Insurance when you're laid off: What to ask for on your way out the door

Nobody wants a layoff notice, but critical insurance moves on your way out the door can help extend your health insurance (and other coverage) and save you thousands of dollars at a critical time.

Insurance.com spelled this out today in an article titled "Insurance smarts during a layoff: 3 must-do moves."

Among the advice:

• Ask for an extension of health care benefits. Ask for the employer to keep you covered for 3-6 months.
• Negotiate with your employer to have them pay COBRA insurance premiums, which can be very expensive.
• Convert group life insurance or group disability coverage to an individual plan, particularly if you're older.

Don't forget flood coverage

We can't stress this enough: many people assume that their homeowners policy includes flood coverage.

It doesn't. Standard homeowners-, renters- and business policies do not cover flood damage. If your property is in a flood prone area, you should strongly consider buying flood coverage.

How do you know if you're in a risky flood area? Type your address into the red box on the home page for the federally run National Flood Insurance Program. That's where most people buy their flood coverage. Many local insurance agents sell these policies.

And if you think a few inches of water wouldn't cause much damage, you might be surprised. The NFIP put together an interesting interactive simulator that details -- item by item -- the costs of different levels of flooding in a typical home. See the link above.

Report: Health costs' rapid rise

The Commonwealth Fund has published a new report looking at state trends in health insurance premiums and deductibles from 2003 to 2010.

The upshot: employees' annual share of premiums increased by 63 percent over those 7 years (and premiums themselves rose 50 percent as well). In Washington state, for example, family health insurance premiums rose from $9,212 to $14,188 during that period. That's a 54 percent increase.

Not surprisingly, given stagnant incomes in recent years, premiums as a percentage of median household income during that time increased dramatically. In 2003, only a single state (West Virginia) had average premiums above 20 percent of median household income. Today, about half the states are in that category.

For a look at premiums (single and family) by state, here's a good interactive map from the report.

The report continues:

 At the same time, per-person deductibles doubled in large, as well as small, firms.

If premium trends continued at that rate, the researchers predicted, "the average premium for family coverage will rise 72 percent by 2020, to nearly $24,000."

Federal health care reform, passed in early 2010 but taking effect largely in 2014, offers the hope of some savings, the report says:

Health reform offers the potential to reduce insurance cost growth while improving financial protections. If efforts succeed in slowing annual premium growth by 1 percentage point, by 2020 employers and families together would save $2,161 annually for family coverage, compared with projected premiums at historical rates of increase.

Colorado couple ordered to stop selling insurance in Washington state

A Colorado couple, Robert W. Ramlet and Patricia Ramlet, has been ordered to stop selling insurance in Washington state.

In 2006, the two sold two life insurance policies in Washington state without being licensed as insurance agents here.

Insurance New - Friday, November 29, 2013

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

• A great article on the need for provincial regulation of towing in Ontario and the industry's connection to fraud.
• DirectAuto Insurance in the U.S. has rolled out new mobile capabilities, including a pay-by-text feature and an app that evaluates driving habits.
• Renault has developed a low-cost, part-time self-driving car that could go on sale as early as next year - the automated feature will only work at speeds under 19 mph and in areas where no pedestrians or bicycles are allowed. It's a start.
• The first public road test of Nissan's Autonomous Drive technology on a Japanese highway was a success.
• Though motor vehicle deaths have been declining, a recent study found that deaths in pedestrians and cyclists are increasing as a result of distracted driving.
• Electric vehicle charging stations are now available at five GO stations.

Let. It. Go.

Longtime readers may recall the sorry saga of California insurance agent Glenn Neasham, whose conviction on apparently trumped-up fraud charges was recently dismissed.

Not content to lick her wounds and take the loss as an appropriate repudiation, Deputy Attorney General Hanna Chung is petitioning the California State Supreme Court to reverse the reversal.

Since I'm not a lawyer (nor do I play one on TV), I can't speak to the validity of Ms Chung's arguments. Hopefully, she'll be laughed out of (Supreme) Court; we'll keep you posted as this drags on goes forward.

Is Self-Regulation Realistic, For The Ontario Towing Industry?

The recently released report of the Ontario Automobile Insurance Anti-Fraud Task Force recommends province-wide regulation of the towing industry, which has strong support from the insurance industry. The Task Force would like to see a province-wide licensing scheme administered by an Administrative Authority (AA).

 There have been a number of attempts to review and/or regulate the cost of towing and storage of vehicles in Ontario over the past decade, several of which I had some involvement. In 2003, the government attempted to introduce a $300 cap on towing and storage costs through a revision to the Ontario Automobile Policy (OAP 1) but that was abandoned out of concern that consumers would be responsible for any excess charges.

In 2004, the Ministry of Finance and the Financial Services Commission of Ontario (FSCO) formed a working group with representatives from the government, insurance industry, police forces and towing industry to address some of the abuse reported by consumers and insurers. There was no consensus coming out of the working group and it was eventually abandoned.

On June, 4, 2008, MPP David Zimmer introduced Bill 87 which would have provided for the self-regulation of the towing industry in Ontario. The bill never proceeded beyond second reading. David Zimmer reintroduced the bill at Bill 147 on December 10, 2010 but it also failed to proceed beyond second reading.

History of Administrative Authorities 

 The key to the Task Force’s recommendations on regulating the towing industry is the formation of an AA which would act as the regulator. Personally, I have some concerns with these recommendations.

Administrative Authorities are not new to Ontario. In 1976, the government established its first AA when Board of Funeral Services was established by the Funeral Services Act to regulate funeral services. As well, Tarion (formerly the Ontario New Home Warranty Program) was established by the Ontario New Home Warranties Plan Act to administer warranty coverage to new homebuyers.

