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.

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.

Consumers who had trouble with Washington Healthplanfinder have a second chance to enroll

The Washington State Health Benefits Exchange has announced a special enrollment through Feb. 23, 2015 for people who have experienced trouble enrolling in a health plan for 2015 through the state’s exchange, Washington Healthplanfinder.

“I am pleased that Washington consumers who have had trouble with Washington Healthplanfinder have an option for getting coverage effective Jan. 1,” said Insurance Commissioner Mike Kreidler. “I encourage affected consumers to act sooner rather than later.”

The special enrollment applies to people who made an effort to receive health coverage through http://www.wahealthplanfinder.org/ before the Dec. 23 deadline, but who were unable to complete their applications due to a technical error associated with the Washington Healthplanfinder system.

Starting at noon today, affected consumers should fill out an online request form for coverage retroactive to Jan. 1 at: https://petition.wahealthplanfinder.org/. If customers need assistance or do not have Internet access, they can call the Exchange’s Customer Support Center at 1-855-923-4633. Each request will be reviewed and customers will receive a notification of their special enrollment through email or mail.

The Exchange also posted a list of frequently asked questions about the special enrollment period.

Does insurance have to replace my entire roof?

Here's a consumer question related to winter weather: My insurer will repair a portion of my roof that was damaged, but won’t replace the entire roof to match. Can they do this?

This is a common question and it's a frustrating issue for consumers. The short answer is yes, insurers can do that. Home insurance policies cover direct physical damage to the roof, like a tree branch falling in a wind storm and poking a hole in the roof, or blowing a section of your shingles off and allowing water to enter. The insurer will repair the damaged portion of the roof and any resulting water damage. The insurer would not pay to repair any sections of your roof that are not damaged. 

If you decide you want the entire roof replaced, you would have to pay for replacing all non-damaged areas of the roof.

Read more about homeowner insurance on our website. Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Oregon Insurance Commissioner extends comment period on Mutual of Enumclaw holding company conversion

The Oregon Insurance Commissioner has extended the open comment period following the Dec. 15 public hearing of the proposed mutual holding company conversion of Mutual of Enumclaw Insurance Co. Comments must be delivered to the Oregon Insurance Commissioner by 5 p.m. on Dec. 29. Comments should be sent to Russell Latham, Financial Regulation Section, Oregon Insurance Division, P. O. Box 14480, Salem, OR 97309-0405.

Mutual of Enumclaw Insurance Co. and its subsidiary, Enumclaw Property and Casualty Insurance Co., have requested permission from the Oregon Insurance Commissioner to reorganize into a holding company structure. Holding companies are corporations that own and control other companies. The new holding company would be the direct owner of Mutual of Enumclaw and the indirect owner of Enumclaw Property and Casualty Insurance Co. Read more about the request in our Dec. 9 blog post.

To find information about viewing the plan of reorganization, view the Dec. 15 public hearing notice from the Oregon Insurance Division.

Insurance Commissioner fines health insurer $50,000

LifeWise Health Plan of Washington has agreed to pay a $50,000 fine for overcharging 5,700 consumers $6 to $38 per month for the first six months of 2014. 

The health plans were WiseEssentials 25 and WiseSavings 20, which are catastrophic plans that trade a high deductible for a lower monthly premium. They are usually purchased by young, healthy people who want coverage in case of an injury, accident or serious illness. Each year, health insurers are required to file with the OIC their health plans--called "forms" in insurance vernacular--and the rates they will charge for each plan. The OIC then reviews and ultimately approves the plans and rates, working with the insurers when they need to. 

In this case, the 2014 rates that LifeWise filed for those catastrophic plans had decreased slightly, depending on the enrollee’s age, because the deductible increased. From January through June 2014, LifeWise charged those consumers rates that were based on the 2013 plans, which had higher deductibles.

As part of the agreement, called a consent order, LifeWise will repay the affected consumers the amounts they overpaid plus 8 percent annual interest. View the consent order here. 

You can search our disciplinary orders or file a complaint against an insurance company, agent or broker on our website.

Edmonds man no longer able to sell insurance

The Office of the Insurance Commissioner has revoked the license of insurance producer Earl C. Dennis of Edmonds.

