The various charges on life insurance



In just a few years, the whole area of life insurance has changed. The reason is simple: the arrival of new financial institutions in this sector, offering their products directly over the Internet.
The first consequence of this evolution has involved service fees. Often present, right from the opening of accounts, online banks have in fact used to diminish and even, for some, to make them disappear. Nevertheless, today, insurers on the web and traditional contracts and coexist with very different performances, and costs to present every moment of life insurance.
It keeps, however, affect the good results of the latter which continues even today to be the favorite of the French savings in terms of capital invested before the Livret A.
Mainly five types of fees are found in virtually all life insurance contracts.

<> Costs Life Insurance Investment <>
First of them to be billed, fees. These are indeed due upon signing the contract. They are payable only once and are often confused with fees that have nothing to do since about the payments.
These fees, therefore, are often reduced to a sum not exceeding 50 euros since and to cover administrative costs of registration of the contract. While many institutions have now abandoned these charges by making even one of their business case, for others it is quite possible to negotiate. This is not the case for collective contracts. The latter, concluded between the insurer and an association to which each adheres insured, do indeed any individual negotiation. They are then often at the expense of joining the association.
Other charges very common, reports of payment. Otherwise known as entry fees, they are primarily charged by traditional banks, distributors of life insurance contracts. Indeed, banks and insurers online, in their vast majority, following their appearance in this segment in the early 2000s, abandoned these charges often very expensive, especially for small savers. Their principle is the percentage charge on all payments since the opening of the contract. The capital is well placed systematically amputated. The banks shall, however, regularly, to promotional campaigns to receive payments without deduction for a limited time.

<> The management of pay life insurance <>
Other costs unconditional life insurance, management fees. These relate to the operations performed on the contract, throughout his detention, placement in either euros or MPT funds. Their samples are, in turn, defined within the contract, due in principle annually. The total amount is on average between 0.5 and 2% of the amount of savings. They are often slightly higher in institutions offering contracts online.
They are paid from interest earned on investment for all funds in euros. For any investment in units of account, the calculation is instead on the value of each share or the number of units. They are, thus, higher on the latter.
These management fees may also be multiplied with, following the establishment, implementation management fee of investment funds, not to mention the transaction costs of these funds.
Focused solely on MPT contracts or units of account, the underwriters are liable for costs of arbitration. These concern the transfer of shares from one medium to another. Their calculation is performed on the sums involved in this change and is expressed as a percentage. The costs of arbitration is often the equivalent of 1% of the amounts so tilted.
Several banks offer life insurance contracts apply a flat rate or application of a minimum investment. Others apply, however, a minimum amount of sampling, which can also be capped. Finally, banks and insurers online have often made it a principle to include in their commercial offers, free of a number of arbitrations per year. The best bid is then often a function of the amounts to invest and move from one medium to another.
Finally, last costs traditionally collected, checked off the cost. Although less common, they are however still available and require greater attention following the perspective of saving everyone. Indeed, without consequence for a long-term investment, they are however very disadvantageous for the short term.
Their principle is simple because instead of taking a percentage from each payment, the financial institution determines that the first filings are used to pay fees in advance, may well amount to a package. Often attached to one or two years with regular payments, then this corresponds to dispose, at the end of this period, a zero capital. After this period, payments are then free of any withdrawal. Hence the interest not to enter such contracts for an investment in the long term. To ensure better visibility to the subscriber's contract, the law now requires the insurer to provide, upon signing the contract, a table showing the values of future redemptions after the scheduled deposition.
The costs are particularly numerous on investments in life insurance. Also, it is necessary to take this into account in any comparison to avoid any unpleasant surprises. However, to simplify matters for investors, more and more schools now report their returns net of fees. A good way to know with more precision the exact amount of interest and capital gains that each policyholder can expect ... while keeping in mind that every investment in cross-channel and unit of account, corresponding to stock market investments, remain uncertain about the results to be expected.

The different management options in life insurance contracts


Life insurance today's in its finest hour and it does not seem ready to stop considering the many benefits it provides to all its holders.
Tax exemption at the end of eight years after the opening date of the contract, no inheritance tax of up to 152,500 euros and feasibility of designating the beneficiaries of his choice, here are some of his qualities, combined with the ability to devote the money paid to the beneficiaries, whether for retirement planning, to bequeath a share or for a specific project.
Life insurance offers several carriers to choose according to your investor profile, between conservative or, conversely, dynamic. To do this type of contract offers three options, regardless of the insurer, the funds in euros particularly safe, or the MPT units accounts for higher profits, but also a substantial risk taking.
Another choice to make when opening a life insurance policy: its management. Indeed, all the banks and insurers offering these contracts also involve them in solutions to manage their money every day, following the wishes of each and time to devote to it.

<> The utility management services to life insurance <>
Management options are used to optimize the life insurance contract. Increasingly regarded as genuine financial services, they offer a wide range of products adapted and often reassuring.
Many banks offer these options for free or by including them in packs to multiple services. From there often resulting costs, either through sampling or packages in each operation.
Primarily, three types of management are offered under different names depending on the well: the free management for managing the contract at will, especially with new online tools, management-led actions to provide automated and secure management that can automatically protect their capital but also its capital gains.
All these forms of management are divided into several functions, using grouped or individually, according to his needs.

<> Management options for a better life's savings <>
Indeed, whatever their management choices, each subscriber can then take advantage of these related services, either by triggering itself, either by switching to automated actions and programmed.
Thus, the first of these management options that are most used, automatic rebalancing. This tool keeps your investor profile, taking into account the changes in selected investments. Data must be entered when subscribing to this option to define the risks and precautions to be taken and that the wishes of protecting savings gained.
Its operation is simple: the composition of the media at a given time is compared to the previously defined risk taking. The account is then adjusted as necessary to correspond exactly to the investment chosen. This includes cross-channel investments or units of account in order to maintain the original profile of the subscriber. The entire process is done automatically, without the insured having to deal with it. This feature also helps protect the interest generated.
For best results with this system, however it is advisable to opt for a rebalancing formula performed each quarter, rather than annually, corresponding to a time when too large to effectively monitor the fluctuations of the exchange.
Another management option, boosting the fund's capital gains in euro. This feature helps protect the capital invested in the euro fund by reinvesting the capital gains generated on the unit-holders in the present contract. This option contracts in MPT. This arbitration is generally done annually. Thus, all risks are transferred exclusively on profits by offering the possibility of better performance. All the money invested is well preserved, amputated fee payment in the event they are charged. The option can, in most insurance be taken out at any time but is, however, often dependent on a minimum amount of transfer. A management option which is also given more often and has even become a must investment in MPT.
For all the investments chosen on dynamic media, each investor can then make the choice, conversely, to secure the capital gains on investments in units of the fund accounts in euros.

<> The incremental investment: the tool for all life insurance <>
Still, everyone is not an investment expert. To better understand the investment in stock market through life insurance, a new tool is proposed for investment in MPT , it is the incremental investment. With a capital invested in funds in euros, the subscriber can then gradually take progressively more aggressive option through arbitration conducted according to a predefined schedule, and payments on life insurance also scheduled. Thus accessible to smaller investors, however, it is recommended only for a vision of long-term investment.
Among the options for managing the most common, there is one last, that of progressive security of savings. These are available automatically to protect their capital gains. This step is often chosen to prepare for retirement, to get the best performance while protecting certain amounts on a regular basis according to a predetermined schedule and ensure an income.
Management options are likely to be made available to purchasers of life insurance policies to guarantee them a good return, without manual intervention on their part. Often billed as the products are fully automated and take account of previously defined criteria. So a good solution to live in serenity its savings while ensuring good returns, securing its capital and a progressive amount of capital gains.

