life settlements?

Life settlements are when you sell your life insurance policy to someone else. You get immediate cash, and they collect the value of the policy when you die.

There's a similar type of transaction, known as a viatical settlement, in which a terminally ill person sells his or her life insurance to someone else.

Both these types of transactions are mentioned as options in a notice that life insurers are required to send to some Washington policyholders.

According to a New York Times article published last month, the fast-growing life settlements business swelled to $12 billion in transactions by 2007, but has dropped off dramatically, with only $3.8 billion worth of policies changing hands in 2010. Life settlements brokers maintain, however, that with trillions of dollars in life insurance out there, the industry is still in its infancy.

Insurance News - Wednesday, September 25, 2013

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

• California regulators have made technology-based ride sharing services legal in the state including minimum insurance requirements, obviously the taxi industry is not happy.
• How advanced are telematics in the U.S.? Allstate’s driver tracking program has now logged a billion miles. 
• Washington State man sentenced to 6 months in prison for selling more than 950 counterfeit vehicle airbags on eBay and Craigslist.
• NDP Leader Andrea Horwath accuses insurance industry of jacking up auto premiums to compensate for mandated 15% rate reduction.
• While the first self-driving cars are coming soon, overcoming motorists’ distrust of them may be a challenge.
• One reason is that self-driving cars are progressing faster than rules of road.  A driver could be charged with distracted driving if not paying attention to the road.

Health insurers rebates

Q: I've read in the news that health insurers are having to send rebates to their customers because of health care reform. But I didn't get a rebate? What's going on?

A: Yes, we've heard from a number of folks that are wondering whether they're going to get a rebate. The rebates are from companies that aren't putting enough premium dollars toward actual medical care (as opposed to marketing, administrative costs, etc.).

Here in Washington, however, most companies are already spending a high percentage of your premium dollars on medical care. That's the good news. But that also means that few Washingtonians will get rebates. Here's more about the rebates and a state-by-state breakdown.

Retroactive Claims For Attendant Care

Section 42(5) of the SABS states:

An insurer may, but is not required to, pay an expense incurred before an assessment of attendant care needs that complies with this section is submitted to the insurer. 

A similar provision (39(3)) can be found in the SABS that applies prior to September 1, 2010.  Seems pretty clear.  An insurer would not have to pay for attendant care expenses before a Form 1 is submitted by a claimant. 

Well it seems that might not be true according to T.N. v. The Personal (FSCO A6-0003999, July 26, 2012) which deals with s. 39(3) of the Old SABS.

The provisions of s. 39 (Old SABS) clearly indicated that an insurer was only obliged to begin payment within 10 business days after receipt of the Form 1. Similarly, the insurer’s right to assess attendant care needs and correspondingly adjust payments appeared to arise only after receipt of the Form 1. Pending receipt of the Form 1, the insurer had no explicit right to assess the claimant's attendant care needs.

Arbitrator Bayefsky found that s. 39(3) did not displace the insurer’s obligation to pay “reasonable and necessary Attendant Care Benefits” determined in accordance with a submitted Form 1. While s. 39(3) provided that an insurer was not required to pay Attendant Care Benefits before the Form 1 was submitted, this did not, in Arbitrator Bayefsky’s view, mean that a claimant forfeited their right to attendant care benefits prior to submitting a Form 1.

These provisions were included in the SABS specifically to prevent retroactive claims for attendant care in an effort to contain fraud in the system. An insurer is at a considerable disadvantage when presented with a claim for 6 months of retroactive attendant care benefits during which it may have limited or no information as to the extent of the attendant care needs or “expenses incurred”.

Insurers can expect for retroactive attendant care benefit claims which will likely be used as leverage for settlements. The best advice for containing exposure is to proactively request submission of For 1s where the claim does not involve a minor injury.