In 1996, the Safety and Consumer Statutes Administration Act came into effect which allowed for the creation of a number of AAs. Between 1997 and 1999, the government delegated authority and responsibility for day-to-day regulatory administration to the following sectors in accordance with this Act:

• Motor Vehicle Dealers and Salespersons → OMVIC 
• Real Estate Salespersons and Brokers → RECO 
• Travel Retailers and Wholesalers → TICO 
• Electrical inspections and safety → ESA 
• Safety in 4 sectors: boilers & pressure vessels, amusement & elevating devices, hydrocarbon fuels, upholstered & stuffed articles → TSSA 

  In 2000, the VQA Ontario was designated as the not-for-profit corporation responsible for administering the Vintners Quality Alliance Act.

On May 1, 2010, the TSSA became a statutory corporation with enhanced accountability requirements upon the proclamation of the Technical Standards and Safety Statute Law Amendment Act, 2009.

 The Retirement Homes Act, 2010, established the Retirement Homes Regulatory Authority (RHRA) and sets out its role, responsibilities and powers with respect to care, safety standards and other requirements applying to licensed retirement homes in Ontario with oversight by the Ontario Senior’s Secretariat.

Key objectives of this model in the 1990s was to reduce government expenditures, deliver services more efficiently, avoid unnecessary regulatory burden, and harmonize regulatory regimes across jurisdictions in response to mounting trade pressures.
 

Administrative Authority	Type	Evolution
Technical Standards and Safety Authority (TSSA)	Public safety	Responsibility transferred in 1996 from the Technical Standards Division of the Ministry of Consumer and Commercial Relations
Electrical Safety Authority (ESA)	Public safety	Responsibility transferred in 1998 from the Electrical Inspection Division of Ontario Hydro
Ontario Motor Vehicle Industry Council (OMVIC)	Consumer protection	Responsibility transferred from the Ministry of Consumer and Commercial Relations
Real Estate Council of Ontario (RECO)	Consumer protection	Responsibility transferred from the Ministry of Consumer and Commercial Relations
Travel Industry Council of Ontario (TICO)	Consumer protection	Responsibility transferred from the Ministry of Consumer and Commercial Relations
Tarion Warranty Corporation	Consumer protection	Evolved from the New Home Warranty Program that was originally established in 1976
Board of Funeral Services (BOFS)	Consumer protection	Formed in 1976 but predecessor organization established in 1914
Vintners Quality Alliance Ontario (VQAO)	Consumer protection	Established by Ministry of Consumer and Commercial Relations in 2000

  Will the AA model work for the towing sector? 

The Ministry of Consumer Services has oversight responsibility for eight of the authorities currently in operation. With the exception of the VQA sector, the government regulated the other seven sectors directly. These sectors were selected for delegated responsibility because they were mature sectors which had demonstrated their ability to work in partnership with government, and had a track record for addressing and resolving consumer and public safety concerns. With exception to the VQA sector, there were pre-existing statutory standards in all of these sectors.

The first problem with a proposed Towing AA is that there is no existing provincial public authority is currently regulating the sector. There are only municipal authorities that issue business licences but they do not really regulate the industry. Therefore, there is no regulatory expertise or knowledge to transfer to the private sector.

In addition, the towing sector does not have the maturity or a track record in dealing with consumer complaints and public safety issues. Representatives from the towing sector (Provincial Towing Association (Ontario) and Ontario Recovery Group) met with the Task Force to express support for self-regulation but their enthusiasm will not make up for the lack of regulatory expertise.

The Task Force reported that participants repeatedly complained that towing operators are engaged in organized or premeditated auto insurance fraud. There were concerns expressed regarding road safety concerns, insufficiently trained employees, improper equipment, a lack of clarity around fees and the illegal referral fees. Industry representatives reported that they have been unable to deal with corruption in their industry and legitimate operators have become so frustrated that they have begun to leave the industry. This does not sound like an environment where you can create a self-regulatory body.

I’m not suggesting that an AA model for the towing sector can never happen. To its credit the Task Force points out that there is a need for capacity-building in the towing industry. I just think it would be irresponsible if it were to happen in the near future.

So where can we go from here? 

The current patchwork of municipal licensing systems is not protecting the public. The Task Force is correct that a province-wide regulatory framework needs to be established. I believe the first step to creating a Towing AA is to establish a regulatory authority within government to develop and enforce industry standards. If the government is contemplating creating a government-run regulatory system for treatment and assessment facilities then it should also consider creating one for towing operators. Only after a regulatory system has been established should consideration be given to transferring it to the private sector. This will provide the towing industry and its associations time to develop some experience in working with the government, working with consumers and establishing some credibility.

Giving Thanks

Insurance News - Thursday, November 28, 2013

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

• A great article on the need for provincial regulation of towing in Ontario and the industry's connection to fraud.
• Who has the most accidents per km of driving? No it's not teens, it's actually seniors. 
• Insurance telematics have evolved into 4 different models: the silent witness model, the simple measurement model, the behaviour-based model and the context information model. 
• The insurance industry is divided on who will choose telematics - good drivers (to save money over a classic policy) or bad drivers (to improve experience and get back to a classic policy).
• One of the offshoots of Obamacare is that e-billing is spreading to more insurance lines in the U.S.
• Another Google car has been involved in a collision but again Google says the car was being driven manually.

Avoiding the Thanksgiving ObamaTax Rush

So it's come to this:

"White House officials, fearful that the federal health care website may again be overwhelmed this weekend, have urged their allies to hold back enrollment efforts so the insurance marketplace does not collapse under a crush of new users."

Which reminds me:

Did y'all see that plea from Amazon to take it easy on the orders come Black Friday?

Musta missed that one.

