Learn how to avoid falling victim to fraud at free event on Feb. 15

The OIC and AARP are hosting a free event in Puyallup on Feb. 15 where people can learn ways to avoid becoming victims of fraud.

Where: 
Pioneer Park Pavilion, 330 S. Meridian, Puyallup WA 98371

When: Wednesday, Feb. 15

Free breakfast starts at 9:30 a.m., followed by presentations and free Medicare counseling. 

The event wraps up at 1:20 p.m.

Who:

Washington state Insurance Commissioner Mike Kreidler will speak first, at 10 a.m. 

Other organizations that will be there include:

• OIC's Statewide Health Insurance Benefits Advisors (SHIBA)
• OIC's Criminal Investigations Unit
• Office of the Attorney General
• Department of Labor and Industries
• Department of Financial Institutions
• AARP of Washington
• Sound Outreach
• Better Business Bureau of the Northwest
• Consumer Protection Washington 

Seating is limited -- registration is required! To register:

• Call: 1-888-902-3011, extension 7456 
• Online: www.sendrsvp.com/7456

Criminal insurance fraud unit investigated 150 cases in 2015, 2016

Many people don’t know that the Office of the Insurance Commissioner investigates criminal insurance fraud, much of which is referred to us by insurance companies themselves. The work is done by the OIC’s Criminal Investigations Unit (CIU), staffed by law enforcement and criminal analysts. They refer the results of their investigations to state and local prosecutors, who bring charges against the people who are suspected of committing the fraud.

CIU staff conduct a search during
an insurance fraud investigation

In 2015 and 2016, the CIU:

• Received 3,571 referrals, which are questionable insurance cases that consumers and the insurance industry send to us to review.
• Opened 150 criminal fraud cases.
• Submitted 52 cases to a prosecutor.
• Had 40 criminal cases charged; 37 of those were heard before a judge.
• Had 44 convictions for various crimes.
• Saved $3.6 million in immediate and projected insurance claim payouts. These efforts resulted in $857,353 of restitution ordered paid back to victims and $26,760 in court costs ordered back to the judicial system.
• The vast majority – 73 percent – of the cases we investigate involve personal property or property damage. Bodily injury frauds are 11 percent, fraud by insurance agents and brokers (called producers) is 6 percent, and the rest involve disability, a medical provider, staged auto collisions or other types of cases. 

Other information about CIU:

• CIU was established by the Washington state Legislature in 2006. Since then, we have pursued 434 cases and adjudicated 105 of them. Our workload has steadily increased each year.
• It maintains a list of insurance fraud most wanted suspects, who have been charged with a crime but did not appear in court to face the charges. 
• In November 2016, the CIU earned law enforcement accreditation from the Washington Association of Sheriffs and Police Chiefs (WASPC), joining the 20 percent of law enforcement agencies in the state to have it.
• CIU hosted the 19th annual 2016 Fraud Directors Conference, a gathering of more than 70 insurance fraud professionals from 26 states and DC. It was the first time the conference has been held in Washington state. 
• The insurance commissioner is required by law to appoint a 10-member volunteer board to advise him on fraud investigations.

Read more in the CIU’s most recent report to the Legislature.

New rule protects consumers from unintentional long-term care policy lapses

This week, we adopted a rule that affects consumers who have long-term care insurance policies and their families.

If you are not familiar with long-term care insurance, it pays for the polcyholder to stay in a long-term care facility when their health meets certain criteria. Many consumers purchase polices years or decades before they need it. Because the policies are in place for so long, sometimes people forget to pay if their mental or physical health declines, such as cases of dementia.

We started the rulemaking because of stories like this--a consumer filed a complaint with us about her mother’s long-term care policy, which had lapsed because the mother had stopped paying the premiums without her daughter’s knowledge. The daughter found out the policy had lapsed when her mother needed long-term care and the claim was denied. The company said it had notified the mother and the daughter that the policy was canceled, but neither of them received the notice.