Insurance News - Tuesday, September 24, 2013

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

• What would happen if your self-driving car was to cause a crash in Ontario? Under Ontario's current system you would be at-fault which is no different than if you caused a crash using your cruise-control but your insurer will pay.
• While the first self-driving cars are coming soon, overcoming motorists’ distrust of them may be a challenge.
• With insurers no longer able to use gender as a rating factor in calculating premiums under new EU regulations, the use of telematics to become critical.
• Toronto Sun article suggests GISA numbers show Ontario’s auto insurers can easily afford a 15% reduction in premiums over 2 years.
• NDP Leader Andrea Horwath accuses insurance industry of jacking up auto premiums.

Mike Colle Introduces Bill For New Drivers And Minor Accidents

Liberal MPP Mike Colle who is familiar with the auto insurance file while Parliamentary Assistant to former Finance Minister Greg Sorbara introduced a Bill, the Insurance Amendment Act (Minor Accidents and New Drivers), 2013 on September 18, 2013.   

Bill 100 if passed with require that a risk classification system used by an insurer to determine rates for auto insurance could not consider minor accidents and would provide for lower rates for new drivers by crediting new drivers, in certain circumstances, with additional years of driving experience.

Minor accidents are accidents that result in $2,500 or less in damages, no injuries or death, and that did not result in an insurer making any payments that were not fully reimbursed by an insured driver.

A new driver is disqualified from receiving additional years of credit in a number of circumstances, including if the driver has been found to be more than 25% at fault in a claim arising from an accident, has been convicted of certain driving offences or has had his or her driver’s licence suspended for non-payment of certain fines.  The Bill is similar to an amendment passed in New Brunswick for new drivers called "First Chance" as part of reforms in 2005.

The Bill would reduce rates for new drivers and would prevent rate increases for anyone at-fault in an accident and paid the cost of repairs out of pocket as long as the repairs are less than $2,500.

On August 24, 2013, the Minister of Finance, the Hon. Charles Sousa, issued a policy statement that directed FSCO to review ways to “treat first-time drivers fairly” and to study the mandatory collision reporting threshold as a “potential cost reduction” initiative. 

Insurance Information Institute: Only 37 percent of renters have insurance

The number of people who rent a place to live instead of buying continues to rise, especially in high-cost urban areas. According to the Insurance Information Institute (III), only 37 percent of renters have insurance on their belongings, compared to 95 percent of homeowners who have a homeowners policy. Read the full report.

“Renters insurance provides a very important financial safety net when there is a disaster,” said Jeanne M. Salvatore, senior vice president and chief communications officer for the I.I.I. in a news release. “And, renters insurance is relatively inexpensive — the average cost of a renter’s policy is only $187 per year, or less than four dollars per week.”

Homeownership has fallen for over the past decade, according to Pew Research. The Northwest Insurance Council reports that up to 45 percent of people in the Puget Sound region rent rather than own their residence. That trend is mirrored in other major cities such as New York, Los Angeles, Chicago and Houston, where renters outnumber homeowners, the U.S. Census Bureau reports.

Landlords typically have insurance to cover the value of the property and structure, but that coverage does not cover the renter’s belongings (contents). A standard renter’s policy covers contents, personal liability, premises medical coverage if someone is injured on the property you rent, and additional living expenses if you have to temporarily relocate from your rental property.

Read more about renter insurance. Need help? Contact our consumer advocates online or at 1-800-562-6900.

Lindsay Lohan Could Be Paying Six Figures For Car Insurance

It may be a struggle for Lindsay Lohan to be insured on movie sets given her troubled history, but it seems the actress, despite multiple run-ins with the law and multiple auto-related incidents, is still somehow able to get auto insurance.

Lohan was arrested in New York City on Wednesday for leaving the scene after allegedly clipping a 34-year-old chef while driving a 2010 black Porsche Cayenne SUV in an alleyway between two hotels.

In June, Lohan’s Porsche crashed into a dump truck on Malibu’s Pacific Coast Highway, and was totaled.

In March, Lohan reportedly attempted to maneuver a Porsche in a crowd of paparazzi in Hollywood and hit the manager of a popular VIP hangout.

In 2007, she received two DUIs in the span of three months. In addition, the actress’s name routinely pop up in association with dings, bangs, bumps and law breaking – including a spin in her Porsche this past July in which she tapped the back of a silver mustang, getting pulled over by police for running a stop sign in Beverly Hills, and reports that she pulled her high-powered Maserati out of her West Hollywood apartment building and ran a red light before running into a stroller being pushed by a nanny. 