Thanksgiving Risk Parade

There's wild turkey (for the roaster, fryer or smoker) and then there's Wild Turkey (for the shot glass or the tumbler). While most of us are quite aware of the risks involved in preparing the former (salmonella, fire, etc), we shouldn't overlook the risks inherent in serving the latter.

Margarita (heh!) Tapia, of the IIABA tips us that "party hosts need to understand their responsibilities when inviting others into their homes and serving food and drinks."

That includes potent potables, of course, but also food that your guests may bring, or that you have catered in. The organization reminds us that:

"Even if food was prepared outside your home by a caterer, another guest, a local deli or the neighborhood pizza joint, YOU could be held liable if someone becomes ill from consuming it on your property. Make sure that you check food and don’t put anything out that you suspect may be undercooked, spoiled or contaminated. Use only reputable food purveyors. Follow proper food-handling, heating/cooling and storage recommendations. When in doubt, throw it out."

In that vein, Allstate has provided a useful "infographic" about some of the risks associated with Turkey Day Mayhem:

[Click to embiggen]

Allstate also notes that " an average of 67,500 homeowners insurance claims occur during the holidays, and some threats to home security and safety rise significantly during the holiday season."

Not to mention (but of course we will), "there are three times more turkey fryer claims during the holiday season than any other time of the year." And the "median cost for turkey fryer-related claims is almost $29,000."

That's some expensive bird.

Have fun tomorrow - but be careful, too.

Insurance News - Thursday, November 27, 2014

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, November 27, 2014:

• John Tory joins the Competition Bureau in speaking out against Toronto’s move to file an injunction in court against Uber ride-sharing service.
• A Toronto undercover investigation concluded that there are “real and urgent” safety problems with Uber, including issues with insurance coverage, driver screening and vehicle inspections.
• Meanwhile in California, ride-sharing service drivers from companies such as Uber and Lyft will soon be able to buy an amendment to their auto insurance coverage that will provide them with protection from the moment that they sign on and are waiting for a call to pick up a rider,
• Experts claim driverless cars could add $1.3 Trillion to U.S. economy from reduced accidents and productivity gains.
• Of course driverless cars could also open up employers to steal the last of your free time.
• Fraud has caused ridiculously high auto insurance rates in Detroit which now threatens the city's economic recovery by making it expensive for residents to stay in the city and discouraging newcomers.

Health Co-Ops Never Had a Chance

"[T]hese co-ops, started as a great hope for lowering insurance costs, are already in danger, says the Washington Post." (Tip o' the hat to John Goodman at NCPA.)

But wait.  I sense something, a presence I've not felt since . . .

. . . since January 4, 2013:   "Turns out, the CO-OPs are now taking their turn under the bus"

. . . or since January 7, 2013:  " Notwithstanding this generous, reckless federal plunge into more “investments” it does not understand, CO-OPs will encounter harsh reality . . .  I think the appropriate taxpayer response to CO-OPS, is “Uh-oh”."

. . . or since  June 12, 2013:  "[T]he Freelancers’ Union which in 2012 was granted $341 million in Federal loans to set up an insurance CO-OP under Obamacare  . . . says that Obamacare’s onerous regulations and taxes will burden its innovative health insurance model for the self-employed with enormous added costs.”  In other words, Freelancers’ problems are the same Obamacare problems that businesses and other insurance companies have been warning about for the past four years.   They were neither unpredictable nor unexpected."

Oh nowwww I get it.  The presence I sense is yet another impractical Obamacare Great Hope evaporating into thin air under the unforgiving sun of reality (and, lest we forget, the presence of yet more billions of taxpayer dollars evaporating along with it).

Cavalcade of Risk #197: Happy Thanksgiving edition

Louise Norris hosts a very special Thanksgiving edition of the Cavalcade. She's done a terrific job of adding her own thoughts and context to each post. Kudos, Louise!!

Direct practices lose 35 percent of enrollees, raise fees 23 percent

Each year, the OIC reports to the Legislature on the status of direct health care practices in Washington. A direct health care practice is an arrangement where a health care provider charges a patient a set monthly fee for primary health care services. The provider doesn’t bill the patient’s insurance for the services and only provides certain medical services in the office.

The December 2014 report contains data from July 1, 2012 through June 30, 2014, which is two fiscal years’ worth of information.

Some highlights from the report:

• As of June 30, 2014 there were approximately 8,658 direct-practice patients in Washington at 29 practices around the state. Patient participation decreased by 35 percent from fiscal year 2013. Four new practices opened in Seattle, Camas and Centralia. Three practices closed in Spokane and Lakewood.
• Monthly fees at direct practices ranged from $25 to more than $200. The most expensive was $910 per month. The average monthly fee weighted by the number of patients was $150.78, a 23 percent increase from fiscal year 2013.
• The OIC received no consumer complaints regarding direct patient practices in fiscal year 2014.

The Affordable Care Act now requires health insurance plans to cover 10 essential health benefits, which include preventive services and chronic disease management. It also puts a cap on deductibles that consumers pay each year and direct practice fees do not count toward that yearly maximum. In addition, Washington expanded its Apple Health (Medicaid) program and the state’s individual health insurance market grew 30 percent in fiscal year 2014 to more than 327,000 people.

View the full report to the Legislature.

Government Motors Meets Obamacare

Our fleet of company vehicles is due for a major overhaul so today I am out car shopping. I’m looking at several different options because come January the prices of the cars are going up by 40%-80% and the selection of options for the vehicles will become extremely limited.

Lucky for me President Obama is allowing a couple of options to avoid the major aspects of his new car law. There are two options I can choose from. One is renewing my leases early without having the dealership check the mileage and wear and tear. The other is renewing my leases when they are due April 1st but now the dealer has the right to increase my price based on those three criteria. The question is, which option should I choose?