Life insurance, a good way to prepare for the future

At its creation in the life insurance was a contract whereby an insurance company agreed to pay a sum of money, determined to advance to a designated beneficiary upon subscription, if achieving certain events concerning the insured person, such as a death or disability. If this form of life insurance continues.
At its creation in the life insurance was a contract whereby an insurance company agreed to pay a sum of money, determined to advance to a designated beneficiary upon subscription, if achieving certain events concerning the insured person, such as a death or disability. If this form of life insurance continues to exist today under the name life insurance, a new form of life insurance has been established, opening access to taxation in a particularly advantageous and now require, by the insurer, the release of capital saved by the subscriber and increased by a rate-dependent media on which the funds were invested. Although these two types of contracts are generally two distinct forms, some insurers offer the opportunity to enjoy "mixed", capable of providing, at a time, the guarantees provided by insurance death and those obtained by the life insurance.
Can be used by investors to prepare for retirement, life insurance has a specific legal framework governing all aspects of this investment, this applicant, since the signing of the agreement, a number of references to clearly inform the subscriber. It is thus necessary for the insurer to include in its contract, the particulars necessary for identification of the beneficiary, the exact date when the payment of principal or annuity will be held, and the value of over the contract. If, in many respects, the life insurance contract may resemble other commitments, such as deposit accounts, it should be emphasized that the money remains fully available here, and at any time.
Particularly attractive, life insurance policies also differ from other savings products by tax preferences, leading to a fixed withholding tax of 7.50% LibĂ©ratoire only where the subscription has lasted a minimum of eight years and more, well Naturally, social contributions, enabling guests to enjoy an investment the most profitable. The possibility of designating a beneficiary appears, too, as a major advantage of these formulas, since it gives the opportunity to the subscriber, to prepare his estate during his lifetime, and it induces, again, preferential taxation for the heirs, this time, while benefiting from a reduction of € 152,500, the tax levied on the excess capital amounting to 20% then after a second reduction of € 4,600 per year minimum. It is also important to remember that the amounts deposited by the purchaser after the age of 70 are, in turn, reinstated the estate of the latter involving the payment of inheritance tax, after deducting an allowance of € 30 500.
Intending to achieve the dual objective of preparing his retirement and organize his estate, life insurance, coupled with a guarantee death, can enjoy the benefits of these devices and thus provides a particularly effective way to prepare its future and that of his relatives.

Consumer toolkit, online complaint filing, agent lookup: New tools for the New Year

We're rolling out new consumer tools for the new year, including an easy way to look up past violations and complaints against insurers and agents.
The insurance commissioner’s website now includes a “consumer toolkit” that offers:

• Easy-to understand information on different types of insurance.

• Online filing – and tracking – of complaints against an insurance company.

• Online filing of complaints against an insurance agent or broker.

• And a new system to look up contact information, licensing history, past violations and consumer complaints against agents or companies.

The agency also continues to expand its website and its social media presence, including a new page on Facebook.

NEW YEAR RESOLUTIONS

New Year’s Resolutions


This is the time of year when many will make those promises to themselves, we call “New Year’s Resolutions.”

Here are a few suggested ones, on both the legal and personal fronts that may prove helpful:


1. Spend more time with a child. Children spell “LOVE” as T-I-M-E.

2. Spend less than you make, or you will always be behind. If you are in debt, rather than pay a little extra on everything, try targeting one at a time with all you can raise.

3. Have your Will, Living Will, and Durable Power of Attorney for Healthcare drawn up by an attorney of your choice.

4. Forgive those who have wronged you. It may not be healthy or safe to actually restore them back into your life, but forgiving them is a gift you give yourself.

5. Get a physical and listen to what your doctor recommends. If you smoke, please quit. Start walking regularly, preferably with your spouse.

6. Just in case there is a fire, earthquake or flood, take a video tape of the inside of your house, garage and attic, and send the tape off to a friend or relative far away. If you have an insurance claim, the proof of claim forms will be a breeze compared to doing it by memory alone.

7. Give to the church or charity of your choice. “Takers eat well, givers sleep well.”

8. Call up a friend, coach, pastor or teacher you have not seen a in while.

9. Check with your car insurance agent and make absolutely sure that you have plenty of Uninsured Motorist (UM) insurance on every car. Don’t assume that “full coverage”includes that if you are with a discounted insurance company. Also, a car lot that carries insurance on your vehicle does not generally pay for that. Please check it. It pays you if you are hit by a hit and run driver, or an under insured driver.

10. Attend the church of your choice this year. Examine the evidence for God and His Son, for one day, maybe this very year, you will meet Him.

11. Install at least two smoke detectors, and put new batteries in any you have.

12. If you are married, tell your spouse how you feel about them every day.

13. If you are in a parental role, tell the children you are proud of them. All kids need Attention, Affection and Affirmation every day.

14. If you have choice this year between upgrading to a nicer car or getting a nicer house, choose the house.

15. Work hard, but take time off when you can. After all, no one on his death bed, ever rose up to say that he wished he had spent just a little more time at work!

Happy New Year!

SJC holds that separate limits apply to family members seeking coverage under Massachusetts Insurers Insolvency Fund

I wrote here about the Superior Court decision in Mass. Insurers Insolvency Fund v. Smith, which held that the statutory claim limit of $299,999 applies separately to individual family members seeking primary and loss of consortium damages from the Massachusetts Insurers Insolvency Fund.

In 458 Mass. 561 (2010) the Supreme Judicial Court affirmed that decision. The court held that allowing only one limit would substitute the word "occurrence" for the word "claim" in the statute.

Automobile Policy Exclusions

The Superior Court of Justice has re-emphasized the requirement that an insurer must take appropriate steps to bring exclusions to the insured’s attention where the effect of an exclusion will have the harsh result of denying coverage under an automobile policy.

In GMAC Lease Co. Corp v. Lombard Insurance (2007), 87 O.R. (3d) 813, at paragraph 9, the Court of Appeal held that an insurer must provide the insured with a copy of every endorsement, per section 232(3) of the Insurance Act. The fact that an insurer can provide a certificate of insurance instead of the policy does not take away the duty imposed by section 232(3).

The obligation then is to provide the policy or certificate in an improved form as well as a copy of every endorsement. Since the insurer had failed to comply with section 232(3) of the Insurance Act by failing to deliver a copy of the OPCF 28A endorsement, excluded driver, the insurer cannot rely on the exclusion.

Justice Chapnick more recently in Chen Estate v. Chung, [2010] O.J. No. 5086 (SCJ), reiterated the Ontario Court of Appeal’s decision in GMAC Lease Co. Corp. v. Lombard Insurance.

Job opening: Financial examiner

We're looking for a person to fill a financial examiner 3 position in our company supervision division, which is located in Seattle. Applications must be received by 5 p.m. on Friday.

The successful applicant will plan, conduct, and lead in-the-field financial examinations of insurance companies and other entities that our agency regulates. Duties include:
Examines and analyzes annual financial statements, actuarial opinions, management discussions and analyses, audited financial statements, holding company statements, quarterly financial statements, financial ratios, and other sources of information to discern financial condition, difficulties, trends, statutory compliance, accuracy, and completeness.


For more details, please see the job announcement.

Insurance Matters: Claims-Made Policies

From my monthly column for CU Management, the basics of claims made policies...





Your credit union directors’ and officers’ insurance is unlike most other liability insurance policies.



“Normal” casualty insurance policies (general liability, automobile, workers' compensation) pay for events that occur during the policy period. These are called “occurrence policies.” For example, an auto insurance policy will pay for an accident that occurs while the policy is in force. You could cancel your auto insurance the day after the accident and still be covered.



Full Article Here

Stranded traveler? Here are some things to check

The weather on the East Coast has clearly scrambled plans for a lot of travelers this holiday; here are some tips that might help as you sort out your plans for getting home.

If you're wondering what your rights are, do an online search for the name of your airline and the words "contract of carriage." (Here, for example, is a summary of United's.) This is your contract with the carrier. If you feel they're violating it, you can file a complaint here. The bad news: Travel experts say that airlines generally aren't obligated to provide meals or a hotel if the problem is weather-related.

Also, if you used a credit card to buy the ticket, check with your credit card company. Cards come with a variety of perks, and you may have trip coverage without knowing it. Mastercard, for example, offers many cardholders reimbursement for lost or delayed baggage and trip cancellation insurance, as long as the tickets were paid for with an eligible MasterCard card.

For general information on travel insurance, see our page on this topic, which spells out the types of coverage and what they mean, in plain language. We're not trying to sell you anything; we're the state agency that regulates insurance in Washington state.

Lastly, here's the list of toll-free numbers for airlines.

Good luck.

Tool to compare insurance companies by the number of complaints

One of the most-used features of our website is our "Complaint Comparison Tool," a free and simple online tool that lets you compare the number of complaints filed by consumers against different insurance companies.

The information's broken down by year and by type of insurance (health, life, homeowners, auto, etc.). It also compares the number of complaints to an insurer's market share, which makes for easy apples-to-apples comparisons with other companies.

Take a look. We've posted 5 years' worth of data, and should be posting more soon.

Testimonial

More nice comments from a great client...



"I have been thoroughly impressed with Scott's knowledge and understanding of the Insurance industry. Working with a consultant of Scott's caliber certainly makes my job as CEO a lot easier, as it is nearly impossible to stay on top of all the changes in the industry. Knowing that we have the proper type and amount of insurance protection is very comforting. Scott has been very easy to work with and extremely responsive to all my questions and concerns."