In 2012, Dennis borrowed $210,000 from a 79-year-old insurance client, which was a significant portion of the client’s net worth. Dennis promised to secure the loan with the deed to his house, which he never did. He arranged to repay the client at a 2 percent interest rate; an unsecured personal loan from a bank ranges from 7 percent to 15 percent or higher. Dennis stopped making loan payments and still owes the client $90,000. State insurance law allows the Insurance Commissioner to revoke an insurance producer’s license if they borrow money from an insurance client who is not a family member or financial institution.

In 2011 and 2012, Dennis sold the same client three annuities, which the client paid for by surrendering two annuities that had higher guaranteed interest rates. In addition to having lower guaranteed interest rates, the three new annuities had limitations and penalties that the old annuities did not have. Insurance producers who sell annuities are required to make an effort to verify that annuities are suitable for their clients’ financial needs and they are required to adequately explain the products to their clients. Dennis did not meet those requirements in this case.

The OIC sought to revoke Dennis’ license in August 2014, but Dennis invoked his right to a hearing. The hearings officer upheld the OIC’s revocation, which means Dennis is no longer legally able to sell insurance in Washington state. You can read the findings from the hearing on the OIC’s website.

Tacoma woman pleads guilty to felony insurance fraud

Christine Marie Larsen, 30, of Tacoma pled guilty in Pierce County Superior Court to insurance fraud for purchasing insurance on her vehicle after it was totaled. 

In November 2013, Larsen’s 2004 Lexus IS300 was totaled in a collision on the freeway while being driven by someone else. The next day, Larsen took out a policy on the car, which was uninsured. She filed a claim for the damages on Dec.1, 2013, stating she had been in a collision that day. The insurance company deemed the car a total loss and paid her $11,250.


The insurer, citing red flags, later investigated the claim and found a Washington State Patrol report for the Nov. 25 collision involving Larsen’s car. The driver was cited for the collision and for not having insurance. The insurer referred the case to the Office of the Insurance Commissioner’s Special Investigations Unit (SIU). SIU investigates insurance fraud and works with the Attorney General’s Office and local prosecutors to prosecute criminal cases.  

Larsen was ordered to repay the insurance settlement and court costs. Read the news release about the case.

Mutual of Enumclaw seeks to convert to holding company

Mutual of Enumclaw Insurance Co. and its subsidiary, Enumclaw Property and Casualty Insurance Co., have requested permission from the Oregon Insurance Commissioner to reorganize into a holding company structure. Holding companies are corporations that own and control other companies. The new holding company would be the direct owner of Mutual of Enumclaw and the indirect owner of Enumclaw Property and Casualty Insurance Co.

While the Washington Office of the Insurance Commissioner (OIC) is not overseeing this conversion, Mutual of Enumclaw has a large customer base in Washington state. The OIC wants Washington consumers to have an opportunity to attend this hearing or provide comment, if they wish to.

The hearing is at 6 p.m. on Dec. 15 in Seattle. View the notice for the hearing location and instructions on how to participate by telephone. Comments may be submitted in writing to this address before Dec. 22:

Russell Latham, Financial Regulation Section, Oregon Insurance Division
P.O. Box 14480
Salem, OR 97309-0405

OIC's online applications not available

Some of the Office of the Insurance Commissioner's online applications are down or do not have full functionality. We are working on resolving these issues and hope to restore all online services as soon as possible. Thank you for your patience.

Contractors Bonding and Insurance Co. seeks OK to redomesticate

Contractors Bonding and Insurance Co. has requested approval from the Office of the Insurance Commissioner (OIC) to redomesticate from Washington state to Illinois. View all related documents.

The OIC has scheduled a public hearing on this request for 11:30 a.m. on Dec. 16 in the Tumwater office. All interested parties may submit letters of support or objections to hearings@oic.wa.gov. Any member of the public may attend the hearing.

Commonwealth Insurance Co. of America requests approval to change its state of domicile

Commonwealth Insurance Co. of America has requested approval from the Washington State Insurance Commissioner to redomesticate from Washington state to Delaware. In plain talk, that means it wants to move its corporate operations from Washington to Delaware. View the documents the company submitted.

The Office of the Insurance Commissioner has scheduled a public hearing on this request for 10:30 a.m. on Dec. 16 in the Tumwater office. Interested parties may submit letters of support or objections to hearings@oic.wa.gov. Any member of the public may attend the hearing. 

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.

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.

