What is the insurance company's role in home repairs?

It’s common for consumers to call us with their concerns about their home repair or home rebuild claims and the insurer's involvement in oversight of the work. The insurer’s duty is to pay according to the terms laid out in the policy. Unless your insurance policy contains a provision, or unless your insurer has given you assurances, that obligates them to manage a covered home repair or rebuild, it is your responsibility to oversee the project with your contractor, and when applicable, your lender.


However, if you using an insurer’s recommended (sometimes called “preferred”) contractor, then you should expect assistance from the insurer in answering your questions about the contractor’s actions and performance.

Read more about homeowner insurance.

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

Year-end LinkFest

Sliding in just under the wire:

■ Given this:

"According to the Obama administration, more than two million people have enrolled in health insurance plans through the federal and state exchanges"

Here's the $64,000 question: How many have actually, you know, paid for their coverage?

Here's a hint:

"[O]fficials could not say how many Americans had actually paid for such coverage."

■ So you say you want a revolution? Best not tick off one of your core constituencies:

"A video advertisement released shortly before Christmas by Out2Enroll, which features four young buff men wearing tight underwear and not much else ... This cynical ad betrays the depths Obamacare advocates will sink to in order to pad their pathetic enrollment numbers”

Ooops.

■ And something else about the ObamaTax really bites:

"Within a few years, private dental care with a trusted and known practitioner may be limited ... The [ObamaTax] requires dental-care coverage for children through age 18. This expansion appears to be a good device for improving healthcare generally. Yet, as private health plans move in this direction, the cost of dental insurance for adults will increase"

Smile!

And all of us at InsureBlog wish you and yours a very Happy New Year!

New car? Call your insurance agent

If you take advantage of a good end-of-the-year deal on a new vehicle, be sure to report it to your insurance company right away, and don’t forget to ask them for a quote for Debt Payoff Coverage. This coverage will pay off the outstanding loan balance if your vehicle is destroyed in a covered claim and its current market value is less than your outstanding loan. Your agent and insurer can answer your questions and provide more detail on how the coverage works.

Learn more about auto insurance in Washington state.

Insurance statistics in Washington state

Each year, the Insurance Information Institute, an industry-backed research group, compiles data on the insurance industry in each state.

From this year's Washington edition:

• Number of people working in the insurance industry in Washington state: 49,445.
• Their payroll: $3.2 billion.
• Premium taxes paid: $406 million
• Premiums: About $19 billion.

The report includes a lot of other information, including details about which companies write the most insurance, losses incurred, etc.

FSCO Releases Standard Benefit Statement Form

Another anti-fraud measure is being introduced by FSCO effective September 1, 2014.  

Recommendation #17 of the Anti-Fraud Task Force recommended that insurers itemize the list of invoices they have received when they provide a benefit statement to a claimant every two months.  Ontario Regulation 14/13 amended the SABS to include a number of changes recommended by the Task Force including providing the Superintendent with authority to issue a standard form that insurers must use when issuing bi-monthly benefit statements.

The Superintendent has now released the Standard Benefit Statement form that insurers must use. 

Insurers have eight months to perform the necessary system and operational changes in order to begin producing Statements beginning September 1, 2014. 

 

 Subsection 64 (2) of the SABS authorizes delivery of Statements by multiple methods, e.g., by ordinary mail, or by email if the claimant has agreed to delivery by email.

 

The new form can  be found here.

Insurance News - Tuesday, December 31, 2013

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday, December 31, 2013:

• The NAIC reports that New Jersey had the highest auto insurance rates in 2011 with average premium of $1,302.  FSCO reports that the average premium in Ontario in 2012 was $1,551.
• OSFI releases new draft Minimum Capital Test guideline for property and casualty insurers.
• Manitoba Public Insurance says its fraud investigations saved ratepayers $8 million last year.
• Michigan becomes the 4th state to approve self-driving car research on public roads after California, Nevada and Florida. 
• New Hampshire increases speed limit on interstate highway to 70 mph.