Matt Kaubris, CEO

Oxford Federal Credit Union

Mexico, ME

Superheroes require super insurance

This blog post discusses insurance issues in the superhero world.

Happy holidays, everyone.

Job opening: Chief market analyst

Our office is looking for a chief market analyst to fill an opening at our Tumwater office.

The person will manage staff performing market analysis, and help ensure that companies are acting within the scope of their license and are complying with laws and regulations.

Here's the job listing, which has much more detail about qualifications, salary, etc.

The critical part: Applications are due by 5 p.m. on Dec. 31, 2010.

Also, here's a handy online tool from careers.wa.gov that can e-mail you information about any job openings at state agencies, universities, etc.

Appeals Court holds that ch. 176D applies to captive insurer

Lemos was injured in 2001 as a result of defects in a lawnmower manufactured by Electrolux. He obtained a jury award of $550,500. He then brought an action against Electrolux's captive insurer, Equinox, alleging that it engaged in unfair claim settlement practices in breach of Mass. Gen. Laws chs. 176D and 93A.

As explained by the court in Lemos v. Electrolux North Am., Inc., 78 Mass. App. Ct. 376 (2010), a captive insurance company is formed to bear the risks of the parent company. Premiums paid to a captive may be tax-deductible, and a captive has the potential to produce lower insurance costs.

Electrolux was the parent and sole shareholder of of Equinox. The director of risk management at Electrolux, who was also the president of Equinox, stated that Equinox had no employees, only a board of directors. Its role was purely that of a funding vehicle for the reimbursement of Electrolux for claims that are paid by Electrolux.

Equinox argued that because it is a captive company, Electrolux is in effect a self-insurer, and that Equinox is therefore not engaged in the business of insurance so that the requirements of ch. 176D to not apply to to it.

The Superior Court agreed and granted summary judgment to Equinox.

The Appeals Court reversed. It noted that Equinox is a separate, for-profit entity that calculates the premiums it charges based on loss experience and costs, calls itself an insurance company, and issued a policy that states it provides commercial general liability and other coverage. It also noted that Electrolux receives a financial benefit from using a captive insurer rather than being self-insured.

Statutory Third Party

Ahmed v. Maharaj, [2010] O.J. No. 4922 (S.C.J.)

Here's a decision that might be useful to counsel for a Statutory Third Party. There were two issues in this motion:

1. Whether the Statutory Third Party is entitled to pursue a crossclaim against one of the co-defendants; and
2. Whether the Statutory Third Party could be compelled to answer questions on examination for discovery about why it denied coverage.

Justice Stewart held as follows:

1. The Statutory Third Party is entitled to bring a crossclaim, since the Insurance Act does not expressly limit it to the right to file a Statement of Defence;
2. The Statutory Third Party is not required to answer questions about why coverage was denied. Generally issues of coverage and issues of liability are to be kept separate. A plaintiff who wishes to challenge a denial of coverage may do so following judgment pursuant to s. 258(1) of the Insurance Act but until that happens, issues of coverage are generally not relevant.

Honesty, Ethics, and Openness

I talk with about 5 insurance agents every day in my work for clients. There are some agents I have known for 20 years. Others, I'm talking to for the first time.



Today I spoke with three agents whom I had never met. I did not know them and they did not know me. Two of the three were not convinced that I was not some kind of shadow agent looking to take their business away. I tried to assure all that I never accept fees or commissions from agents or insurers in my work for insurance buyers. I have no ties to any agents. I will not invest in a stock of an insurance company (though, full disclosure, I do own some investments through mutual funds that have small stakes in an insurer or two.)



Several years ago I owned stock in a large bank. The bank bought an insurance agent. I sold the stock.



Agents try to buy me lunch. I politely refuse. Agents send me sporting event tickets. I return them. Several times I have received gifts from agents. They are returned or, if perishable, donated to my local fire department.



The UPS guy knows to check with me this time of year when a gift box comes as I have refused several deliveries.



I'm not trying to put myself out as some paragon of virtue. Frankly, having firm rules of conduct make things easier for me. I know what is right and what my clients expect of me.



Also, frankly, I have wondered on more than one occasion if an agent isn't testing me by sending a modest gift. I picture the sender waiting with baited breath to report any indiscretion to my client. Try me and you will be disappointed.



Some say that true character is what you do when nobody is looking. I just assume that ethical lapses will always come to light.

We're expanding our social media presence

As a small agency with a broad consumer-protection mission, one of our hardest jobs is simply getting the word out to consumers that we can help them. Increasingly, we're turning to social media tools to help spread the word.

In the summer of 2009, we launched this blog, which is getting thousands of visitors a month. Shortly thereafter, we set up a Twitter feed, which we believe is now the second-largest among state insurance departments nationwide. From what we can tell, the blog tends to attract consumers Googling around for information. Our Twitter followers tend to be industry folks: agents, brokers and insurers.

Now we've launched an agency Facebook page. We're hardly the first Washington state agency to do so (Here's the list, put together by the good people at access.wa.gov), but surprisingly few insurance departments are using this tool. We'll see how it goes.

Carbon Monoxide

A friend had a scare with carbon monoxide. Her daughter lives a few doors down the street with her husband and little children. The CO monitor went off last night. By the time she got the kids out and the fire department arrived the CO levels were lethal. What a very different morning today would have been.



You need a CO monitor on every level of your house. Check the batteries on the monitors you do have.

Where to look if you can't afford health coverage

We've put together a list of resources, suggestions and alternatives for folks who cannot find affordable health coverage. Our "can't afford health care coverage" page includes links and information about:
  • community clinics and local free clinics,
  • state-offered health coverage,
  • free cancer screenings
  • hospital charity care
  • dental exams and treatment
  • and specific programs for certain diseases or disabilities.

High wind warning for eastern Puget Sound

The National Weather Service is forecasting gusts of up to 60 miles per hour tonight and Saturday in the east Puget Sound lowlands, which includes Bellevue, Gold Bar, Enumclaw, North Bend and Buckley. The good news is that those are the gusts; the wind will generally be 20-30 miles per hour in the area.

Wet soil and high winds often mean tree damage, so here's our ever-popular winter storm guide, with common questions about insurance and storm damage.

Insurance survey ranks Olympia as the safest mid-sized U.S. city in America; a dozen other Washington cities also score well

Farmers Insurance Group has released its seventh annual list of the safest cities in America.

Scoring highest among mid-sized cities: Olympia, Wash. Also doing well: Seattle/Bellevue/Everett, Bellingham, Yakima, the Tri-Cities, Spokane, Bremerton-Silverdale, Wenatchee, and Mount Vernon-Anacortes. (Some areas are grouped into single statistical areas.)

How do they decide? Here's what their press release says:
The rankings, compiled by database experts at www.bestplaces.net, took into consideration crime statistics, extreme weather, risk of natural disasters, housing depreciation, foreclosures, air quality, terrorist threats, environmental hazards, life expectancy and job loss numbers in 379 U.S. municipalities.

Case closed: Man who claimed $33k tie collection had been stolen pays the money back, pleads guilty

A Lynnwood man who claimed that thieves had repeatedly made off with his collection of more than 200 silk neckties has paid back more than $33,000 and pleaded guilty to two counts of making a false insurance claim.

Under a diversion agreement, the felony charges will be dropped from his record if he complies with the agreement.

Carlton H. Wopperer, 50,  was charged with two counts of insurance fraud in Snohomish County Superior Court in July. Last week, he paid restitution of $33,370.67 and signed the diversion agreement.


Three times in 9 years, Wopperer claimed, thieves had stolen his collection of 212 silk neckties from his vehicle. But an investigation by the state insurance commissioner's office revealed that Wopperer had returned many of those ties within minutes of buying them.

On Jan. 5, 2009, Wopperer told the Mill Creek Police Department that his vehicle had been broken into while parked at a greeting card store. He said that four plastic containers containing 212 of his silk neckties had been stolen. He said that he’d taken the ties to a quilt shop to see about having them sewn onto a quilt for display.

Wopperer purchased replacement ties from Nordstrom, Butch Blum, Barneys New York and Mario’s of Seattle, submitting the receipts to his insurer. His insurer, PEMCO Insurance, paid him $33,370 under the terms of a provision allowing for replacement cost of stolen items.

Six months later, on June 9, 2009, Wopperer reported a very similar crime. He told the Everett Police Department that his vehicle had been broken into while he was moving. The 212 replacement ties that he’d purchased following the January theft had been stolen, he said. He subsequently filed an insurance claim for approximately $35,000.