But given this history, how on earth is Lohan still able to get motor vehicle insurance, and what kind of premium must she be paying?

“Lindsay’s auto insurance policy is likely to be in the hundreds of thousands of dollars a year, not to mention that some insurance providers in California may require a bond,” according tp a spokesperson for AutoInsuranceQuery.com, Roger Brideaux.

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Be in the know with electronic updates from OIC

The Washington State Office of the Insurance Commissioner recently launched a new digital communication service to help consumers, media, partners and insurance professionals stay informed about Washington insurance news. 

 

Features include:

• Electronic notification: Receive alerts by email or text message—no password is required.
• Subscription management: Manage your profile online, including subscription topics and frequency of updates.
• Automated web alerts: Receive notification when new website content of interest to you is posted.

You can select your subscription preferences, update your subscriptions or cancel this service here.

Consumer alert: Real Benefits Association

Consumer alert

An unlicensed company named "Real Benefits Association" may be offering bogus discount health care plans in Washington state.

Again: This company is not licensed to do business in Washington state.

We've heard from consumers who said they paid monthly premiums to the Real Benefits Association, believing that they would receive legitimate medical and prescription drug coverage, but to date, the company has paid none of the health care claims they submitted.

Real Benefits Association and its owner, David Clark, were issued a cease and desist order by our office in January 2010. They are operating in violation of that order by collecting premiums for bogus discount health care coverage from Washington state consumers.

Friday wildfire update: We're hearing that some insurers have stopped writing new policies in the fire areas

The AP is reporting that wildfires in central Washington have merged and now cover more than 47 square miles, with officials urging more than 100 homeowners north of Ellensburg and in the Liberty area to evacuate. Here is a checklist of things to do if a wildfire is approaching a home.

Crews are digging lines, using bulldozers and trying to douse the flames and protect structures with fire retardant dropped from aircraft. Here are maps showing the areas that are burning. The fire began Sept. 8th with a lightning strike near Cle Elum. 775 firefighters are on scene, but fire commanders this morning ranked both the terrain difficulty and growth potential of the blaze as "extreme."

We have heard a few reports from consumers that some homeowners' insurance companies have stopped approving new policies in areas close to the fires. Nobody wants to hear this if they're trying to close a deal on a home, for example, but insurers are allowed to suspend writing new policies in cases like this.

It's a common practice, for example, with earthquake insurers to stop writing policies after a quake, for fear of aftershocks. And flood insurance typically comes with a 30 day waiting period, to prevent people from waiting until the storm clouds are overhead before they buy coverage.

Several other fires are burning in the state. Most of the state is now at high or very high fire danger.

U.S. 97 in both directions is closing today from 8 a.m. to 6 p.m. from milepost 150 (at the junction of SR 970) to milepost 177 (8 miles south of the junction of U.S. 2) for back-burning and fire containment operations.

Update: (5:02 p.m.) Some insurers have also stopped writing new auto policies in certain Eastern Washington zip codes due to the fires.

Teens Copy Parents' Bad Driving Habits

A new survey from Liberty Mutual Insurance and Students Against Destructive Decisions (SADD) finds an alarming percentage of teens report their parents have risky driving behaviours.  Even more concerning is that the surveyed teens repeat their parents' poor driving habits.

The survey was based on focus groups held in Boston and Atlanta earlier this year involving 1,700 teens.

	Parent bevaviour (observed by teens)	Teen behaviour (self-reported)
Talking on phone while driving	91%	90%
Speeding	88%	94%
Texting while driving	59%	78%
Driving without seatbelt	47%	33%
Driving and drinking	20%	15%
Driving under marijuana	7%	16%

Given the high percentage of teens who report their parents engage in unsafe driving behaviour while their teen is in the car, it follows that two-thirds (66 percent) of teen drivers report their parents live by different rules than the ones they expect of their teens.  These findings highlight the need for parents to realize how their teens perceive their actions.

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