Some homeowner policies offer percentage deductibles

When you are considering homeowner insurance, it’s good to be aware of what type of deductible you have. Some insurance companies charge deductibles that are a percentage of the home’s value, rather than a flat dollar amount. For example, if your deductible is 0.5 percent and your home’s value is $500,000, your deductible would be $2,500.

Some people would prefer to pay a higher deductible and get a lower monthly premium. It’s important to do the math and find out what that half-percent will cost you. Keep in mind, your home’s value is likely to increase over time, which means your deductible will, too.

Read more about homeowner insurance on our website. Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Been in an auto accident? Beware of this scam

KING 5 news reported yesterday that some accident victims are being scammed into getting unnecessary chiropractic treatment to drum up payments from insurance companies. Consumers who experience this -- or any other type of insurance scam -- should report it to our consumer advocates at 1-800-562-6900 or online.

According to KING 5, the scammers use Washington State Patrol’s collision reports to find people who've been in auto accidents. One family reported they were led to believe the insurance company wanted them to be seen and gave them a time limit for the visit.

"They said the claim was going to close immediately. They said we need to come in if we want to have any future claims," the victim told KING 5. 

If you are involved in an accident, the auto insurance company will not require you to see a doctor. It is up to you to seek medical treatment at your discretion. However, if you claim you have medical problems related to an accident, the insurance company may request verification from a medical professional. Consumers should always contact their insurance company’s claim representative or their insurance agent or broker when they have questions about a claim.  

In addition to misleading consumers, tricking consumers into getting unnecessary treatment can drive up insurance rates. Insurance companies base their rates in part on the claims they paid in previous years and unnecessary claims get factored into future rate increases.

Read more about insurance fraud and scams.

Can OIC recommend insurance agents to consumers?

Consumers call our hotline daily to ask us questions about insurance. Sometimes, consumers ask us to refer them to insurance sales agents who might be able to sell them the type of coverage they are looking for.

While we do regulate the insurance industry, we do not refer consumers to specific agents or brokers. However, we encourage consumers to check the licensing status of agents, brokers or companies on our website. Consumers can also call our hotline and ask one of our consumer advocates to look up that information on their behalf.

Read more about your insurance on our website.

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

Online services are running slowly due to network issue

OIC's online services are running very slowly at this time due to network issues at the state level. Users may experience difficulty trying to access our online services while technicians work to resolve the issue. Thank you for your patience.

Seattle area warned about landslide risk

Today, the Seattle Times published a warning about the risk of landslides due to recent heavy rains: Heavy rains bring increased risk of landslides, SPU warns. "With rain late Thursday and Friday morning, Seattle exceeded the official U.S. Geological Survey’s landslide threshold."

In addition to taking the steps outlined in the article, homeowners should take a look at the insurance policies. Homeowner policies typically do not cover damage caused by land movement or a landslide if the underlying case is excessive water.

There are options for homeowners who wish to have coverage in the event of a landslide. Consumers can purchase a rider that covers the contents of their home from all perils, including landslides. Some companies also sell earth-movement coverage for any structures on your property. Flood insurance may cover landslide damage that is due to heavy rains. Your insurance agent or broker can tell you what type of coverage is best for your situation.

Read more about flood insurance on our website. If you have questions, contact our consumer advocates at 1-800-562-6900.

Insurance tips for consumers affected by Longview tornado

Yesterday, people in the Longview area experienced a tornado, a rare occurrence in Washington state. Luckily, there are no reports of injuries but there was some property damage to buildings and vehicles, according to news reports. Read more about the tornado in The Columbian newspaper.


Photo courtesy KING5.com

Standard homeowner and commercial property policies typically cover damage caused by tornados or wind. Damage from tornados can damage building exteriors and roofs, which can leave them susceptible to water damage from rain, and can cause trees to fall on buildings and cars. Personal auto and commercial auto policies would need to have comprehensive coverage in order pay for damage caused by wind.  

If you experienced any damage from yesterday’s tornado, contact your agent or broker to discuss what coverage you actually have and to get your claim started. If you have questions, you can contact our consumer advocates online or at 1-800-562-6900.

Insurers largely unprepared for climate change

A report issued today found only 9 percent of insurers are well prepared to face the risks posed by a changing climate. Only two of those insurers are headquartered in the United States.  