But a PEMCO adjuster, checking with the retailers, learned that most of the ties purchased in January had been returned almost immediately. PEMCO denied Wopperer’s claim and reported the case to Insurance Commissioner Mike Kreidler’s Special Investigations Unit. State investigators interviewed store employees, documented the paper trail and referred the case to the Snohomish County Prosecutor’s Office.

(The investigation also revealed that there had been a third claim. Nine years earlier, on June 19, 2000, Wopperer told the Lynnwood Police Department that his collection of 212 silk ties had been stolen from his vehicle while parked at a mall. His insurer at the time paid his $16,900 claim.)

LAW SCHOOL NO LONGER GUARANTEE OF JOB

LAW SCHOOL NO LONGER
GUARANTEE OF JOB

Back in the early 1990’s, when I attended law school, most students were pretty confident that they would land jobs upon graduation. The placement rate of over 90% back then, seemed to at least guarantee an income, if not a dream job.
I have been blessed in many ways, and have run my own plaintiff injury firm for over a decade now. However, I was surprised to learn that the National Association for Law Placement reported the 2009 placement rate to remain at an astounding 88.3%. I am surprised it is that high, and I was quite skeptical of that number.
In fact, that number turned out to be misleading. More than 30% of the 88.3% employed are actually working either temporary or part time jobs. There is no telling how many of the others may be considered “under employment.”
There are several trends that make jobs much more scarce for the new lawyer out there today.
First of all, I have watched one insurance company after another take their lawyers “in house.” This term means that they hire attorneys on salary to handle most matters. While larger or more complex litigation may be “jobbed out” to a traditional defense firm, much of that work dries up. These larger firms are the very ones who often hired interns during the summer and even had hiring tables set up in the lobby of the law schools. No more.
There is also the role of mediation. While I am a Rule 31 Listed General Civil Mediator by the Tennessee Supreme Court, I also recognize that the reduction it provides in litigation hurts defense lawyers out there.
Thirdly, so-called “tort reform” measures threaten both plaintiff lawyers and defense firms. Caps on judgments and various restrictions lessens risks to wrong doers who use larger firms.
Both political parties in Washington, D.C are constantly tossing around tax policy like the proverbial hot potato. Smaller law firms declare all income as personal, and therefore may find themselves in higher tax brackets. It is these small businesses that provide many jobs for paralegals, receptionists, assistants and lawyers. Without clarity of what the tax burden will be, many smaller firms are unwilling to hire more staff.
The law schools are still churning out 100’s of newly minted J.D.’s each year. Many have costly student loans to repay. Some who will graduate in the next couple years actually only went back to school to “wait out” the recession. Thus, there will be a further surge of hungry souls out here ready to travel to exciting cities, meet interesting people, and sue them.
Finally, the advent of television advertising has greatly increased competition for plaintiffs’ injury cases of all kinds. This can decrease margins for struggling firms and restrict hiring even further.
In general, unless you are called to practice, do not consider law school. Academically, financially and socially, law school is quite a challenge. And, with no assurance that you will even get a job interview, it is even less attractive.






The real downside to the secondary mortgage market: consecutive mortgagees can't get their paperwork to insurer

WMC was the mortgagee of property in Athol, Massachusetts. (Reminder: the mortgagee is the entity such as a bank to whom the homeowner makes mortgage payments.) MPIUA issued a homeowners policy for the property which provided coverage to both the homeowner, Brohl, and WMC.

WMC transferred the mortgage note to UBS. UBS retained Ocwen to service the loan. The MPIUA policy was amended to add Ocwen as a mortgagee.

On January 25, 2007, Brohl notified MPIUA that the property had sustained water damage. On February 4, 2007, there was a fire at the property.

On June 12, 2007, Ocwen sent MPIUA a notice of claim seeking damages under the policy. The letter defined Ocwen as "the mortgagee." (Meanwhile, Brohl was being foreclosed upon.)

MPIUA requested documents from Ocwen. On July 16, 2007, the mortgage note was sold back to WMC, and Ocwen never provided MPIUA with the requested documents.

On December 20, 2007, WMC resold the mortgage loan to Credit Suisse. SPS serviced the loan for Credit Suisse.

On June 19, 2008, SPS submitted a claim to MPIUA on behalf of SPS "as the insured mortgagee under the policy." SPS enclosed with the letter a number of documents regarding the transfer of the loan. MPIUA responded with a request for documentation showing SPS' or Credit Suisse's status as proper claimants, including a paper trail from WMC to SPS. It also requested documents showing that SPS had notified MPIUA of its mortgagee status or any efforts to amend the declarations page of the policy.

SPS provided documentation regarding the mortgage transaction, and stated that it was unaware of notices to MPIUA regarding the change in mortgagees.

MPIUA responded to SPS that the documentation it provided was insufficient, and requested copies of the agreements assigning the mortgage from WMC to any subsequent mortgagee. SPS did not provide the requested information.

On September 28, 2008, WMC repurchased the loan from Credit Suisse.

WMC did not notify MPIUA that it had repurchased the mortgage. Instead, on March 23, 2009, it sued MPIUA, claiming that MPIUA breached its contract by failing to pay WMC’s mortgagee claim and had engaged in unfair settlement practices.

After the lawsuit was filed MPIUA continued to request evidence of WMC’s status as mortgagee. On September 22, 2009, WMC produced documents proving that it was now (again) the mortgagee. However, MPIUA did not pay the loss.

MPIUA argued that it was entitled to summary judgment because prior to filing suit WMC and its predecessors failed to provide satisfactory proof of their right and title as mortgagees. In WMC Mortgage Corp. v. Mass. Property Ins. Underwriting Ass’n, 2010 WL 3734120 (D. Mass.), the court held that MPIUA was entitled to summary judgment on the claim that it failed to act in good faith when it refused to provide coverage without additional documentation.

The court also held that MPIUA could not avoid coverage of the loss. Under Mass. Gen. Laws ch. 175 §97, a statute regulating fire insurance, MPIUA’s obligation to provide coverage to a mortgagee named in the policy arose upon satisfactory proof of the mortgagee’s rights and title as a mortgagee.

WMC was named as a mortgagee in the policy, and after the lawsuit commenced it provided sufficient evidence to establish its status as the current owner of the mortgage.

Finally, the court found that the various mortgagees breached the duty to cooperate when they failed to comply with MPIUA’s requests for information and that MPIUA was thereby prejudiced. The court held that the prejudice would be remedied by an order directing WMC to pay MPIUA’s attorney’s fees and costs incurred in the lawsuit.

Tort Reform: liberal or conservative??

Is tort reform liberal or conservative??

As a conservative tort lawyer I am always accused of being liberal by
conservatives and vice versa. Liberals think I'm conservative due to my
social stances as a christian. They are right. But what about conservatives
who call me liberal? Well they are not right. Why? Because tort reform is
not truly a conservative issue.

Tort reform takes power away from the individual and gives it to the
government. That is clearly not conservative. Empowerment of the
individual and allowing market forces to shape policy argues strongly
against tort reform.


Tort reform hurts people who did nothing wrong. While conservatives might
be criticized for being pro life we also tend to be for capital punishment.
It is the taking of innocent lives that we object to. On what grounds is
that consistent with further punishing a victim??

Not only does tort reform hurt those who already got hurt, it actually
protects the hurter. Assume a doctor who is rushed as cuts off the wrong
leg.
That happened not long ago. Who should say what that is worth? Is it
worth more if it is an 8 year old?

jurors who see the evidence, are in a much better position to decide an
individual case than buerocrats in government.

I think that the court system allows the davids of the world to take on the
goliaths.
One reason airlines, cars and hospitals are generally safer is due to your
access to court

More specifically it is the potential unlimited award that protects you.

Never get Fooled into thinking that tort reforms protects
Anyone other than those who hurt you.


David B. Peel
PeelLawFirm.com

tort reform song

this is a funny song reminding us about the realities of tort reform



Earthquake Excluded & Other Stuff Is Too

Almost all property insurance policies exclude earthquake. Coverage is available almost everywhere in the US - either through standard or specialty insurers.



What is not commonly discussed is that the earthquake exclusion is broader than just earthquakes.



The following are excluded in the same breath:



landslide,

mudflow,

sinkhole,

mine subsidence

land shock waves before, during or after a volcanic eruption,

and any other earth movement including shifting, rising, or sinking.



These exclusions are in commercial policies and in personal insurance policies.



Class dismissed.

Individual plan open enrollment for kids ends Dec. 15

If you want to buy an individual health plan for your child this year, or add your child to your individual plan, or if you’re an emancipated minor looking for an individual health plan, the 2010 open enrollment ends today. Kids still can get coverage through the Washington Health Insurance Pool and, if they qualify, from the Pre-existing Condition Insurance Plan.