Early Renewal

The current leases expire in April of 2014 but I am able to renew my leases December 1st. The new price allows me to keep the cars that I like while only increasing my price by 8% a month. By extending my leases I have the ability to renew it for another 12 months now, which will carry me through November of 2014.

Renew and Retain

I also have the ability to keep my current lease price, but come April my lease price might change. It could go up quite a bit depending on the mileage and the wear and tear on the vehicles. And I can’t change any of the terms of my leases or I become subject to the new requirements. These new requirements will cause substantial price increases for new vehicles because they'll be required to include free roadside assistance and oil changes; I'll also be forced to purchase options like navigation systems and DVD entertainment units. The worst part is that I have no idea of what the costs will be for keeping my current leases, nor do I know what it will cost me to lease new vehicles.

Decisions, Decisions

As the business owner I have a limited budget and absorbing a large cost hike for the fleet could put us out of business. Since our current leased cars don’t meet the guidelines for vehicles set in March of 2010, I don’t have any choice but to change to the new ones available next year. I can potentially buy time through the early lease renewal program or I can roll the dice until April and hope that my employees have taken very good care of their cars. In that case I could keep my costs lower until April of 2015. My gut tells me to take the safe route and renew my leases with the 8% increase December 1st. At least that way I can budget for 2014. Because after that, all bets are off.

We're looking for a Deputy Commissioner of Operations

We're currently recruiting for a Deputy Commissioner of Operations. This in an executive level exempt position that manages 35 employees in the following areas: Human resources, budget and fiscal, facilities and telecommunications, information technology and public records.

The successful candidate will be an active member of the Executive Management Team (EMT), setting the strategic direction of the agency, developing legislative priorities, ensuring fiscal responsibility and creating an inclusive, performance-based work environment.

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

The job is open until Dec. 9, 2014.

How many millions... [UPDATED]

Will lose their current plan? Turns out, those who thought that their employer-based coverage was sacrosanct are about to find out - the hard way - that it's not:

"Almost 80 million people with employer health plans could find their coverage canceled because they are not compliant with [the ObamaTax]"

This comes on top of the 5 million or so currently slated to lose their individual plans.

But remember, if you like your insurance, you can...oh. Never mind!

UPDATE: 80 million is a statistic, perhaps. But one is a tragedy:



[Hat Tip for vido: Ace of Spades]

Insurance News - Tuesday, November 26, 2013

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

• FSCO has revised the OAF 1 – Ontario Application for Automobile Insurance to reflect new data reporting requirements.
• Auto insurance fraud lawsuits continue against Toronto medical assessment centres.
• PEI is considering raising no-fault auto benefit caps including increasing the medical/rehabilitation limit to $50,000, the weekly for income loss limit to $250. They are also considering raising the cap on court awards for pain and suffering for “minor personal injuries” to $7,500.
• The U.S. National Highway Traffic Safety Administration to give green light to self-driving car projects.  Apparently they like what they see in self-driving cars: their potential to operate more safely and fuel-efficiently.
• Meanwhile, U.S. lawmakers are not necessarily on the same page as they expressed a mix of wonderment and concern about driverless cars during congressional hearings.
• Still, 17 states (and Washington D.C.) have considered legislation addressing autonomous vehicles while 4 have already enacted laws.

My new article is up...

At Answers.com:

"Gap Filler insurance plans are a way to help mitigate the additional out-of-pocket expenses one may accrue due to co-pays and deductibles. They are often reasonably-priced, but it's important to compare different plans to see which, if any, fit your particular needs."

Told ya so

As we pointed out nearly 2 weeks ago, it's one thing for Our Betters in Capital City to magnanimously proclaim that, despite what the ObamaTax law actually mandates, "if you like your policy you can keep it." T'is quite another to make that a reality:

"It's one thing if an insurer erroneously cancels your policy... But it's quite another thing when the insurer must cancel an entire policy form"

As we asked then, "[h]ow can the government force carriers to re-file cancelled policy forms, and how do they handle the immediate problem that these plans are unlawful under the ObamaTax?"

Today we learn the answer, and it ain't pretty. Via email:

"Medical Mutual is not able to extend individual plans that do not comply with the Affordable Care Act (ACA) into the New Year, because we have no plans or rates approved by the Ohio Department of Insurance (ODI) for these products in 2014"

I suspect that they're not alone.

Monday Exchange Blues

Submitted by an anonymous reader:

[Click to embiggen]

Your tax dollars at work.

UPDATE: Timing is everything. Here's the latest from Ms Shecantbeserious, courtesy of our friends at Cornerstone:

All brokers – update on changes to ACA Individual Deadlines

INDIVIDUAL ACA ANNOUNCEMENTS – DEADLINE CHANGES

CMS announces extension date for individual sign-up to December 23, 2013

The Obama Administration announced (Friday, November 22, 2013) they are giving consumers an extra eight days to sign up for health coverage that takes effect Jan. 1, 2014.

The Centers for Medicare & Medicaid Services — a part of the U.S. Department of Health and Human Services and the parent of the Center for Consumer Information & Insurance Oversight — said it will push the individual coverage enrollment deadline to Dec. 23, from Dec. 15.

ALSO

HHS announces one-month delay for start of ACA sign-ups for 2015
HHS plans to delay by a month the start of next year's Affordable Care Act enrollment period for coverage in 2015 to give insurers additional time to set premiums and evaluate their experiences in 2014. Instead of the previously announced window of Oct. 15 to Dec. 7, 2014, enrollment for the 2015 plan year would start Nov. 15, 2014, and end on Jan. 15, 2015.

You really can't make this stuff up.

 

A simple solution for one of ACA's many problems...