Ceres today released its 2014 climate preparedness scorecard, which ranks the nation's 330 largest insurance companies on what they are saying and doing to respond to escalating climate risks. The report is based on a 2013 survey of insurers with an excess of $100 million in direct written premiums conducted by insurance regulators in Washington, California, Connecticut, Minnesota and New York.

 

More results:

• 276 of the 330 companies that responded scored in in the bottom half.
• The top nine best-prepared companies are: ACE, Munich Re, Swiss Re, Allianz, Prudential, XL Group, The Hartford, Sompo Japan and Zurich. Only The Hartford and Prudential are headquartered in the United States.
• Overall, property and casualty (P&C) insurers are better prepared than life and health insurers, which are largely unprepared.

Washington Insurance Commissioner Mike Kreidler and the other insurance regulators care about this issue for a couple of reasons – first, climate change brings extreme weather events, which can cause widespread damage to homes and other property, as we saw during this summer's wildfires. More frequent and more severe natural disasters mean more claims, which means insurance companies need to make sure they have enough money to pay those claims. Insurers can help maintain their financial solvency by making sure their money is invested soundly and in climate-friendly ways. Secondly, insurance companies can reduce their risk by being proactive. Kreidler has called for insurers to get involved in building codes, land use practices and working with developers to help mitigate the effects of climate change.

“The insurance industry is uniquely positioned as the bearer of risk to make adjustments now to lessen dramatic impacts we know are coming. This is not a partisan issue, it’s a financial solvency issue and a consumer protection issue,” Kreidler said in the Ceres news release.

Take a look at our media roundup about the report findings.

Consumer alert: Trade marketers banned from selling health care products

The federal government this week banned a trade association from selling health care-related products to consumers. The OIC issued a cease-and-desist order against the same group in 2012 for selling discount health plans in Washington without a license.

The Federal Trade Commission banned the Independent Association of Businesses (IAB) from selling any products that could be construed as health insurance or health care products to consumers. The group marketed its products as health insurance but consumers who purchased it were in fact enrolled in an IAB membership that included discounts on many services, including travel protection, identity theft protection and certain medical visits that were subject to broad exclusions and limitations.

IAB indicated to our investigators that it had sold 190 memberships to 161 Washington consumers as of September 2010 and it was still doing business at the time of our order in February 2012, even though it knew it wasn’t legal to do so. Consumers should be wary if they see marketing from IAB or any of its affiliated business names: International Association of Benefits, International Marketing Agency, Independent Association of Businesses, or IAB. You can report any activity from this marketer to the FTC’s online complaint center. If you have questions about health insurance, call our consumer experts at 1-800-562-6900 or visit us online.

Change your Medicare enrollment now through Dec. 7

Medicare’s open enrollment period for prescription drug plans (Part D) and Medicare Advantage plans starts today and runs through Dec. 7. Our Statewide Health Insurance Benefits Advisors (SHIBA) provide help in your community.

SHIBA offers free help to people with Medicare questions, including what changes are happening this year.

“Our unbiased volunteers in your community can answer your questions and help you search for plans online,” said Insurance Commissioner Mike Kreidler.

Before you make your Medicare decision, consider the following:

• Plan costs and coverage will likely change every year, so carefully review all letters and notices from your insurer.
• Make a list of all current prescription drugs you take, the doses, and how often. Then, use the Medicare Plan Finder to compare prescription drug (Part D) plans.
• Review the 2015 Medicare & You handbook. You should receive it in the mail by mid-October.
• If you have limited income and need help paying for prescription drugs, check out Medicare’s “Extra Help” program. To see if you qualify, contact the Social Security Administration at 800-772-1213 or visit www.socialsecurity.gov. 

Call our Insurance Consumer Hotline at 800-562-6900 to ask for help or to schedule an appointment with a SHIBA volunteer in your area. You can also find a free Medicare workshop in your area on our online calendar and sign up to receive Medicare consumer news from us by email or text.

We are back in business!

All of our web-based applications are available again and we are able to respond to emails now. Thank you for your patience!

Web-based applications, email are down

A state-level technical glitch is causing OIC's web-based applications to be down for the time being. OIC staff email and Internet access are also down, so please be patient if you are trying to reach us electronically. We do not yet have an estimate of when our services will be restored and we appreciate our users' patience.