We'll announce enrollment options for 2011 in the next few weeks.

New consumer protections under the Affordable Care Act prevent all health plans from discriminating against children because of a pre-existing condition. However, special enrollment periods are allowed. Washington state’s 2010 individual plan open-enrollment period was Nov. 1-Dec.15. During this time, children under age 19 could enroll in an individual health plan without having to take a health screen.

Insurance Commissioner Mike Kreidler created the special open enrollment period through a rule. After today, children under age 19 can get coverage through the Washington State Health Insurance Pool (WSHIP), or if they qualify, through the new Pre-existing Condition Insurance Plan (PCIP-WA). To enroll in PCIP-WA, you must have been uninsured for at least six months and have a pre-existing medical condition. There are some exceptions where parents can apply for coverage anytime in the individual market, such as the birth or adoption of a child or if a child or the parent:

■is no longer eligible for a state program.
■loses coverage due to a divorce.
■loses employer-sponsored coverage.
■moves and their plan is not available in where they live.

If you have questions about how to find health insurance or if you need help understanding your rights, call us at 1-800-562-6900 or read our health insurance page.

Home Deck Safety

Inspect the support system for your back-yard deck at least once a year. Make sure the frame of your deck is lag-bolted and not just nailed where it is attached to your home.

Settlement of Accident Benefits is Not an Admission Threshold Met in Tort

Anand v. Belanger, 2010 ONSC 2345 (CanLii)

The plaintiff was injured when she was struck by a stolen vehicle. State Farm was the plaintiff’s accident benefits provider, and was named as a tort defendant pursuant to the uninsured motorist provisions of the policy.

State Farm paid IRBs until the 104 week mark, when it terminated benefits on the basis that Ms. Anand did not suffer a complete inability to engage in any employment for which she was reasonably suited by education, training or experience. At a mediation, the parties settled past and future IRBs for $100,000. Ms. Anand signed a release that included a provision that the settlement was not an admission of liability.

At the tort trial, the plaintiff sought to preclude State Farm from alleging the plaintiff did not meet threshold on the basis that it had paid for past and future IRBs, which constituted an implicit admission.

Justice Stinson held that payment of IRBs does not amount to an admission in the tort action. The plaintiff signed a release specifically agreeing that the settlement was not an admission of liability. In addition, in its capacity as the accident benefits carrier, State Farm had contractual duties and a duty of utmost good faith in dealing with its insured, Ms. Anand. As a tort defendant, State Farm owed no such duties. Accordingly, State Farm was free to argue the plaintiff did not meet threshold.

Justice Stinson's decision is sensible, especially given the differing characteristics of accident benefits and tort. It also underscores the importance of including a paragraph in releases that settlement is not an admission of liability.

Wind damage and insurance

High winds swept through western Washington last night, with peaks of 70 mph in Hoquiam, 62 at Alki Point, 54 at McChord Field and 43 in Puyallup. (Here's a National Weather Service map of the winds and list of other cities' wind speeds.)

Power was knocked out for thousands of people, according to the Seattle Times, and there were downed trees throughout the area: 3 trees fell on one brick home in Seattle, a falling tree killed a woman in her mobile home in Kitsap County, and firefighters in Snohomish County freed a man trapped in his home by a fallen tree.

All of which brings us back to a frequent topic this time of year: winter storms and insurance. We've posted a long list of questions and answers online, including things like:

-Is your car covered if tree limbs fall on it?
-Will insurance pay to clean up all that tree debris in your yard? (Sorry; no.)
-What if your boat in the marina sank in the high winds?
-What if the power surge killed your TV?

...and much, much more. Take a look, and if you have questions or are having trouble getting a claim paid -- and you're a Washingtonian -- call us at 1-800-562-6900. We're the state agency that regulates insurance in Washington state; we'll try our best to help you.

WSJ - Tis The Season to Be Stupid

I got a short mention in yesterday's Wall Street Journal...



I'm always amazed when I find non-profit boards of directors without directors' and officers' insurance.

Flooding and insurance: What to do

We're starting to get calls and emails from folks who sustained flood damage from this weekend's heavy rains. Here's some advice about what you can do if you're trying to clean up:

-Document the loss. Take photos, notes, video, etc.
-Contact your insurer as soon as possible. Be aware that standard homeowners coverage does not cover flood damage. But you may have flood coverage without knowing it -- in flood-prone areas, it's often required in order to qualify for a mortgage.
-Mitigate the damage as best you can. Get furniture and belongings up out of the water if possible. Shovel or squeegee mud and water out. Start drying things out.
-Create a paper trail. If you rent a pump, save the receipts. If your electrical system's damaged and you have to move to a motel temporarily, save those receipts.
-Where practical, avoid throwing out damaged items. The adjuster may want to see them.

Also: Standard flood coverage generally doesn't cover basement improvements, like finished walls or floors, or furniture or personal belongings in a basement. It does, however, cover essential equipment like your furnace and water heater.

Defence "Life Care" Assessment

This entry was prepared by Alexandra Lacko, articling student.




In the case of Vanderidder v. Aviva Canada Inc., 2010 ONSC 6222, the moving party sought an order compelling the plaintiff, Vanessa Vanderidder to participate in a life care plan assessment by a certified life care planner.

The action arose out of an accident in which the plaintiff sustained an injury when a rock fragment fell from a truck, deflected from the road surface, went through her open car window and struck her in the head. The plaintiff alleged that she sustained serious injuries which caused permanent and serious disfigurement and serious impairments of important physical, mental and psychological functions. She also alleged that she continued to suffer and required treatment, and would continue to suffer from the effects of her injuries for an indefinite period of time. The plaintiff claimed damages for future health care costs as a result of the effects of the injuries on the activity of the plaintiff.

In support of Vanessa Vanderidder’s claim for future health care costs, counsel for the plaintiff served a future care cost report authored by Keith C. Hayes, Ph.D. The report was analysed by an actuary and placed a present value on the plaintiff’s future health care needs at $719,901.00.

As a result of the substantial monetary claim of the plaintiff, the moving party wished to have Vanessa participate in a life care assessment/future care cost assessment by an individual who had a Bachelor of Science in Occupational Therapy and was defined as a “practitioner” pursuant to s. 52 of the Evidence Act, R.S.O. 1990, c. E.23. The basis for the moving party’s motion for the life care assessment/future care cost assessment was prejudice.

The position of the responding party, Vanessa Vanderidder, was that the moving party had not deduced any evidence that the requested assessment was necessary to aid a health practitioner as a diagnostic tool.

Plaintiff’s counsel asked Justice Granger to recuse himself from hearing the motion on the grounds that in Kozhani v. Gelbart, [2010] O.J. No. 1348, Justice Granger ordered the plaintiff to submit to a life care assessment/future care cost assessment by an occupational therapist without a health practitioner requiring the assessment as a diagnostic tool. Plaintiff’s counsel suggested that based on Justice Granger’s earlier decision, there was a reasonable apprehension of bias and that Granger J. should recuse himself from hearing the motion. Justice Granger went through the test for bias and found that plaintiff counsel’s apprehension was an apprehension of lack of success rather than an apprehension of bias and Justice Granger did not recuse himself.

In coming to his decision on the assessment, Justice Granger underwent an analysis of the case law in the area of non-medical expert assessment. Justice Granger stated that:

It would seem to me that if Vanessa Vanderidder elects to place before the court evidence concerning her future care needs as determined by a non-health practitioner, she can hardly be heard to claim that it would be unfair to order her to submit to such an assessment by a person of the choosing of the defence.

The Court concluded that “fairness can only be achieved by ordering Vanessa Vanderidder to participate in a life care assessment by a person other than a “health practitioner” notwithstanding that there is a lack of evidence before me from a health practitioner that such an assessment is needed by a health practitioner as a “diagnostic aid.”

The plaintiff was therefore ordered to participate in a life care plan assessment by the certified life care planner and occupational therapist. The Court’s goal was to achieve fairness in the trial process in order to create a “level playing field” for trial.

Testimonial!

"Scott's knowledge and expertise of the insurance industry are unmatched. With his professional input, we were able to consolidate our insurance needs and identify any gaps in coverage that we had. He was always available to answer our questions, help review our policies and provide feedback on our insurance coverage. We could not have developed a successful insurance program without his invaluable advice."



Renea Hohenfeldt

Bell Management

Joplin, MO

Winter storm update: Flood insurance

Heavy rains over the weekend raised rivers high throughout the region, but the storms this morning began moving to the southeast. Many rivers in the region, according to FEMA, crested Sunday night, with longer rivers cresting Tuesday or Wednesday.