Everybody that I've led through a CoveredCA application stumbles when they get to the subsidy section.  The problem lies in the estimation of next year's income.  The law asks you to predict the future and that's not possible to any degree of accuracy.  California addresses the issue by requiring enrollees to login and update their information every time their income changes...a requirement that'll be forgotten (or ignored) by most people.  I assume other states have a similar requirement.

My suggestion...Change the law to base next year's subsidy on the current year's income.  If someone is signing up in the October through December enrollment period, they should be able to estimate year end income far more accurately than next year's income.  And if you're signing up after January 1, the books are already closed.  A (not-so) simple change will eliminate a lot of surprises when tax returns are completed and people find out they under/over estimated their subsidy. 

$58, same as in town

In which we offer these two ObamaTax stories. Any perceived relationship is purely coincidental:

"Dana Howard, the deputy director of California’s Healthcare Exchange program ... revealed that enrollment counselors are paid $58 for each individual they successfully enroll in the California’s insurance exchanges."

And:

"The Affordable Care Act has been touted as a boon to America's self-employed ... That includes the independent contractors at the Moonlite Bunny Ranch, otherwise known as prostitutes."

Commissioner Kreidler on health care reform, the individual mandate, and rate transparency

Commissioner Kreidler was interviewed by host Austin Jenkins on TVW's Inside Olympia program this morning to discuss health care reform, health insurance costs, and his successful push to release confidential rate information from health insurers.

On the federal Affordable Care Act: "While this act is not perfect, it is the best thing that we have going right now to get our hands around a very serious problem for this country of ours...People are really being hurt...The current system is broken."

On the individual mandate to buy health coverage, starting in 2014: "If you have people opting in when they're sick and out when they're well, it just plain won't work."

On health care exchanges: "It's going to be a lot like online shopping that a lot of people are familiar with. And that's going to be a huge advantage over what we have now."

Insurers Trying To Keep Claimants in the MIG Will Need Medical Reasons Before an IE

Insurers may be in a "Catch 22" situation in efforts to keep claimants within the limits of the Minor Injury Guideline (MIG).  Many insurers have been routinely sending claimants for an insurer examination (IE) to determine if a claimant has a minor injury and should be treated under the MIG. But according to a recent FSCO arbitration, an insurer needs to provide "medical reasons" for denying a benefit and requesting the claimant attend an IE.  The SABS require a benefit denial to trigger an IE needed to determine if the claimant belongs in the MIG but also medical reasons which insurers normally obtain through an IE.

In the decision, Kadian Augustin and Unifund Assurance Company [FSCO A12-000452] the arbitrator considered whether or not Ms. Augustin is allowed to dispute the insurer’s denial of treatment because she failed to attend an IE.  In order to make a determination the arbitrator needed to consider whether or not the IE was compliant with the SABS.

Unifund wanted to send Ms. Augustin to an IE to determine if she was within the MIG after receiving a treatment plan that, if approved, would take her out of the MIG.  Unifund provided the following notice to Ms. Augustin in their Explanation of Benefits: “Based on our review of the medical documentation provided to date, we require an assessment by an independent medical assessor, in order to determine if your impairment is predominantly a minor injury as described in the Minor Injury Guideline. Please see the Notice of Examination for further details.”

The arbitrator found that this explanation did not comply with section 38(8) of the SABS because it did not state that Unifund “believes” the MIG applies, or why.  Nor did it state the “medical reasons and all of the other reasons why the insurer considers any goods or services, or the proposed costs of them, not to be reasonable and necessary.  The arbitrator noted that it provided no reason, medical or otherwise, explaining why it refused to pay the benefit.

Health care providers have been complaining for some time that benefit denials often to not come with proper explanations regarding the reason for a denial.  The government has amended these provisions several times to make it clear that the claimant is entitled to a proper explanation.  Now an arbitrator has ruled on the wording.  The problem is that no one knows what explanation would satisfy an arbitrator.  As well, the arbitrator failed to reconcile that the purpose of the IE is to collect medical information and assist in making entitlement decisions.

The decision can be found here.

Additional flood warnings in WA

After overnight rain in parts of the state, the National Weather Service has issued another flood warning, including:

The Nooksack River at North Cedarville (Whatcom County)
The North Fork of the Stillaguamish near Arlington (Snohomish County)
The Deschutes near Rainier (Thurston County)
The Chehalis at Porter (Grays Harbor County)

Minor flooding is expected at some of those locations today or tonight. The Chehalis River at Porter was close to flood stage at 8:45 this morning.

See the link above for details.

Update: (11:41 a.m.) Another warning's been issued, including some other area rivers. The upper reaches of most rivers crested this morning or will crest this afternoon, with crests moving downstream through Thursday.

My new article is up...

At Answers.com:

"As with any insurance policy, a Critical Illness plan is a risk management tool. In this case, the risk is that one may suffer a major, life-threatening illness or condition and need additional funds to pay for unexpected costs associated with it."

Ontario Automobile Insurance Anti-Fraud Task Force Releases Their Final Report

The Ministry of Finance has released the final reportof the Ontario Automobile Insurance Anti-Fraud Task Force outlining 38 recommendations, many of them will expand the power of FSCO, the province’s insurance regulator.  

The report confirms that fraud is a substantial problem in Ontario despite the fact the Task Force was unable to accurately quantify how much it costs policyholders.  The report indicates that the public is aware that fraud is a problem but calls for educating consumers so they can better recognize and avoid fraudulent activity.  In addition the report calls for greater public disclosure on the part of insurers, provincial-wide licensing for the towing industry and licensing health care and independent assessment facilities.  My report to the Task Force on licensing heath care and independent assessment facilities was also released by the Ministry of Finance.

There is a considerable expansion in responsibility for FSCO proposed by the Task Force.  In recognition of the challenge that the implementing the recommendation will present FSCO, the Task Force is recommending that the governmentt should ensure that government-wide hiring constraints do not delay or prevent the FSCO from acquiring necessary resources to carry out an expanded mandate.

