Public Enemy or Navigator?

From the "Told Ya So" Department:

"Health and Human Services secretary Kathleen Sebelius [sic] said today that Obamacare navigators don't need to undergo criminal background checks ... "So a convicted felon could be a navigator and could acquire sensitive personal information from an individual unbeknownst to them?"

And what do you know?

"At least 43 convicted criminals are working as Obamacare navigators in California, including three individuals with records of significant financial crimes."

And that's just in the Golden State. What about the other 57?

In case it's not obvious, here's the issue:

These folks may well be completely rehabilitated, morraly upstanding and good to their mothers. But why would the state take the chance that one or more of these previously convicted felons would see a pretty lucrative opportunity here? And of course, you can't sue the state for foisitn these potential identity thiefs upon its citizenry.

Just another reason to avoid the Exchange - and especially Navigators.

[Hat Tip: FoIB Holly R]

Less than two weeks left to enroll in health plan for 2015

The last day to enroll in a health plan for 2015 is Feb. 15. Coverage takes effect March 1 if you enroll before 11:59 p.m.

If you qualify for a subsidy or Medicaid, you should obtain health insurance through the Washington Healthplanfinder, our state’s health benefit exchange. If you do not qualify for a subsidy, you can buy a health plan directly from an insurance company. Here’s a list of the plans that are available in Washington.

There are ways to qualify for a special enrollment after Feb. 15, including losing health coverage provided by an employer, adding dependents and consumers who had trouble enrolling through Washington Healthplanfinder. Read more about special enrollments.

Need more information?

• Read about understanding health insurance.
• Get application quick tips from Washington Healthplanfinder.

Insurance News - Monday, February 2, 2015

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Monday, February 2, 2015:

• One Ontario broker is suggesting that insurers are blaming everyone else and not taking responsibility for rising claim costs.
• Queen’s Park is looking at ways to curb speed limits in Ontario cities and towns, including lowering the standard from 50 km/h.
• At least 15 family members have to charged in California for being part of an auto insurance fraud ring. Must be the family business.
• California regulator approves filing from Metromile Insurance to provide insurance coverage to Uber drivers.
• Germany will use of a "digitized" stretch of Autobahn to develop domestic alternatives to Google cars.
• Considering human drivers like to speed, will we be satisfied with driverless cars that rigidly follow speed-limits?

Insurance News - Thursday, February 2, 2012

Insurance Benefits Backlog a Nightmare for Accident Victims

Getting hurt in a car crash is bad enough, but for many people in Ontario, it’s only the beginning of a lengthy nightmare.
People turned down for accident benefits by insurance face a wait of as long as two years before their appeals wind their way through the system administered by the Financial Services Commission of Ontario.
read more...
Steps being taken by the Financial Services Commission of Ontario (FSCO) to address the mediation backlog include mandatory settlement blitz days, joint consent to fail mediation, and the introduction of an electronic scheduling process.
read more...
FSCO also released a Request for Proposal on January 16, 2012 with the intention of contracting with up to four dispute resolution companies to provide high volume services to eliminate the file backlog. The companies would need to be able to provide arbitration services in addition to mediation services to prevent a backlog in arbitration cases as files work through the system. The deadline for proposals is February 24, 2012 and contracts are expected to be in place by May, 2012.
read more...
FSCO Releases the Costs of Goods Guideline

The Financial Services Commission of Ontario (FSCO) has released a guideline on the costs of goods. The Guideline was developed as a result of a recommendation by the Auto Insurance Anti-fraud Task Force in its interim report regarding measures that should be undertaken as soon as possible.

The Guideline indicates that where an insurer has agreed to pay for a medical or rehabilitation good under sections 15 or 16 of the SABS, they are only required to pay the lowest retail price available to any member of the general public in Ontario. In the event of a dispute, the onus is on the insurer to provide evidence of the retain price of an item.

read more...

Social Media Sleuthing

Social media has quickly become the foremost activity on the Internet. The explosive growth in user-generated content has been a boon for insurance claims adjusters and fraud investigators. Navigating the social media landscape, however, can be tricky.

read more...