Important change may affect business owners’ insurance

Business owners carry commercial insurance policies to protect their financial interests in their property and to cover their liability arising out their business operations. One of the important liabilities that is covered is in the event that a business is sued. The typical commercial insurance policy includes a clause called “duty to defend,” which means the insurance company is required to defend the business if it is sued and it will pay the associated legal costs. However, some commercial policies are being changed to require businesses to repay legal defense costs if the insurer later determines a claim is not covered.

How will you know if your insurance company will require you to repay legal costs? Read your policy or talk to your agent , broker, or with the insurer. Insurers may be adding the clause to new policies or to renewing policies, so it’s important to know what your policy says.

It’s also important that you promptly report lawsuits to your insurance company. Reporting this information to the insurer too late can impede the insurer’s ability to defend your business against the lawsuit. 

More information:

• Read more about the duty to defend and repaying legal costs.
• Who needs business insurance?  
• Things to consider before buying business insurance.

Questions? Contact our consumer advocates online or at 1-800-562-6900.

Insurance News - Tuesday, December 30, 2014

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

• Bill 15 changes to prejudgement interest calculations will become effective on January 1, 2015.
• Many ride-sharing drivers are perplexed by the mixed messages that they receive and therefore opt for silence when it comes to informing their insurers. The situation is becoming problematic as ride-sharing programs expand and drivers are having accidents.
• As Uber collects a mountain of data from its ride-sharing app, it is very likely that the information will be used to expand into services, such as moving goods not just people.
• Once you get passed the rhetoric, what has become clear is that Uber has exposed flaws in taxi services in Canadian cities. Consumers look forward to reforms.
• California’s Department of Motor Vehicles will miss a year-end deadline to adopt a new set of rules for driverless cars and other cars of the future because there’s still no certainty that driverless vehicles are safe.

Year-end chat with DOI

In an InsureBlog exclusive, we present a year-end wrap-up of some of the ACA-related issues being dealt with by the Ohio Department of Insurance. Public Information Officer Robert Denhard was kind enough to answer some of our questions:

What are you hearing from insurers regarding receiving data on the back-end that allows individuals to actually pay for insurance?

We are hearing there are still problems but that the situation is better than it was. Either way, we're concerned about any impact on consumers if information is still wrong come Jan. 1.

Have you had any feedback from carriers about missing/incorrect 834's? What are they telling you?

Anecdotally we are hearing that there continue to be issues that need worked out.

How is ODI planning to handle the continuous influx of new plans that carriers will have to submit in order to stay within the narrow parameters of actuarial value? That is, since this will require plan changes each year going forward?

We will work with companies as we did last year to review plans as necessary.

With so many folks in the individual market opting to keep their plans until December 2014, what impact do you think that will have on 2015 Exchange rates? 

It is too early to try to predict rates since we do not even know yet what enrollment will ultimately look like and what the risk composition of those enrollees will be.

We’ve had a lot of questions about Navigators. How many Navigators have actually been certified in the state of Ohio?

Information about the number of certified navigators is available here [ed: that takes you to the Ohio Agent Locator page, from which Navigator information is available. At the time of this post, there are but 70 for the entire state].

Has ODI had any (many?) complaints about Navigators? If so, what kinds of issues have been raised?

We have not received any complaints about navigators.

This seems to be an issue at the national level, would be interested to know: how many Medicaid sign ups in OH vs Exchange plans? That is, how many have (been) enrolled in Medicaid as opposed to signed up for actual insurance policies through the Exchange?

A total of 5,672 people had signed up for the exchange as of Dec. 1, according to the U.S. Department of Health and Human Services (HHS). You will have to check with the Ohio Department of Medicaid for their enrollment numbers.

Finally, do you have a sense of the percentage of agents who’ve been Marketplace certified?