In addition, the Minister of Finance should, at an appropriate time, commission an independent review of how well FSCO is carrying out its new responsibilities.

An Early Gift From The Obamacare Clan

After (or in spite of) all the "fumbling" and "glitches" the citizens of Obamanation have been

granted a gift in the form of an extra 8 days to sign up for your new Obamapolicy.

The Centers for Medicare & Medicaid Services — a part of the U.S. Department of Health and Human Services and the parent of the Center for Consumer Information & Insurance Oversight — said it will push the individual coverage enrollment deadline to Dec. 23, from Dec. 15.

Benefits Pro

That is 8 more days to try and sign on to healthcare.gov, hopefully without getting booted off or having your personal data compromised.

Or if you are like all of my clients, 8 more days to buy OUTSIDE of the exchange, get a better plan with a broader PPO network and not have to worry about giving out your income and tax information.

Did I mention it only takes 5 minutes to sign up for coverage when you buy OFF the exchange?

No ObamaScrooge here.

Flood warning issued for parts of Lewis, Thurston, Pierce counties

The National Weather Service has issued a flood warning for the:

• Newaukum River near Chehalis (reaching flood stage this evening, continuing through Weds night or Thursday)
• Chehalis River near Doty (this evening)
• Chehalis River at Centralia (late tonight)
• and the Chehalis River near Grand Mound. (late tonight)

"Minor to moderate flooding is expected along the Chehalis and Newaukum Rivers beginning this evening," the weather service says.

In addition, a flood watch remains in effect for the lower reach of the Chehalis River in Grays Harbor County, where the NWS says flooding is possible starting late Wednesday.

Up to 4 inches of rain has fallen in the Chehalis River Basin during the past 24 hours. Another 2-5 inches is expected from now through Wednesday night. For more details, including specific roads and areas likely to flood, click the link above.

Here's the critical part, from our perspective: Flood damage is not covered under a standard homeowners insurance policy. If you want coverage against flooding -- and your lender may require it if you live in a flood-prone area -- you'll need to buy extra coverage.

For most homeowners, that means going to the National Flood Insurance Program, a federally run insurance plan that's sold by local agents. But the coverage takes 30 days before it goes into effect. Flood season is long in the Pacific Northwest. If you think you're at risk -- and see the red "One-stop flood risk profile" box check your flood risk and get an estimate of premiums -- definitely consider flood insurance. And don't delay.

Update: (12:02 p.m.) A new alert has been issued for minor flooding along the Puyallup River near Orting and the Deschutes River near Rainier.

Two warranty companies ordered to stop selling in Washington

We issued a cease and desist against Charter Warranty Services of Detroit, MI and TracGuard Services of North Miami, FL, ordering both to stop selling protection products in our state without a license.

Both companies were selling motor vehicle service contracts and protection products guarantees but had not registered with us. In Washington state, all motor vehicle service contract and protection product providers must register with our office.

If they fail to do so, they're required to get a certificate of authority to act as an insurer and get an agent or producer license in order to sell their products.

Don't recognize these two companies, but still wondering if you should get a warranty on your next big purchase? We can help. See if the company is registered before you buy a policy.

And consider these helpful tips on negotiating a price and what to ask before you buy.

Some Unusual Comprehensive Claims

In Ontario comprehensive coverage is optional and pays for the cost of repairing or replacing your vehicle up to the actual cash value if it is damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, a natural disaster, or a riot or civil disturbance.  Just about everything that isn't the result of a collision.

I thought I would share some photos of unusual comprehensive claims - no hailstones or falling trees here.  No one was injured in these incidents.

  

Cavalcade of Risk #197: Call for submissions

Jay Norris hosts next week's Cav. Entries are due by Monday (the 25th).

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

You'll need to provide:

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

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

What's the rush?

Or to put it another way, "if you like your accounting rules, you can keep your accounting rules."

Or maybe not.

As we've been saying, the HC.gov train-wreck and the "Keep Your Policy" debacle are only the two most visible manifestations of the ObamaTax. Here's another (or three) to keep you up at night.

Remember the other day, when we noted that Ms Shecantbeserious and her crew still hadn't finished building the website? Well, they also haven't quite gotten around to figuring out the various ObamaTax accounting rules:

"Insurance regulators are just starting to figure out the accounting rules for a core Patient Protection and Affordable Care Act component – a collection of three PPACA risk management programs."

Yes, you read that right - three (3) rules that involve hundreds of millions of your dollars, slated to be shoveled into the hungry maws of insurance carriers as they try to figure out who's paying for what. Two of them are supposed to be temporary [ed: suuuure], the other's supposed to provide a sort of insurance backstop for carriers who get stuck with more than their fair share of "undesirables" (that would be anyone who actually buys an ObamaPlan, methinks).

Topping it all off, the agency responsible for providing guidance on these rules hasn't.

I'm beginning to suspect that this whole program may not be well thought out.

A Modest Increase...

I was just looking over the list of my Anthem ACA plan replacements and came across this gem...

Current Plan - Clear Protection Plus 5000   $548/mo.
Replacement Plan - Anthem Core DirectAccess - CAAE  $1563.63/mo.

That's right.  Their family premiums are going up by almost 300%...over $1000 per month.  

They'll be uninsured after the first of the year.  But if they could afford coverage, at least it wouldn't be "substandard".

Job opening: Senior market analyst

We're looking for a senior market analyst in our Tumwater office. Here's the job description, including salary, responsibilities, and timeline. The deadline for applying  is just before 5 p.m. on Monday, Dec. 3.*

Also, we still have an opening for an Information Technology Specialist 4 (.NET developer).

*Update: The deadline has now been extended to Dec. 17, 2012.