Insurance News - Friday, February 1, 2013

Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Friday, February 1, 2013:

• Thomson, Rogers video on anticipated changes to catastrophic impairment definition.
• In the U.S. auto insurers spends billions on marketing, but fewer drivers switching companies, maybe consumers only care about price.
• Fraser Institute likens Ontario to economic basket-cases as province’s debt climbs.  I guess that means what Greece is to Europe, Ontario is to Canada?
• According to a recent Insurance Market report by Marsh, favourable Canadian P&C market conditions will continue into 2013 with some possible upward rate pressure in second half of the year.

Ontario Court Finds Broker Failed to Properly Offer SABS Optional Coverage

The Ontario Superior Court has dismissed a plaintiff’s action against a broker, claiming the broker did not ‘properly’ offer him the chance to purchase optional income replacement benefits.

In Zefferino v. Meloche Monnex Insurance, the plaintiff was injured on a May 27, 2005 in a motor vehicle accident. The plaintiff had purchased standard coverage including income replacement benefits to a maximum of $400 per week.

The plaintiff alleged that the insurer failed to offer optional income replacement benefits which, if they had been offered, the plaintiff would have purchased. His income at the time of the accident would have qualified him for income replacement benefits of $1,000 per week.

The defendant claimed that their practices were consistent with industry practices which was to mention the availability and only follow up if the consumer showed some interest.  The judge found that the broker’s conduct fell below the required standard of care required of a seller of insurance as set out in the SABS.

However, the judge dismissed that action because the judge was not convinced that the plaintiff would  have purchased the optional benefits had they been properly offered. The plaintiff and his spouse purchased insurance from four other insurance companies during the ten years and never purchased more that the standard accident benefits coverage.

This case has some significance in light of the reforms introduced in Ontario on September 1, 2010.  With the reduction of standard accident benefits coverage and the expanded  optional coverage, brokers, agents and direct writers are vulnerable to similar actions if their practices fall below the standard of care expected. 

 Zefferino v. Meloche Monnex Insurance, 2012 ONSC 154

If the Shafia Family Lived in Ontario Would They Qualify for SABS Benefits?

The Montreal Gazette reports that despite some media reports the Shafia family, who resided in Montreal before they were convicted of first-degree murder, might receive payouts under Quebec's no-fault auto insurance system, there will be no payout, the board says.

The three Shafia family members convicted of four counts of first-degree murder made no request for auto insurance compensation for their four relatives found dead in a car in an Ontario canal, said Gino Desrosiers, a spokesperson for the Société de l'assurance automobile du Québec (SAAQ).

In any case, they would not be eligible, he said, because the Shafia case does not meet the criteria for compensation.

SAAQ rules state that the car involved must have been in an accident on a public roadway; that the vehicle must not have been used for anything other than its intended purpose (to transport people from A to B under its own power); and that the injuries or deaths that resulted were due to a car accident.

So if the Shafia family resided in Ontario, would they be able to claim death and funeral benefits under the Statutory Accident Benefits Schedule (SABS)?

Subsection 3(1) of the SABS defines an “accident” as “incident in which the use or operation of an automobile directly causes an impairment.” The Crown in this case contends that the four passengers in the vehicle were likely killed before it went into the lock. If that is the case then clearly there is no entitlement because the use or operation of an automobile did not directly cause their death.

Even if the four passengers had drowned in the lock, the evidence presented at trial was that the vehicle was not driven into the lock. The key in the ignition was on the off position and the front seats were reclined in a position that would have made it impossible to operate the automobile. The evidence suggested that the automobile had been pushed in by another vehicle owned by the family. Again, their death was not directly caused by the use or operation of an automobile.

This is consistent with Ontario Court of Appeal decision Chisholm v. Liberty Mutual Group. In that case the plaintiff had become a paraplegic while driving his wife’s car as a result of wounds from gun shots fired by an unknown assailant. Liberty Mutual denied SABS benefits because the use or operation of the automobile did not directly cause the impairment. The Court agreed and indicated that the provision in the SABS provided a restrictive causation requirement.