Agents who are marketplace certified is information officially maintained by HHS.

Thanks, Robert!

Lynnwood auto repair shop charged with insurance fraud

A Snohomish County auto repair shop has been charged with insurance fraud after charging for repairs it didn't do and parts that it never installed.

Northwestern Collision, of Lynnwood, was charged Dec. 14 in Snohomish County Superior Court. Arraignment is set for Jan. 9.

In 2009, Farmers Insurance investigators inspected 11 vehicles that had been repaired by the shop between 2007 and 2009. Of the 11, 10 "had substantial and specific" deviations from the repair estimates that Farmers had agreed to.

Among the problems: parts missing and not replaced, repairs not performed, and repairing items that were supposed to be replaced.

On Dec. 8, 2010, officers from the state insurance commissioner's Special Investigations Unit, the State Patrol and the Snohomish County Sheriff's Office served a warrant at the company's Lynnwood office. They gathered up paper files on 10 of the 11 vehicles.

The records indicated that in some cases, new parts that were supposed to be installed were instead returned to the parts dealer.

The insurer was overcharged nearly $11,000, and had to buy one customer's car, which had been rendered unsafe to drive, for another $15,446.

Happy New Year!

I'm away at the Jersey shore and won't be posting again until January 7th.  I will likely still be using my Twitter account.  Wishing everyone a happy and prosperous New Year and a some NHL hockey.

Willie

Cease and desist order issued to TracGuard Services

The Washington state insurance commissioner's office has told a Florida-based vehicle service contract provider to stop selling unauthorized contracts in Washington state.

TracGuard Services LLC, Jose L. Terry and Alberto Tudela, all of North Miami, have been ordered "to immediately cease and desist from engaging in or transacting the unauthorized business of insurance" in Washington.

Neither the company nor the two men are authorized to solicit or transact insurance in the state. They have not registered as a motor vechicle service contract provider in Washington.

The three have been ordered to notify all Washington residents who have purchased a service contract from them. It also warns that, pursuant to Washington state law, unauthorized insurers "shall remain personally liable for performance of the contract."

Cease and desist order issued to Mill Creek man

A Mill Creek man and company have been ordered to stop selling unauthorized vehicle service contracts.

The order names Scott L. Stevens and RVProtection.net, Inc., both of Mill Creek, Wash. In August of 2010, they sold a consumer a vehicle service contract offered by Genuine Warranty Solutions, Inc.

The problem: Genuine Warranty Solutions, Inc. is not a registered vehicle service contract provider in Washington.

The Dec. 19 order took effect immediately. Stevens and the company have the right to appeal the order.

Did a furry new family member join you this holiday season?

If Santa brought you or someone in your household a puppy or kitten, you may be thinking about purchasing pet insurance.

Pet insurance is relatively new in the insurance world. It helps pay veterinary bills for preventive care or if your pet is ill or gets hurt. Most plans limit coverage to dogs and cats, so you can stop reading now if you got a new bearded dragon or bunny. Most also require a health screening to make sure your dog or cat is healthy; if you have an older pet, it likely won’t qualify for coverage.

Be a smart shopper – make sure the insurer is licensed in Washington, compare plans’ coverage, deductibles, copayments, coverage limits and exclusions.

Read more of our tips on pet insurance.

Aetna fined $1 million for insurance violations

A Connecticut insurance company has been fined $1 million by Washington State Insurance Commissioner Mike Kreidler for multiple violations over several years.

Aetna Life Insurance Company has agreed to pay the fine. The violations include issuing unapproved insurance policies, failing to file legally-required documents with the state and charging unapproved rates.

“All insurers must comply with state law, and most of them do,” said Kreidler. “I hope that this fine and compliance plan resolves these problems with Aetna.”

Among the violations:

• Starting in 2005, Aetna issued health, disability or life insurance policies to more than 4,400 people that did not comply with state law. Among the violations: The policies had not been filed for approval with Washington state.