The new rule strengthens consumer protections in cases of lapsed policies:

• Insurers still are required to notify consumers at least 30 days prior to canceling a policy for nonpayment; however, now they have to prove they notified the policyholder and that person’s designee. 
• The insurer has to notify the person who sold the policy to the consumer, such as an insurance agent or broker. That gives the agent or broker an opportunity to check with their client to make sure they are intentionally letting the policy lapse. 
• Insurers are required to ask the policyholder once a year if they would like to change their designee. Previously, they were required to ask every two years. 

Read more about the rule and about long-term care insurance. Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Does your homeowner’s insurance cover theft from your storage unit? The answer might surprise you.

There’s a reality show on A&E about people who bid – sight unseen – 
on the contents of abandoned storage units. Yep, that's a thing.  

Self-storage is a booming business these days, according to Bloomberg. New warehouses are being built at a record pace to store Americans’ extra belongings. Nearly 10 percent of Americans rented a storage unit in 2015, according to Sparefoot.com, a storage unit comparison site. There are even luxury storage units to store your vintage car collection or to give you another space to hang out in.

Before you rent a storage unit, luxury or otherwise, you should be thinking about what happens if your belongings are damaged or stolen.

Generally, if your homeowner or renter policy covers contents that you store offsite--say, at a storage unit--they limit the coverage to a certain dollar amount, and they do not cover theft from the storage unit. That’s really important information to know before you fill a storage unit full of your belongings.

It may not be a good idea to store items of high value, like art, antiques, jewelry, collectibles, furniture or rugs, in a storage unit. Unless you have had the items appraised and insured for those amounts, it’s likely the dollar limits on your coverage will not be enough to pay to replace your possessions if they are damaged.

If you need to store valuables of that nature somewhere other than your home, talk to your agent or insurance company.

Most storage unit businesses offer their own insurance policies, but are they a good deal? That depends on if you already have coverage through a renter’s or homeowner policy. If not, read the policy offered by the storage company. What does it cover? What does it not cover? What is the dollar limit for the coverage? Is there a time limit for the coverage? What is the deductible on the policy?

Storage businesses that sell these policies are required to be licensed insurance producers. That means if you have trouble, you can file a complaint with us.

Here are some tips if you rent a storage unit:

• Read your policy or talk to your agent or insurer about covering any contents you are storing anywhere other than your residence
• If your renter’s or homeowner policy does cover offsite storage, there may be limits on:
• The dollar amount of coverage.
• How long things in storage will be covered – think temporary, not long-term or indefinite storage.
• The types of losses that will be covered – theft likely is not covered.
• Create an inventory of what you are keeping in storage. It can be as basic as taking photos with your phone, or you can download an app from the National Association of Insurance Commissioners, your insurer, or some other app. Or, you can make a list that you store somewhere safe. 

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

Deadline for Jan. 1 coverage through Exchange extended to Dec. 23

Washington consumers can sign up for health and medical plans through Washington Healthplanfinder until 11:59 p.m. on Dec. 23 for coverage that starts Jan. 1.

• Online: 24/7 at wahealthplanfinder.org.
• By phone: 1-855-WAFINDER (1-855-923-4633). Normal hours are 8 a.m. to 8 p.m. every weekday. Extended hours:
• Dec. 15 from 8 a.m. to 10 p.m.
• Dec. 17 from 10 a.m. to 2 p.m.
• Dec. 18 from 10 a.m. to 2 p.m.
• Dec. 23 from 8 a.m. to midnight.
• Find help in person with a navigator or a broker.

If you don’t qualify for a subsidy, you can purchase a plan on the individual market directly from an agent or broker. The deadline for Jan. 1 coverage varies by plan.

• Find a licensed agent or broker.
• Look at 2017 individual and family plans and premiums by county.

If you miss the Dec. 23 deadline, you can still get coverage. Open enrollment runs through Jan. 31 for coverage that will likely start March 1. 

• Learn more about health insurance.

Direct practices lose 3 percent of patients statewide

Each year, the OIC reports to the Legislature on the status of direct health care practices in Washington state. In a direct health care practice, a health care provider charges a patient a set monthly fee for all primary care services provided in the office, regardless of the number of visits. No insurance plan is involved, although patients may have separate insurance coverage for more costly medical services. Direct practices are sometimes marketed as “retainer” or “concierge” practices.