Our agency's particularly interested in south King County's Green River Valley, where we've set up what's called a "market assistance plan" to help businesses find flood insurance coverage. According to FEMA, the amount of rain falling in that area "is not expected to be of concern for Howard Hanson Dam operations or for flooding on the lower Green River Basin."

Still, this is probably a good time for a reminder: Contrary to what many people think, standard homeowners coverage and business insurance policies do not cover damage from floods. For flood protection, you generally have to buy a separate flood insurance policy. If your property is in a flood hazard area, you'll probably be required by your lender to have this coverage.

Fortunately, flood coverage is widely available through the National Flood Insurance Program. For more on that, and a link to an easy site to check your property's flood-risk profile, see our flood page.

To Bid or To Renew, Your Insurance, That is the Question - Version 2

Here is version 2. I added a box and arrows showing the idea of a broker of record letter. My thinking evolves as I write the white paper that will explain my graphic.



Chinese Drywall A Casualty Loss According to IRS

The insurance press has been filled with info on the Chinese Drywall saga over the past year or so.



The IRS has released a ruling that allows for a casualty loss on your taxes for certain expenses.



See the IRS announcement.



The Center for Disease Control has information on the health affects of the Chinese drywall...



See The CDC drywall info site.

A plain-language guide to Washington state insurance law

For quite a while, one of our staffers has been periodically maintaining two plain-language guides to Washington's lengthy insurance laws. One's for life and health plans, the other's for property and casualty policies.

We've used these as a staff resource for years, and figured it might be helpful to post it online for anyone to use. Trying to find the insurance laws about emergency medical services? Think you've been unfairly discriminated against? Have detailed questions about life insurance or long term care policies?

Take a look, and feel free to bookmark them.

(Of course, we'd also be happy to sell you a printed copy of the state's insurance laws, for $20-$25 each. But the web versions are so much easier to search. And free.)

Testimonial!

"Hiring Scott to review the Bank's Insurance Policy quotes has proven to be a very good decision for the Bank. Scott is knowledgeable, thorough, and understood what we were trying to accomplish thru the evaluation process. Scott accomplished this on short notice and gave us his recommendation with detailed exhalations between the different proposals. On top of this he ended up negotiating a significant decrease in our premium."



Roger Metheny, EVP/CFO

Clear Mountain Bank

Bruceton Mills, WV

Distinct Advantage Administrative Services ordered to stop selling illegal vehicle service contracts in Washington state

Our office has ordered a Federal Way, Wash.-based company to stop selling unauthorized vehicle service contracts in Washington state.

The order names Distinct Advantage Administrative Services, LLC, company principal Michael Phelps and former insurance agent Thomas L. Ross. Ross is a former Washington insurance agent whose license was revoked in March 2003. Nonetheless, he began marketing Distinct Advantage service contracts around October 2009 as an "agent" for the company.

None of the three are registered with Washington as a service contract provider.

Distinct Advantage sold at least 37 vehicle service contracts, totalling $26,468, through 6 car dealers. The contracts were not approved for sale in Washington. The forms state that Distinct Advantage is insured by Colonial American Casualty and Surety Co., but Colonial American has no record of any affiliation with Phelps or his company.

Here's a link to the full order.

Lost Laptop = $1,000,000 Reward

Hip-hop artist Ryan Leslie is really wants his stolen laptop back. He is offering a $1 million reward for its return.



Read more here.



Of course he wants his laptop - but he really wants his data-files. Too bad he didn't spend $100 on a backup system and another $50 for a service like Lojack for Laptops.



Backup all your computers. Protect your laptops with tracking software.

An Interesting Twist on Beasley v. Barrand

The fallout from the Beasley v. Barrand decision continues. You may recall that in Beasley, the Court refused to permit expert evidence at trial from accident benefits assessors.

In Jeffrey v. Baker, [2010] O.J. No. 4415 (S.C.J.), the defendant sought to compel the plaintiff to attend at an orthopaedic IME. She had already attended at two IMEs with a physiatrist and psychiatrist, and the defendant had lost a motion in 2009 to compel two additional examinations.

Justice Quigley allowed the motion and ordered the plaintiff to attend the orthopaedic assessment. One of the reasons for allowing the IME was that prior to enactment of the new rule 53 the defendant would have been at liberty to call accident benefits assessors to give expert evidence at trial, but given the rule change this is no longer permitted, as made clear in Beasley. The Court was satisfied there was a real risk the defendant would be left without evidence to refute the plaintiff’s claims if the orthopaedic IME was not permitted.

First Circuit holds that bouncer's unintentional injury to bystander comes within assault or battery exclusion

Zachary Eaton was minding his own business at a nightclub in Maine called Ushuaia. Another patron got into a skirmish with a bouncer. The bouncer kicked open a glass-and-aluminum door, which struck and injured Eaton.

Eaton sued Ushuaia, which submitted to judgment and assigned its rights against its insurer, Penn-America, to Eaton. Eaton then sued Penn-America to satisfy the judgment.

Penn-America denied coverage on the basis of an exclusion for "damages resulting from assault or battery or physical altercations."

In Eaton v. Penn-Am Ins. Co., __ F.3d __, 2010 WL 472287 (1st Cir.), the United States Court of Appeals determined the coverage issue under the law of Maine.

The court held, first, that while it is acceptable for appellate decisions to be pretentious, they should not "wax longiloquent." (Okay, to be fair, that was just dicta.)

It then held that because the door was dislodged in the course of the assault, Eaton's injuries resulted from the assault and the exclusion applies. It further held that the fact that the bouncer did not intend to injure Eaton was irrelevant to the exclusion, which does not have the same definition as assault and battery in a criminal context.

Des Moines insurance agent charged with multiple counts of first-degree theft

Brenda MacLaren-Beattie, a longtime insurance agent in Des Moines, Wash., has been charged with first-degree theft for allegedly selling fake insurance to oral surgeons in Washington and Oregon.

An investigation by Insurance Commissioner Mike Kreidler’s office found that MacLaren-Beattie, 67, sold thousands of dollars in fake business-insurance policies, often issuing counterfeit certificates of insurance to doctors and clinics.

She was arraigned last week in King County Superior Court. She faces 14 counts of first-degree theft, totaling $41,729 in payments from 11 clinics for non-existent coverage.

The fictitious policies were for business owners’ general liability insurance, rather than professional liability/medical malpractice. General liability insurance typically covers things like slip-and-fall accidents, employee theft, and damage to rented property.

To Bid or To Renew, Your Insurance, That is the Question

I've been playing around with a graphical representation of the decision a business must make to bid or renew their insurance.



Here is the latest. A white paper is in the works.



(Click on the image for a larger view.)



Health insurance rates, by state

Update: (6/20/2013): Here's information on the latest state-by-state breakdown of health insurance premiums and deductibles. And here's information on the rate filings we're getting for 2014.

Here's the original post:

The Commonwealth Fund has put together an interesting state-by-state breakdown of private-employer health insurance premiums and deductibles over the past 6 years.

The upshot: premiums for businesses and their employees rose 41 percent, while per-person deductibles jumped 77 percent. (Continue those trends out to 2020, and an average premium for family coverage will be more than $23,000.) The report also looks at the potential for federal health reform to reduce that cost growth.

This chart shows employer premiums as a percentage of median household income for people under age 65:

In Washington state, the cost of premiums rose 38 percent between 2003 and 2009, with family coverage costing an average of $12,758 here last year.

How's that compare to everyone else? About in the middle. In a list of the 50 states plus Washington, D.C., from highest family premiums to lowest, we come in 28th. (The U.S. average premium for family coverage: $13,027.) Arkansas ($10,969) came in with the lowest rates; Massachusetts ($14,723) with the highest. Oregon's ($12,783) are slightly higher than Washington's.

WA insurance commissioner rejects new Regence rate increase

From a news release our office issued this morning:

After several requests for additional information, Insurance Commissioner Mike Kreidler has formally rejected requests to change the rates of individual health plans offered by Regence BlueShield, Regence BlueShield of Oregon and Asuris NW Health (Regence).

The proposed rates were scheduled to take effect Jan. 1, 2011. Regence has the right to appeal the decision.

Regence BlueShield and Asuris requested 3.7 percent and Regence BlueShield of Oregon requested 4.9 percent.

“I’m disappointed and frustrated that I’ve had to take this step, but Regence’s policyholders are my top priority, said Kreidler. “They’re counting on me to review the rates and make sure they’re justified. Regence failed to make its case.”

See the link above for more information, including links to Regence's rates.

Our North American Dealer Co-Op order -- and what it means if you're a customer

In October, many consumers across Washington received notices from the North American Dealer Co-op (NADC). Our office ordered NADC to send out those notices.