• Also starting in 2005, the company issued health policies that did not include all Washington state health care mandates. Nor did they describe Washington’s appeals and grievance process, as required by law.

• For more than three years, Aetna continued to sell a health policy that had been disapproved.

• Starting in 2009, Aetna issued other health, disability and life policies that had not been filed with the state. Some of those health policies that did not include all Washington state mandates. Nor did the company have an approved appeals and grievance process for those plans.

• In 2010 and 2011, Aetna issued medical and dental plans for more than 100 Nordstrom retirees that had not been approved by Kreidler’s office, as required by law.

The company has also agreed to a compliance plan designed to prevent similar problems in the future.

Fines issued by Kreidler’s office do not go to the insurance commissioner’s office. The money collected goes to the state’s general fund.

Hasta la VISTA, baby!

Perfect:

"The Obama administration has told Vista volunteers and other AmeriCorps workers that their government-provided health coverage does not measure up to the standards of the [ObamaTax], and that they may be subject to financial penalties unless they obtain insurance elsewhere."

So the government itself can't provide an ObamaTax-compliant plan, and is now dumping, er, providing alternate access to well-meaning victims folks whose only crime was trusting that the government that employed them would have a clue as to what it was actually doing.

Yeah, that wasn't ever going to have a happy ending.

Yak insurance vs. yakking about insurance

Nepalese herders, tired of losing their livestock to snow leopards, have come up with an insurance plan to compensate them when a leopard kills a yak.

The herders pay about $1.50 a year to cover each yak, and are paid about $50 if the yak is killed by a snow leopard.

(On a side note, we're betting that this story is driving a significant amount of traffic to insuranceyak.com, which is a blog devoted not to yak insurance, but to yakking about insurance.)

My new article is up...

at Answers.com:

"When a business must temporarily close its doors due to damage to or destruction of business property, Business Interruption insurance coverage pays for business income lost while the property is rebuilt. This coverage is intended to help keep the company in business while recovery is underway."

Insurance News - Thursday, December 27, 2012

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, December 27 2012:

• New Alabama law and online insurance verification system targets uninsured drivers starting Jan 1.
• EU gender price ban raising insurance costs for women but not giving men corresponding lower rates.
• Progressive Insurance in the U.S. reports a 30% increase in single vehicle claims on New Year’s Day.
• Police across the country struggle as Twitter users reveal impaired driving checkstops.
• Progressive Insurance releases terms for usage-based insurance licensing program.

Overseas ObamaTax Conundrum

So, had a client stop by yesterday with a very intriguing question:

His daughter is a US citizen, but is a full time student in, and permanent resident of, Italy. He is himself Italian, but has lived in the US for over 40 years. He's also retired and on Medicare, so she can't be on his plan.

He came by because he'd been reading about "this new law" that required all US citizens to have insurance, and he wasn't sure what to do about his daughter. She's a citizen, but she doesn't live here, so would she be in trouble? Could we even write a plan for her if it was necessary?

All good questions, and I promised to find the answers. As I explained to him, I am very blessed to have built up quite a large circle of insurance experts over the years, friends and colleagues all over the 58 states on whom I can call for help and advice, and it was to this august group that I threw out my questions.

I was not disappointed; within just a few minutes, Louise Norris wrote back with a link to the relevant IRS notice, which included this Q&A:

12. Are US citizens living abroad subject to the individual shared responsibility provision?

Yes. However, U.S. citizens who live abroad for a calendar year (or at least 330 days within a 12 month period) are treated as having minimum essential coverage for the year (or period). These are individuals who qualify for an exclusion from income under section 911 of the Code. See Publication 54 for further information on the section 911 exclusion. They need take no further action to comply with the individual shared responsibility provision.

So it would appear that she (and her father) are in the clear, at last for now. But one wonders how many other ex-pats and the like will be caught up in the ObamaTax net as the full force of the law comes online next week.