The December 2016 report contains data from July 1, 2014 through June 30, 2016, two fiscal years’ worth of information.

Some highlights from this year’s report, as of June 30:

• There were approximately 11,272 direct-practice patients in Washington, a 3 percent drop from fiscal year 2015. That figure represents .016 percent of the state’s population. 
• There were 30 practices in the state. Two new practices opened in Battle Ground and Edmonds. Five clinics in Seattle, Richland, Spokane and Colville reported they no longer participate in direct practices. 
• Monthly fees at direct practices ranged from $25 to more than $1,082. The average monthly fee weighted by the number of patients was $154.65, a 15 percent increase from fiscal year 2015.
• The OIC received no consumer complaints regarding direct patient practices. 

The Affordable Care Act requires consumers to purchase a health insurance plan or pay a tax penalty. Direct practices do not meet the requirements of the ACA and therefore do not qualify as a health insurance plan. That may explain why the number of consumers who purchase direct practice plans has dropped since 2014. However, the incoming federal administration has vowed to alter the ACA, which may drive more consumers to direct practices for primary care. At this point, it’s too soon to tell.

View the full report.

OIC has saved auto insurance consumers $32 million since 2010

The Office of the Insurance Commissioner's rate decisions have saved auto insurance consumers more than $32 million in premiums since 2010.

Personal auto insurers are required to file their proposed rates and rating plans with our office whenever there's a rate change. Our actuaries review the proposed rates, rating plans, and supporting documentation to be sure that the rates are not excessive, inadequate or unfair. 

From 2010 through 2015, the rates we approved for the top 20 personal auto insurers in Washington saved consumers more than $32 million in premiums. 

• 2015: $6.2 million
• 2014: $6.2 million 
• 2013: $8.9 million 
• 2012: $5.6 million 
• 2011: $2.7 million 
• 2010: $2.7 million 

Read more about auto insurance in Washington state.

Before you wax your skis, brush up on winter activities and your insurance

Snow is starting to fall in Washington state's mountains and in some lower elevations. Before you hit the slopes or backcountry, take a moment to consider insurance implications for winter recreation. 

Snoeshowing at Lake Wenatchee Sno-Park,
courtesy Washington State Parks

Ski and snowboard equipment

Winter sports gear is not cheap, and replacing it in the event of damage or theft can put a crimp in your winter fun. 

Generally, equipment you own will be covered up to a specific amount by your homeowner or renter policy. Check the limit in your policy and decide if that will be enough to replace damaged or stolen equipment. Remember to factor in your deductible. 

If you think you need more coverage, ask your insurance agent about a rider that might allow you to increase coverage (and your premium) for specified personal property.

Snowmobiles

Snowmobiles may be covered under homeowner policies when they are used for maintenance of your insured property. They likely aren’t covered by a renter or auto insurance policy. If you want to be covered, talk to your insurance agent about a snowmobile policy. If you take your snowmobile off your property, carry proof of insurance.

If you are traveling and plan to rent a snowmobile, you may consider rental insurance to cover damage to the snowmobile. Your home or renter insurance might provide coverage for your personal liability while operating a rental snowmobile. Read the contract carefully before signing and ask questions of the agent selling you the coverage if you don’t understand the limits or conditions of coverage.

Travel insurance

Traveling in the winter can be full of surprises. Even if you’re traveling somewhere warm, bad weather en route to your destination can cause delays or cancellations. Travel sites and airlines offer travel insurance when you book your trip. Travel insurance can cover everything from lost luggage to delays and cancellations, but make sure you closely read any policy you consider. Learn more about travel insurance.

Health insurance

If you are out of town without access to your physician or local health care center, review your emergency medical treatment requirements:

• Are you required to seek medical treatment at a certain hospital or urgent care center that is in your insurer’s network?
• Will you have a copay?
• If you need to fill a prescription, do you have to go to a certain pharmacy?
• If you are traveling in an area that is out of your network, what is the insurer’s requirements for reimbursing your expenses? 