Even if you think you know what your policy covers, read it again

We've said this before and we will keep saying this ... you must read your policies, the sooner after you purchase them the better.

We receive calls daily from frustrated and often distraught consumers because they are having a problem with their coverage, premiums or outcomes of their claims because they thought they had a certain type of coverage that they did not actually have.

We can't overemphasize the importance of this sentence: When you sign up for coverage of any kind, be sure to check the policy when you receive it! This is your responsibility as a policyholder. Read it, look at the coverage and prices, and ask your agent or insurance company any questions immediately before you have a claim or policy payment issue. It’s much easier to make a correction early in the process rather than after you have a claim and things aren’t correct.

Read more about your insurance on our website. Questions? You can contact our consumer advocates online or at 1-800-562-6900.

OIC orders Fife RV & Auto Center to stop selling warranties

OIC has ordered Fife RV & Auto Center to stop selling vehicle protection product warranties effective immediately. The company has been selling a warranty to repair any surface damage on the interior and exterior of vehicles. Since 2012, the company has sold 236 warranties to Washington consumers without being authorized to do so.    

Warranties are considered insurance under Washington state law and businesses must be authorized to sell them in Washington state.

The company has a right to demand a hearing and it must honor the terms of all warranties it sold to Washington consumers. Read more about warranties and service contracts sold in Washington.

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.

Consumers ask, why is my repair taking so long?

Our consumer advocates receive many calls from consumers wondering why repair work gets delayed, whether it be an auto repair or home repair that is being covered by insurance. 

Generally, if you are using the insurer’s recommended auto repair shop, building contractor, cleaning service, or any other vendor, you should expect the insurer will monitor the progress of the repair and and that you will not be responsible for any added expenses due to repair delays. We do, however, expect the insurer will communicate with your repair shop and contractors in a timely manner to be able to come to an agreed price of and timeline for a repair.

If you decide to use your own repair shop, building contractor, cleaning service, or any other vendor that is not one recommended by your insurance, it is your responsibility to monitor the repair progress and monitor the vendor. Delays created by your shop or contractor and any added expenses or inconvenience created by those delays are not the responsibility of the insurer. In those cases, the insurer will expect you to pay for extra car rental days or alternate living arrangements if a delay is caused.

If you are working with an electrician, plumber, elevator mechanic or manufactured home installer, you should protect yourself by verifying they are licensed with the state Department of Labor and Industries.

In any event, it is always a good idea for you to take an active role in the claims process--do not expect that everything will be done automatically by the insurer or the business that is doing the repair work. Being involved in a claim by its very nature is unpleasant, but you can help lessen frustration by asking questions and keeping track of the progress of your repair.
If you have questions, you can contact our consumer advocates online or at 1-800-562-6900.

Scientists predict another St. Helens eruption; make sure you are covered!

Mount St. Helens, Washington’s most active volcano, is showing signs of reawakening, according to scientists, who say it’s only a matter of time until it erupts again. An eruption started 10 years ago that lasted until 2008, outlined in The Columbian newspaper. The lava dome has since rebuilt and the U.S. Geological Survey is seeing signs of magma activity under the volcano, according to the Associated Press. 

The good news is that most homeowner and auto policies will cover some degree of damage due to volcanic eruptions, but there are, of course, exceptions. The key is evaluating your home and auto policies and talking to your insurance agent before an eruption occurs.

Read more about volcano coverage for your home and auto. If you have questions or complaints about your insurance, contact our consumer advocates online or by phone at 1-800-562-6900.

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. 

 

 

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

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.

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.

Washington businesses refunded more than $1 million in overcharged commercial insurance rates

This month, Zurich North America insurance group completed reimbursing Washington businesses $1.02 million and more than $123,000 in interest on 568 commercial auto policies that had been overcharged.

In October 2013, the OIC took action against a handful of Zurich North America’s companies for overcharging Washington businesses for commercial auto insurance policies. The companies are American Zurich Insurance Co., American Guarantee & Liability Insurance Co., Colonial American Casualty & Surety Co., Fidelity & Deposit Co. of Maryland, Zurich American Insurance Co. of Illinois, and Zurich American Insurance Co. 

The companies agreed in a consent order to pay a $50,000 fine and to refund policyholders, including 8 percent interest, who overpaid based on the incorrect rates.