Here’s the background: Washington car dealers would sell people vehicle service contracts, offering a money back guarantee as an incentive to buy them. If you didn’t use the vehicle service contract after a certain period of time and met other conditions, you were promised your money back.

NADC, in essence, insured that money-back guarantee. (The service contracts themselves are a separate product, and are NOT affected by our order. More on that below.) In 2007, Insurance Commissioner Mike Kreidler told the company that they were acting as an unauthorized insurer in Washington state. The company disputed that; a hearing was held and the commissioner’s decision was upheld.

In October 2010, Thurston County Superior Court Judge Thomas McPhee affirmed the order, which requires NADC to do the following things:

-Stop offering the program to any Washington auto dealers.

-Send a copy of the order to all member dealers.

-Send a copy to all Washington consumers who’d bought an NADC auto dealer extended service contract reimbursement guarantee.

-Tell consumers that should they file a valid claim against that guarantee when their extended service contract expires, it will be honored.

Here’s the critical thing to know: The underlying vehicle service contract should still be in effect. Those service contracts are a different product, covering repairs to the car. Those contracts are not affected by this order.

Our order does, however, require NADC to honor all valid money-back guarantee claims made for unused service contracts under NADC’s money-back guarantee offer.

If you’re a Washingtonian and have questions or concerns that NADC’s improperly denying your money-back claim, contact us at 1-800-562-6900.

Consumers can also contact:

North American Dealer Co-Op
1-800-637-2277
ATTN: Claims Department
1661 Wadsworth Blvd.
Lakewood, CO 80214

Tacoma woman pleads guilty to first-degree theft charges in insurance scam

A Tacoma woman whom repeatedly claimed to have slipped and fallen in grocery stores has pleaded guilty to first-degree theft.

Brenda J. Johnson, 50, claimed to have fallen in two different stores within about 15 minutes. She said she was near a check stand at a Tacoma Safeway store on Sept. 18, 2009 when she slipped on some liquid and fell, injuring her wrist and ribs.

On the same day at about noon, she said, the same thing happened to her in the frozen food aisle of a Tacoma Fred Meyer store. She filed claims with both stores, showing medical care and prescription drug receipts totalling more than $5,500.

A subsequent investigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit found that she had submitted virtually identical medical receipts to each store, including an emergency room report missing some pages. Documents obtained through a search warrant indicated that the treatment was unrelated to a fall at either store.

The investigation also found that Johnson had filed at least five auto-accident medical claims and at least half a dozen slip-and-fall injury claims.

On Nov. 22, Johnson pleaded guilty in Pierce County Superior Court to: $6,017 in restitution, 40 hours community service, and $1,000 in court fees and costs.

The Simmonds' Business Insurance Index™ For December, 2010

Here's my read of the current marketplace for upcoming business insurance renewals:



Renewal Premiums: -5%

Renewal Coverages: Liberal Terms

Buyer's Outlook: Long-Term: Prices Flat



The insurance market "experts" seem to have given up on the marketplace "hardening" any time soon. There have been several articles in the past few weeks predicting that the market will not change in 2011.



The November 15th edition of National Underwriter touts on its cover that the soft market is the new normal.



That may be good news for insurance buyers. I'm not convinced.



The older I get, the more I realize that when the mass of "experts" are saying that something is going to happen, the opposite is most often true.



In the past month I have handled about 15 renewals. Several increased in premium by 2%. Several dropped by 30%. Most dropped by about 10%.



Those that dropped the most had not been out to bid for several years. They were also the best accounts - highly desirable to the underwriters.



I repeat...



--Bid your insurance every 3 years

--Work to make your business an exceptional risk

--Be sure you have a great insurance agent

--Negotiate your renewals for better pricing and better coverage





Go HERE for my comments from past months.

Give us your opinion on our website...

We're looking for feedback on our official website, http://www.insurance.wa.gov/. We're trying to make the site easier to understand and easier to use.


 
If you can spare a couple of minutes to give us your input, we'd much appreciate it. Just click on the link above and look for the "feedback" tab on the left. It's orange, and hard to miss.

The Standard is That There is No Standard In Professional Liability

There are no standard policies in professional liability insurance. Every insurer will have their own definitions, exclusions, limitations, and expansions.



Review your policies carefully.

Tort Defendant May Call SABS Assessors as Fact Witnesses

You may recall that we recently blogged on the case of Beasley v. Barrand, in which Justice Moore held that accident benefits assessors could not be called as experts to testify for the tort defendant at trial. The link is here:

http://insurance-coveragelaw.blogspot.com/2010/10/tort-defendant-not-permitted-to-call.html

In Anand v. State Farm (unreported decision, April 23, 2010), Justice Stinson followed Justice Moore’s decision, but held that the accident benefits assessors could be called as fact witnesses. They were not permitted to testify about their conclusions or opinions, but could testify about their observations of the plaintiff.

Welcome to the Cavalcade of Risk

I am honored to be hosting the Cavalcade of Risk, a blog carnival dedicated to all types of risk.

Liability insurance posts:

Tred Eyerly discusses a new case from Washington state about one of my favorite topics: triggers of coverage for a long-tail loss. The case he discusses held that coverage for water infiltration was triggered when the damages manifested: Policy Language Restricts Ongoing Damage to One Occurrence posted at Insurance Law Hawaii.


Posts about keeping personal documents safe:

Miranda Marquit at Moolanomy posts about keeping personal identification documents safe.

Edward Webber discusses obtaining and keeping safe a UTR, or Unique Taxpayer Reference number (I assume this is the same as a TIN, or taxpayer identification number): UTR Numbers For the Self Employed posted at UTR.org.uk.

Financial posts:

Free Money Finance writes about protecting your job and money against the possibility of being laid off: Career Insurance: Insuring Your Most Valuable Asset posted at Free Money Finance.


Health Insurance posts:

Freefrombroke posts about reimbursement for over-the-counter medication.

Hank Stern argues that medical insurers should not cover birth control: Medical Necessity vs (Stupid) Mandates posted at InsureBlog. Although I completely disagree with his post I include it here as a courtesy because Hank runs the Cavalcade of Risk. And because, unlike the last three posts I've considered for this Cavalcade, his post prsents information and a point of view rather than an advertisement. (Sometimes I think I would like to have a separate blog that discusses only medical insurance issues. Not, like my regular blog, having anything to do with what I do for a living or can write knowledgeably about. Just the trials and travails of my family dealing with health insurance when my husband and I are both self-employed and over-income for any government help. I'm sure there would be a post in that imaginary blog about how all health insurance plans should fully cover everything that helps society as a whole--such as birth control, Hank!)

Jaan Sidorov notes the consistency between the Genetic Information Non Discrimination Act (GINA – or the law that keeps insurers from collecting genetic information) and the recent Transportation Security Administration kerfuffle. In his estimation, our national distaste for profiling leads to everyone being treated equally badly: Can't Trust Health Insurers or Government With Private Data: The Irony of the Genetic Information Non-Discrimination Act & Airport Security Pat Downs

David Williams discusses how Google makes money from free healthcare sites: The downside of free health care sites posted at Health Business Blog.

Life Insurance posts:

Silicon Valley Blogger writes about the different types of life insurance policies: Comparing Whole Life Insurance vs Term Life Insurance posted at The Digerati Life.

Random posts

Jason Shafrin at HealthCare Economists discusses The Drunkard's Walk, a book about randomness and, oh yeah, the price of car insurance. The Drunkard?s Walk posted at Healthcare Economist. Snark alert: If you get irritated when someone says "two categories" and then lists three categories, skip this post.

Self-employed and looking for a small group health plan?

We've heard from a lot of self-employed or sole-proprietors who want to take advantage of the new group of one law but are having trouble finding a health plan.

(The new law took effect in Oct. and allows qualified self-employed people buy health insurance in the less expensive small group market.)

We think we have something that can help: We've added a direct link to the federal government's Healthcare.gov site. Just type in your zipcode and you'll get a list of health plans available in your county. Of course you can also contact an agent or broker directly, but this gives you another option. Here's the link to information we've posted on our site.

If you want to bypass our website and go straight to the place that let's you enter your zipcode - here you go

Have you got enough life insurance?


Having adequate life insurance in place is of utmost importance should the worst happen. Anyone who has dependants needs to be properly protected; by investing in a life insurance policy, you can help to ensure your family will be taken care of financially. As situations change you need to review your policy, but with so many options it can be confusing to know which policy is best. Here's a guide to help you decide , whatever your time of life.