Wind warning for tonight

The National Weather Service is predicting gusts of up to 60 miles per hour in parts of Washington state tonight, including San Juan County, western Whatcom County, western Skagit County and the Admiralty Inlet area.

The day after windstorms, we often get a wave of calls from people with toppled trees, debris-damaged cars, etc.

To help, we put together this list of typical questions, including:

Am I covered if my car was damaged by falling tree limbs?
My yard is covered with branches and debris. Will my insurer pay the cleanup costs?
My boat sank from strong winds. Am I covered?
My business' awning was damaged by the wind. Can I file a claim?

Be careful out there.

What should I know about travel insurance?

If you are getting ready to travel for the holidays, here are some things to consider about travel insurance before you purchase it.

Many travel companies—airlines, cruise lines, resorts—offer travel insurance that will refund most or all of the cost of the trip in certain circumstances. Policies typically cover things like trip cancelations due to illness, civil unrest, job loss, or the transportation carrier going out of business. They’ll also pay for fees incurred by missed connections and delays; baggage damage or loss; medical expenses incurred by an injury or illness while traveling; emergency evacuation; car rental damage; and accidental death.

Before you decide whether to purchase travel insurance, you should consider:

• What your medical insurance covers when you travel.
• What your homeowner or renter insurance covers in the event of lost or stolen belongings.
• What your life insurance policy covers in the event of accidental death while traveling.
• The cancelation policy is for the travel insurance.
• Read the policy's fine print. Some don't cover certain activities such as hang-gliding, bungee jumping or other activities. Some also exclude certain pre-existing conditions from the medical coverage they offer.
• You should also make sure the travel insurance company is licensed to sell insurance in Washington.

Read more about travel insurance on our website.

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

One computer, one camera, fake invoices...and four different insurance claims

A Renton man has been sentenced to jail plus community service after submitting thousands of dollars in bogus claims for a $4,900 laptop, and a $3,200 camera.

Between December 2010 and September 2011, Michael Tran Lai, 32, filed multiple claims with four different insurance companies claiming the loss of the MacBook Pro laptop and Nikon camera. He claimed they were stolen from a car, or lost in luggage while travelling, or stolen from his hotel room. The invoices turned out to be fake.

He also filed multiple claims for the same accident damage to his Lexus.

Laid was sentenced Nov. 16 to 10 days in jail, 160 hours of community service, and $854 in court fees and costs. A restitution hearing is also pending.

Insurance News - Thursday, November 21, 2013

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, November 21, 2013:

• A product that Travelers believes can win back the auto insurance sector from direct writers. 
• Michigan poised to approve self-driving vehicle testing and limiting the liability of auto suppliers and manufacturers of vehicles that are modified for testing. 
• MetroMile in Washington state plans to allow drivers to insure cars by the mile - a new variant of “pay as you drive.”
• CCIR has released its final position paper on e-commerce.
• Here’s how California is to have saved residents $100 billion on auto insurance.
• No surprise, passengers point to their spouses as being “the most annoying drivers” according to a recent survey.

Tips to avoid a turkey-fryer fire...because here's what that looks like

The turkey-fryer disaster video is a YouTube holiday staple, and it's not surprising. Oil burns really well. Turkeys are big.

The biggest mistake seems to be this: overfilling the pot and plunging a big turkey in while the flame is lit, causing a lot of oil to splash over the sides and, yup, ignite.

Bigtime.

  

And sometimes, this happens on a deck or close to a house.

So if you must fry your turkey, here are some key tips:

• Fry outside, away from the house.
• Do not overfill the pot with oil.
• Properly thaw the turkey.
• Turn off the flame before adding the turkey.
• Use the grappling-hook thing to lower the turkey in carefully (and not splash oil).
• Be careful of oil splattering on your arms. Splashed boiling oil can cause horrible burns.
• And -- if in doubt, review video No. 2 above -- keep a grease-approved fire extinguisher handy.

Bonus round: Actual turkey-fryer-mishap-victim William Shatner reviews these points in his cautionary video "Eat, Fry, Love."

What's in a name?

So he was for ObamaCare before he was agin' it?

Health Wonk Review: Pre-Thanksgivukkah edition

Here's an interesting fact about this particular edition of the venerable HWR: it won't happen again for 78,000 years (at which time Julie will still be looking great, BTW).

How's that, you ask?

This year (2013/5774), the first night of Chanukah falls on Thanksgiving, and that happy (if confusing) confluence of events won't happen again for another 78,000 years. At which time, I certainly hope that the host of that 'Review will be kind enough to link back to this one (hey, traffic is traffic, right?).

So the theme of this edition will be freedom and gratitude, which also turns out to be the theme of both Chanukah and Thanksgiving (how serendipitous!):

"He is a wise man who does not grieve for the things which he has not, but rejoices for those which he has." - Epictetus

Although we typically limit participants to one post per 'Review, I'm invoking Host's Privilege with our first entry because:

a) Joe Paduda's the Founder of the Health Wonk Review, and
b) These really are a matched set

First, Joe explains why the Healthcare.gov website isn't going to be fixed by the end of the month. Then, he offers a helpful reminder that the Exchange itself is only one piece of a much larger effort.

"The will of the people is the only legitimate foundation of any government, and to protect its free expression should be our first object." - Thomas Jefferson

Longtime HWR contributor David Williams (who's been quoted - a lot! - in the MSM of late - Mazel tov!) explains that, while 'reference pricing' is a good idea, it’s only useful for a fraction of total medical costs and — despite what some observers want you to think-- it's not a great endorsement for the superiority of the free market.