This month, we closed out the case when Zurich North America reported it had completed the terms of the agreement. The overcharges happened because the companies failed to notify the OIC that they were going to continue to use their old rates, rather than charging new rates filed on their behalf by an insurance rating organization they belonged to. 

OIC orders unlicensed golf tournament insurer to stop doing business in Washington

Yesterday, the OIC ordered L & B Enterprises Inc., also called Tournament Pros, to immediately stop selling insurance in Washington state. Tournament Pros, based out of Maryland, has sold at least 18 insurance contracts for golf tournaments in our state since 2012 without being authorized to do so.

Golf tournaments often buy insurance to pay hole-in-one prizes or prizes for chipping or putting contests. These tournaments are popular fundraisers, as players pay an entry fee and fees to participate in contests.  

The OIC received a complaint after a May 2013 armed forces golf tournament at Bremerton's Cascade Course at Gold Mountain. The tournament organizer purchased a contract for a $10,000 hole-in-one prize on the 185-yard third hole, but a golf course employee mistakenly hung the prize sign on the 14th hole. According to the tournament sponsors, a sailor who had flown in from another state to participate in the tournament got a hole-in-one on hole 14, which was longer at 228 yards from the tips and more difficult. The tournament sponsor reported that it asked Tournament Pros to pay the prize; the company declined but offered to give the golfer $500. The tournament sponsor then complained to the OIC, and our legal team found out the insurer is not authorized to sell insurance in Washington. 

Tournament Pros has 90 days to request a hearing to contest the order. It also can choose to become an authorized insurance producer in Washington, at which point it would be allowed to continue to do business here.

In February 2014, a hole-in-one insurer who had been illegally doing business in Washington and had defrauded several charity golf tournaments and golfers was sentenced in King County Superior Court to $15,000 in restitution to his victims. Kevin Kolenda of Connecticut had been defrauding people in a handful of states for more than two decades and was extradited to Washington to face the charges.

OIC is looking for health care network, consumer advocacy professionals

OIC opened two new jobs this week, both working in our Tumwater headquarters.

The first job will help us ensure that health insurance plans have adequate networks of medical providers across the state. The position is a Functional Program Analyst 3 in our Rates and Forms Division. The person in this position will review network access reports and provider agreements that health insurance companies submit to us. The position reports to our Healthcare Consumer Access Manager and plays a crucial role in our state's implementation of the Affordable Care Act.

The position is open until filled. Read more about the position or apply at careers.wa.gov.

The second job is an Office Support Supervisor 2 in our Consumer Protection Division. We have a robust consumer protection program, working directly with Washington consumers and insurance companies. This position will supervise our consumer hotline staff, oversee consumer hotline operations, serve as the public records coordinator for the division and report on the division's performance.

This opening closes on Sept. 25. Read more about the position or apply at careers.wa.gov.

Can my age be used as a rating factor in auto insurance?

While it may sound like age discrimination, the answer to this question is "yes." A person’s age can be and usually is used as a factor in determining auto insurance rates. Age is connected to risk and is linked to accident frequency, accident severity, and claim costs, so insurers are allowed to factor it into rates. 

There are other rating factors typically used by insurers, which you may review on our website.         

If you find yourself experiencing a little sticker shock when you see your auto insurance premium, it’s always a good idea to shop for competitive auto rates every now and then. We recommend people do that in order to determine if they can find lower rates for the same coverage. Young drivers can sometimes get discounts for good grades and senior drivers can sometimes get discounts for taking driving classes for people aged 55 or older. Ask your agent or insurer about possible discounts.

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

Seattle Children’s Hospital officially withdraws legal complaint

Seattle Children’s Hospital officially withdrew its legal challenge with the OIC on Sept. 5 after it reached an agreement with Regence Blue Shield to include some services in Regence’s health provider networks for 2014 plans.

Seattle Children’s Hospital initiated legal proceedings about a year ago when Premera, Regence Blue Shield and Coordinated Care decided against including the hospital and research facility in their medical networks because of cost concerns. Seattle Children’s argued the OIC shouldn’t have approved 2014 plans from the three carriers because they excluded the facility from their networks for routine pediatric medical care. The plans argued Seattle Children’s charges for routine pediatric medical care would drive up their costs; Insurance Commissioner Mike Kreidler sided with the plans in favor of “narrow networks” to be able to provide cost-effective services for consumers. No families who needed specialty pediatric care were turned away from Seattle Children’s or had to pay out of pocket for those services.

