Jury convicts Spokane man of fraud in case of $200,000 patio cover

A Spokane jury this afternoon convicted a Spokane man of insurance fraud and attempted theft after a snow-damaged patio cover worth about $4,000 mushroomed into a fraudulent insurance claim for nearly $200,000.

Keith R. Scribner, 48, will be sentenced April 16th in Spokane County Superior Court. Both the charges are felonies.

In late July 2009, Scribner's mother, Marilyn Warsinske, filed a claim with Liberty Mutual insurance. She said a patio roof at a home she'd purchased had collapsed due to the weight of snow some 6 months earlier. The policy covered "like kind and quality" replacement. Her son, she told the company, would handle the claim.

Scribner told the insurance company that patio cover was an extensive structure, spanning the entire length of the patio and wrapping around the home's chimney. Claims officials, inspecting the site, wondered why was there no flashing or holes in the masonry. Scribner said that house painters must have made repairs.

He sent the insurance company three bids to replace the cover based on his description. The bids ranged from $195,586 to $213,815.

Claims officials asked Scribner for any photos of the roof prior to the damage or after it collapsed. Perhaps some were taken during a home appraisal prior to the purchase, they suggested. Scribner said there were no photos and was no appraisal.

But a claims handler discovered an aerial photo of the home on a real estate website. It showed a much smaller patio cover than Scribner claimed.

The company launched a fraud investigation and notified Insurance Commissioner Mike Kreidler's anti-fraud Special Investigations Unit.

As it turned out, there had been a home appraisal, the investigators discovered. In fact, Keith Scribner met with the appraiser. And the appraisal included photos of the patio cover. A real estate agent interviewed by investigators described the cover as being "small and nothing special or significant."

The home's previous owner also provided photographs of the structure. It was originally canvas. When that because troublesome to remove each year, the homeowner bought a polycarbonate cover. Cost: About $300.

An architect told a state fraud investigator that he'd met with Scribner in 2008 -- months before the snow collapse -- to discuss plans to replace the deck cover with new, larger one.

A local company, provided with measurements and photographs of the original structure, drew up replacement bids at the request of a state fraud investigator. The bids: $3,913 and $4,782.

Hearing: Proposed acquisition of Western United Life Assurance

Commissioner Kreidler has scheduled a 10 a.m. hearing on March 21 to consider a request to acquire Washington-based Western United Life Assurance Company.

Central United Life Insurance Company is proposing to acquire common shares of Western United Life Assurance Company from Western United's current owners, Global Life Holdings Inc. The acquisition would allow Central United to acquire all common shares of Western United and become its controlling entity.

Central United Life Insurance is an Arkansas stock life insurer with its headquarters in Houston, TX. It has been licensed in Washington since 1974. It writes mainly life and accident and health policies in Washington. Western United Life Assurance is a Washington stock life insurer with its headquarters in Spokane, WA and was established in 1963. Western United writes mainly annuity considerations in 16 states.

Any interested parties may submit letters of support or concerns or objections and/or may participate in the hearing by appearing in person or by telephone at no charge.

For more on this hearing, please go to our hearings archive and look forWestern United Life #13-0033. There you'll find details on how to participate in the hearing and view all documents filed in this matter.

"My agent said I had `full coverage' but won't pay my claim. What gives?"

Q: My agent said I had "full coverage," but when I turned in a claim, I was told that the claim was excluded. What's going on?

In insurance, there's rarely any such thing as "full coverage." Virtually all (if not all) insurance policies have conditions, limitations and exclusions.

It's critical to find out what those conditions, limitations and exclusions are before buying a policy and before you have a claim.

If an agent won’t explain the conditions, limitations and exclusions, then find one that will. If you don’t ask, then you may be surprised and angry when you are told there is no coverage.

What does insurance have to do with climate change?

A lot, as it turns out.

Last year, three states -- Washington, California and New York -- surveyed dozens of major insurance companies about what they're doing to adapt to risks posed by climate change, a potential game-changer for insurers' investments and the risks they take on.

An independent climate-change group, Ceres, this morning released its analysis of the responses to that survey.

Of the 184 companies surveyed, Ceres concluded that only 23 of the companies had comprehensive climate change strategies. "Those companies provide a roadmap for the rest of the industry as it begins to wrestle with the issue," the report's authors wrote.

"Why do I have to do the insurance company's work to get my claim paid?"

This is another question that we hear a lot. Whether or not you are dealing with your own insurer or someone else’s insurer, be prepared to be involved in the claim.

Here's why: Processing a claim is rarely one-sided, and your participation is needed.

You may be asked to provide information, statements, photos, receipts or other things to support your claim.

You may be asked to attend what's called an "exam under oath" or go to an independent medical exam to verify claim details and injuries.

In order to promote a resolution to your claim, we recommend that you actively be involved, ask questions, and be ready to help with processing your claim.

What you can do when your health insurer says no

Little-known fact: When your health insurer denies a treatment or won’t cover a bill, that’s not necessarily the final answer. In most cases, you can appeal that decision.
Even if the insurer says no, consumers can often appeal to an independent group with the power to overrule the company. Nearly a quarter of Washingtonians who do that end up winning.
Our office has posted an easy-to-use guide to filing appeals on its website at www.insurance.wa.gov/your-insurance/health-insurance/appeal. Since we're the insurance regulator for Washington state, it's designed for Washington residents, but many of the tips apply more broadly.
The guide has been recently overhauled to make it easier to use. It includes step-by-step tips, examples, and downloadable letters that consumers can fill out and send to their insurer.
We also experts on staff who can help Washington state consumers with their appeal. They can be reached at 1-800-562-6900 or AskMike@oic.wa.gov.

And if you don't live in Washington state, here's a handy map showing how to contact your state's insurance regulator.

Large health insurer surpluses could help ease premiums

The News Tribune of Tacoma and the Bellingham Herald this morning ran an op-ed column by Commissioner Kreidler, talking about the fact that -- under current law -- our rate reviews of health premiums have to ignore the billion-dollar surpluses that some non-profit health insurers are sitting on.

From the op-ed:

Two of this state’s largest insurers – Premera Blue Cross and Regence BlueShield – are sitting on surpluses totaling $2.2 billion. In fact, their surpluses grew almost a quarter-billion dollars in the first nine months of 2012 alone.


As the state’s insurance regulator, I review insurance premiums. If they’re unjustifiably high, I tell companies they cannot charge that much. This is a critical protection for Washington consumers.

But here’s the elephant in the room: Under current law, I am barred from taking those surpluses into account when I review rates. This is despite the fact that regulators in nearly a dozen other states, including Oregon, have the authority to do so.

We're seeking legislation -- House Bill 1349 -- that would allow us to take surplus into account when the rates are reviewed.

By factoring surpluses into rate reviews, I can help protect consumers from sticker shock in their health care premiums, while still ensuring that carriers are financially healthy. It would be a tragedy – both for the economy and for individuals – if lawmakers chose to put the interests of insurance companies ahead of their constituents.