Make a list of these details and carry your insurance card with you when you travel.

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

What's an umbrella policy?

Commissioner Kreidler recently participated in a Facebook live Q&A with KIRO TV reporter Jesse Jones, where viewers submitted their insurance questions. Jesse and Commissioner Kreidler got lots of great questions, including a couple about umbrella policies.

Umbrella policy is one of those insurance terms that a lot of people have heard but many aren’t quite sure what it means. Simply put, an umbrella policy extends your liability coverage beyond what is covered by your homeowner and auto policies. Umbrella policies pay only after you exhaust the liability limit of your homeowner or auto policies, which are referred to as underlying policies.

Here’s an example: Your dog bites a visitor in your home. The visitor sues you for damages and wins a $1 million award against you. Your homeowner’s insurance policy will only pay up to the $300,000 liability coverage limit listed in your home policy. If you have a $1 million umbrella policy, it will pay the remaining $700,000, minus any deductible. According to the Insurance Information Institute, a $1 million umbrella policy costs $150-$300 per year – that’s about $13 to $25 per month in premiums.

If you are interested in buying an umbrella policy, you should contact your insurance agent or company.

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

Fight health care fraud: guard your Medicare number!

Medicare open enrollment is here (October 15 to December 7), which means fraudsters and identity thieves will increase their efforts to get and abuse Medicare numbers from people.

Fortunately, there are many measures you can take to fight health care fraud:

• Guard your Medicare number. Protect it the same way you do for your credit card numbers. Medicare will never contact you for your Medicare number or other personal information. Don’t share your Medicare number or other personal information with anyone who contacts you by phone, email, or by approaching you in person, unless you’ve given them permission in advance. 
• Don’t ever let anyone borrow or pay to use your Medicare number.
• If you’re looking to enroll in a Medicare plan, be suspicious of anyone who pressures you to act now for the best deal. There are no “early bird discounts” or “limited time offers.” Any offer that sounds too good to be true probably is.
• Be skeptical of offers for free gifts and free medical services. A common ploy of identity thieves is to say they can send you your free gift right away—they just need your Medicare number to confirm. Decline politely but firmly. 
• Do your part to protect your friends and neighbors: remind them to guard their Medicare numbers, too.
• Check your Medicare Summary Notice (MSN)–which gives you information on services submitted under your Medicare number–to make sure you and Medicare are only being charged for services you actually received. While the MSN is only mailed to you every 3 months, you can access your Original Medicare claims at any time on MyMedicare.gov. You’ll usually be able to see a claim within 24 hours after Medicare processes it.

You can report suspected fraud by calling 1-800-MEDICARE (1-800-633-4227).

TTY users should call 1-877-486-2048. 

To learn more about how to protect yourself from health care fraud, visit Medicare.gov/fraud, or contact our state’s local Senior Medicare Patrol (SMP), which is the OIC's Statewide Health Insurance Benefits Advisors (SHIBA) program.

Outdoor, indoor features that you think are covered may surprise you

Many consumers think their homeowner policy covers everything they own, both inside and on their premises outside of their home. However, you should be aware that most homeowner policies do not cover everything you own. 

Creative Commons Backyard Pool by
Alvin Smith is licensed under CC BY 2.0 

Here are some common features that people may think is covered by a standard homeowner policy. 

Outside your home:

• Retaining walls
• Pools that sit above and below ground
• Gazebos
• Spas/hot tubs 
• Rockeries and other landscaped areas
• Driveways
• Sidewalks
• Foundations
• Fences
• Pump houses
• Garden sheds
• Greenhouses 
• Playground equipment

Inside your home:

• Collectibles
• Money
• Jewelry
• Artwork 
• Musical instruments

Talk to your agent or broker to find out if items like these are covered.  If coverage isn’t available, you’ll want to maintain and safeguard the property at your own cost, and do the best you can to keep it from damage. It’s a good idea to have a discussion about these types of property before you buy a policy.

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