Seattle Children’s and Premera Blue Cross last month reached an agreement to include the hospital in its medical networks, effective Sept. 1. Coordinated Care earlier this year made a deal to include the hospital in its network and was removed from the case.  

OIC is in the process of reviewing 2015 plans that are sold outside of the Washington health benefit exchange. At the end of August, OIC approved 90 health plans for sale inside the Exchange, called Washington Healthplanfinder, with a record low 1.9 percent average rate change.

Pierce County woman ordered to repay insurance company for fraudulent car claim

A Pierce County woman was sentenced to 60 days of electronic home monitoring and ordered to repay $17,426 to Travelers Insurance for attempting to collect insurance money for a car she claimed was stolen and destroyed in a fire. Donica Santos, 40, pleaded guilty to one count of first-degree theft and one count of insurance fraud in Pierce County Superior Court last month.

In March 2012, a driver reported Santos’ vehicle was on fire on the side of Reservation Road in north Thurston County at about 1:40 a.m. on March 16, 2012. Santos reported to Travelers’ Insurance Co. later that day that her car had been stolen from her Tacoma home and was a total loss. Santos told investigators that she had last seen her vehicle the previous night and had not left her house or used her cell phone between 10:30 p.m. and 2:50 a.m., when police arrived at her house to investigate.

However, Santos’ cell phone records showed she used her phone repeatedly late the evening of March 15 and the early morning hours of March 16; several of the calls were made in Thurston County, near where her 2006 Chrysler 300C was found on fire. 

Travelers denied the claim, but was required by state law pay off the car loan balance of $17,426.

Santos was charged in December 2013 after she was investigated by Insurance Commissioner Mike Kreidler’s Special Investigations Unit.

90 health plans approved for next year's Exchange - find one in your area

Health plans and their rates for next year's Exchange, Washington Healthplanfinder were approved by our office and certified by the Exchange board this week.

Consumers shopping inside the Exchange will have 10 companies and 90 plans to choose from, depending on where they live. Not all plans are available in every county, but most people will have more choices and minimal rate changes.

Additional insurers and plans for sale outside of the Exchange are still under review. There may be more plans for sale outside of the Exchange, but premium subsidies are not available.

Open enrollment for inside and outside of the Exchange starts Nov. 15 and runs through Feb. 15, 2015.

Check out the map below to see the 2015 plans and rates available in your county.

ACA’s 80/20 rule saves consumers money

Created through the Affordable Care Act law, the 80/20 rule, also known as the Medical Loss Ratio (MLR) rule, requires health insurers to spend at least 80 percent of premium money on patient care and quality improvement activities or pay a rebate back to consumers.

This month, the U.S. Department of Health and Human Services reported that since the rule took effect, more insurers year over year are meeting the 80/20 standard by spending more of the premium dollars they collect on patient care and quality, and not red tape and bonuses. If an insurer did not spend enough premium dollars on patient care and quality improvement, they must pay refunds to consumers in one of the following ways:

• A refund check in the mail.
• A lump-sum reimbursement to the same account that was used to pay the premium.
• A reduction in future premiums.

If the consumer bought insurance through their employer, their employer must provide one of the above options, or apply the refund in another manner that benefits its employees, such as more generous benefits.

In 2013, 9,605 Washington consumers received refunds totaling $792,846, an average of $122 per family.

Read more about health care reform on our website. Questions? Contact our consumer advocates online or at 1-800-562-6900.

Temporary special enrollment for those stuck in Exchange plans begins today

A temporary special enrollment period begins today for those consumers who have experienced difficulties with enrollment in health plans on the Washington Healthplanfinder. 

Insurance Commissioner Mike Kreidler authorized the special enrollment period this week as another option to those who feel they might need more help. This voluntary special enrollment period starts Aug. 27 and runs through Nov. 14, 2014. Only people who attest to having enrollment, billing, or payment issues with an Exchange plan may change plans during this time.

If you’re considering this option, you should be aware of all of the details involved, including the fact that you could lose a current premium subsidy. Special enrollment may not be the best choice for everyone. But as the commissioner notes, “Hopefully, it will bring relief to some.”

 A list of answers to questions about this temporary special enrollment is available on our website.