“Make a pact with yourself today to not be defined by your past. Sometimes the greatest thing to come out of all your hard work isn't what you get for it, but what you become for it. Shake things up today! Be You...Be Free...Share.” - Steve Maraboli, Life, the Truth, and Being Free

David Harlow reminds us that, aside from the technological snafus, the slow beginning to enrollment in Obamacare plans shouldn’t be cause for alarm. After all, when Massachusetts health reform was introduced, it took months before folks started signing up in meaningful numbers.

"The unity of freedom has never relied on uniformity of opinion." - John F. Kennedy

My favorite econ-blogger, Jason Shafrin, observes that according to conventional wisdom, rural areas have poor access to advanced specialists. The CW, however, gets that one quite wrong: recent research indicates that access to oncologists may be much better than previously thought due to visiting consultant clinics.

"Let us be grateful to people who make us happy; they are the charming gardeners who make our souls blossom." - Marcel Proust

It is NOT true that Dr Jaan Siderov's hobby is dumpster diving. A top-secret memo from an insurance carrier's CEO just "happened" to fall into his lap. Hilarity, not to mention health business clarity, ensues.

At least, that's his story,and he's sticking to it.

"Those who deny freedom to others, deserve it not for themselves". - Abraham Lincoln

In the classic Doyle/Holmes tale The Silver Blaze, the absence of an event itself provided a critical clue. In Roy Poses' post, the absence of financial records served the same function, much to the chagrin of the president of the Upstate Medical University.

"As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them." - John F. Kennedy

Brad Wright offers a helpful Q&A on the ACA "fumbling" that's currently making the news, offering his own take on why it happened, what other problems we can anticipate seeing, and (perhaps most importantly) how it affects you.

"Everything that is really great and inspiring is created by the individual who can labor in freedom." - Albert Einstein

Something that a lot of folks haven't really thought through is "where are all the new doc's going to come from?" After all, these newly-insured folks will need someone from whom to actually receive care. Over at Wing of Zock, Jim Lewis notes that students just entering high school would graduate from medical school in 2025, and they'll have access to diagnostic and clinical tools likely even unimagined today. But where will they complete their residency training? The answers may surprise you.

 “You pray in your distress and in your need; would that you might pray also in the fullness of your joy and in your days of abundance.” - Kahlil Gibran

Louise Norris has more details on how plans in place today will fare at their next renewal, and predicts that at least a few folks may be pleasantly surprised at what happens to their premiums over the next few years.

“Gratitude is not only the greatest of virtues, but the parent of all others.” - Cicero

This may be my favorite post in this edition. Hospitalist Dr Bradley Flansbaum shares his experience with a naive international medical school graduate that opened his eyes to the benefits of working with folks cut from a different cloth.

“Some people grumble that roses have thorns; I am grateful that thorns have roses.”- Alphonse Karr

Jonena Relth discusses the ridiculousness of President Obama’s recent announcement that insurance companies may now choose to keep their previously cancelled policies. She asks "why would any insurance executive voluntarily choose to do this?" and observes that it doesn’t take a mathematician to see the alligators in this swamp!

"When we lose the right to be different, we lose the privilege to be free." - Charles Evans Hughes

At Workers’ Comp Insider, Tom Lynch discusses an important new report on how the work population is changing, and the challenges that a diversified workplace will pose to workplace health and safety. In particular, the report focuses on how those delivering healthcare and safety services will need to develop cultural competence, new skills and approaches to communicating with populations that have limited English proficiency. It's an interesting perspective on this brave new world of health care.

“Piglet noticed that even though he had a Very Small Heart, it could hold a rather large amount of Gratitude.” - A.A. Milne, Winnie-the-Pooh

Health Affairs' Tim Jost walks us through President Obama's proposal to extend existing policies, and then details the questions it raises, such as state and insurer reactions, the effects on the ACA and the exchanges, and political implications.

"I disapprove of what you say, but I will defend to the death your right to say it." - Voltaire

Also writing about President Obama's "end run" around House Republicans, Maggie Mahar wonders about "the catch." That is, under the proposal, carriers would need to notify their customers about which benefits their existing policies are missing and alert them to other options available in the ACA's marketplaces.

“Acknowledging the good that you already have in your life is the foundation for all abundance.” - Eckhart Tolle

At the eponymous John Goodman’s Health Policy Blog, guest author Greg Scandlen takes a look at the latest trends in consumer-driven healthcare, aka Health Savings Accounts, and the role they'll likely play as the ACA rolls along.

"Liberty means responsibility. That is why most men dread it." - George Bernard Shaw

Anthony Wright notes that, despite the issues with the federal website, California's ACA implementation is on track, with nearly 1/3 of the national enrollment, and now doing 2,000 enrollments a day, enough to meet state expectations. But, he adds, there's more to do.

And now, our own contribution:

 בָּרוּךְ אַתָּה יְיָ אֱלֹהֵֽינוּ מֶֽלֶךְ הָעוֹלָם שֶׁהֶחֱיָנוּ וְקִיְּמָנוּ וְהִגִּיעָנוּ לזְּמַן הַזֶּה

Ba-ruch A-tah A-do-noi E-loi-hei-nu  Me-lech ha-o-lam she-he-chee-ya-nu v'ki-yi-ma-nu vi-hi-gi-ya-nu liz-man ha-zeh.

(Blessed are you, Eternal God, Sovereign of the universe, for giving us life, for sustaining us, and for enabling us to reach this season)

This is a very special prayer, which we offer in times of great joy. It's also recited, along with the "regular" blessing, on the first night of Channukah. I offer it here as a token of my gratitude for the opportunity to host this 'Review, and for the freedom to do so.

Our post for this edition is a guest article from an actual expert in Quality Management, and his thoughts on how easy it might (will?) be to "game" the ACA.

Please join Jason Shafrin on December 5th for the next HWR.

[Hat Tips to Psychology Today, Good Reads and The Quotations Page for the great quotes]