. Marriage: if you're in your twenties you might think you're too young to worry about insuring your life, but the younger and healthier you are, the cheaper your policy is likely to be. Once you are married and have joint financial responsibilities, you should consider taking out cover to protect your spouse and any children

. Your first home: when you buy your first home with your partner, you should consider taking out a life insurance policy that will cover the cost of the mortgage so your partner is able to continue living in the house. Which? recommends a joint policy which will pay out when the first person dies

. Children: when you have children, Which? recommends taking out individual policies rather than a joint policy. Each of you will need different levels of cover based on your age, fitness and salary, so taking out separate policies can help you get the cheapest deal. By choosing individual policies you also help to ensure your children will be covered; with a joint policy, the surviving partner would be left without cover when the first partner dies

. Health: honesty is always the best policy when it comes to declaring your medical conditions when applying for an insurance policy. If you don't disclose an illness, you could invalidate your cover. With all life insurance policies, you can bundle the product with critical illness cover. This policy pays out if you are diagnosed with a specific condition, or are permanently disabled.

. In trust: life insurance companies usually offer the option of writing your policy "in trust" at no extra cost. This enables the proceeds of your policy to be paid quickly, without waiting for probate, and could also decrease the chances of inheritance tax liability because the payout is likely to be excluded from your estate

Life insurance lures job seekers




A career in life insurance sales is now considered more attractive to job seekers, but employer inflexibility is holding businesses back from securing talented and eager candidates.

According to recruiting expert Hays, there is a growing interest from candidates, particularly at the entry level, in a career in life insurance.

“Candidate feedback shows that there is now a lot less stigma surrounding a career in life insurance compared to what there once was,” Senior Regional Director Jane McNeill says.


“It seems the downturn took some of the shine off the allure of a trading or other higher-risk finance career,” McNeill says.

However, she says there will continue to be a skills shortage in life insurance unless employers relax their focus on only recruiting candidates with five or more years of experience.

“Most life insurers are now looking for experienced life underwriters, either group or retail, as a result of growth in demand and competition within such products,” McNeill says.

“They want candidates that already understand the subject matter, can make decisions and add value immediately. They want someone who can hit the ground running,” she says.

‘UNWILLINGNESS TO INVEST’
Australia’s current supply of such candidates is disproportional to the demand for experienced life underwriters, according to McNeill.

She says despite this, employers will not consider recruiting and training an entry-level candidate, or employing an underwriter with two to three years experience.

“Such unwillingness to invest in candidates has not only led to a number of candidates being unable to pursue a career in life insurance, but it also has obvious long-term skills shortage ramifications.

Kreidler proposes health insurance rate reforms

News release issued by Washington State Insurance Commissioner today:

Insurance Commissioner Mike Kreidler is asking state lawmakers to preserve his authority to scrutinize health insurance rates, boost transparency, and to let him—for the first time—consider some insurers’ surpluses when reviewing rates.

“Some non-profit insurers have built up hundreds of millions of dollars in surpluses in recent years, while still seeking double-digit rate hikes,” said Kreidler. “I want the law changed so we can take a closer look at that, while still maintaining a vital insurance market.”

Under current law, surpluses—including investment income—cannot be taken into account when considering a company’s rate request.

Kreidler also will seek more transparency, so consumers can have a full picture on rate proposals by insurers. Today, most information included in a rate filing is not releasable to the public.

“Tens of thousands of Washingtonians who have to buy insurance on their own struggle to find and keep coverage,” said Kreidler. “We can help protect them by continuing to review rate hikes carefully. They also deserve to see how much of their insurance premium is spent on direct medical care versus administrative overhead and profit.”

Rate review: Kreidler gained the authority to review rates in the individual market in 2008, but it’s scheduled to expire after 2011. He’s proposing legislation to do away with that deadline.

Surpluses: The surplus proposal would only apply to non-profit health insurers, which account for most of the health insurance market in Washington. Also:

• Once a company amasses a surplus equal to 3 months of claims expenses, rate hikes would not be approved.

• The insurance commissioner could grant exceptions, however, if limiting the surplus or rates would pose a threat to the financial health of an insurer.

Transparency: The legislation would allow the public to see:

• What percentage of a specific rate request goes to profit, medical costs and administrative costs.

• How much, overall, a health carrier collected in premiums, how much money it made, and how much it paid out in direct medical claims.

• The medical trends the health carrier is using to project future rates.

“It’s simple: We need oversight of the health insurance industry,” said Kreidler. “And families deserve to see where their money’s going and how their rates are set.”

SJC holds that workers' compensation self-insurance group is an insurer

I posted here about a Superior Court decision in Mass. Care Self-Ins. Group, Inc. v. Mass. Insurers Insolvency Fund . That case held that a worker's compensation self-insurance group, Mass Care, is an insurer within the meaning of Mass. Gen. Laws ch. 175D, which creates a fund that provides insurance benefits when an insurer that would otherwise provide coverage has become insolvent.

Mass Care provided coverage up to a self-insured retention limit to an injured employee of one of its members. The group had an excess carrier over the SIR that had become insolvent. When the damages paid to the injured employee exceeded the SIR, the group sought coverage from the fund.

The Superior Court held that the group was not entitled to reimbursement, because the Fund does not reimburse insurers.

In Mass. Care Self-Ins. Group, Inc. v. Mass. Insurers Insolvency Fund, 458 Mass. 268 (2010), the SJC affirmed.

The SJC adopted the dictionary definition of insurer as "[o]ne who agrees, by contract, to assume the risk of another's loss and to compensate for that loss." The court noted that Mass Care accepts premiums in exchange for the provision of workers' compensation coverage, and described its functions as including many operations ordinarily associated with the insurance business. Without more, Mass Care would be considered an insurer.

The court then turned to the enabling statute, Mass. Gen. Laws ch. 152 §§25E-25U, under which Mass Care and other worker's compensation self-insurance groups are created. It noted that §25E states that self-insurance groups are not to be deemed insurers, and that the reason is to prevent such groups from being subject to the traditional framework of insurance regulation. However, the definitions section of the statute, Mass. Gen. Laws ch. 152 §1(7), makes self-insurance groups subject to consumer laws and regulations applicable to workers' compensation insurers.

The court reconciled the clauses and concluded that Mass Care is a member of the insurance industry whom ch. 175D was not intended to benefit.

The Hills Are Alive... With Danger

Deering v. Scugog (Township), [2010] O.J. No. 4229 (S.C.J.).
Howden, J. discussed the duty that road authorities owe to motorists in the case of Deering v. Scugog (Township), [2010] O.J. No. 4229 (S.C.J.), a case involving a motor vehicle accident that occurred on August 10, 2004, which left two teenage sisters severely injured.

Shannon Deering, the older sister who was 19 years old at the time, was driving her 2002 Pontiac Grand AM up a hill on Coates Road West in Oshawa, when the headlights of an eastbound vehicle appeared over the crest of the hill. The vehicle moved to the right, then arced left, and finally veered to the right over the shoulder of the road.

Justice Howden ultimately found that the segment of Coates Rd. West was in a state of non-repair because in his view, the hill where the accident happened “represented a virtually unique source of danger to ordinary drivers, particularly at night due to its combination of features likely to create an emergency situation with little or no preview time for westbound drivers to deal safely with it”.

At the time of the accident, Coates Road West was paved and flat for close to two kilometers, after which it climbed and fell away over three hills. The third hill was the most significant, and in August 2004, the road had no lane markings, no signage, and an un-posted speed limit of 80 km/hr.

In July 2004, the road was involved in a rehabilitation project to improve the road’s base and surface. The aim of the rehabilitation project was to provide an adequate sub-structure and surface treatment. By July 20, 2004, a dark-coloured sealant or emulsion was applied to the road as the final phase of the project. Immediately afterwards the road was re-opened in its otherwise previous state which was unsigned, unlit and unlined.

After a review of the relevant case law, Justice Howden determined that road authorities have a duty to ordinary motorists to keep their roads in reasonable repair, including the type and location of the road. The standard of care uses as the measure of reasonable conduct the ordinary reasonable driver and the duty to repair arises wherever an unreasonable risk of harm exists on the roadway for which obvious cues on or near the road are not present and no warning is provided, subject to certain defences.

Howden, J. stated that “The ordinary motorist includes those of average range of driving ability – not simply the perfect, the prescient, or the especially perceptive driver, or one with exceptionally fast reflexes, but the ordinary driver who is of average intelligence, pays attention, uses caution when conditions warrant, but is human and sometimes makes mistakes.”

He further declared that “the duty to repair under section 44 should no longer ignore the need in circumstances of pre-design age roads near areas of urban change and growth to incorporate assessments of safety measures into road rehabilitation and reconstruction projects”.

This blog contribution by articling student Alex Lacko.
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