Tacoma insurance fraudster sentenced to two months, restitution

Andre R. Zamora, 25, of Tacoma, was sentenced on July 25 to two months in jail with work release and restitution to all parties in a medical insurance fraud he committed in late 2011.

Zamora was convicted of insurance fraud on July 9 by a King County Superior Court jury after an investigation by Insurance Commissioner Mike Kreidler’s Special Investigations Unit (SIU).

In November 2011, Zamora was involved in a car collision in Tacoma when another driver turned in front of him. After the collision, Zamora sought medical attention at a Renton hospital emergency room and later sought a second opinion from a Bellevue hospital. Zamora then submitted the medical bills to USAA, the other driver’s insurance company, saying he had paid the bills and wanted reimbursement. He submitted three claims to USAA totaling more than $14,857; the actual amount of the three claims totaled $1,621.

Kreidler’s Special Investigations Unit investigates insurance fraud and works with the Attorney General’s Office or local law enforcement—in this case, King County – to prosecute criminal cases. Consumers can report suspected insurance fraud on the Insurance Commissioner’s website.

Health premium rebates coming soon to some Washington consumers

The Affordable Care Act requires health insurers to spend more of the premium they collect on patient care and quality improvement activities or pay a rebate back to consumers.

How much you ask? Well, it depends on the insurance plan you selected. Only two insurers in Washington state's individual market didn't meet the new standard (called a medical loss ratio) - Regence Blue Shield of Oregon  and Time Insurance Company.

A total of $792,846 in rebates will be disbursed to 9,605 consumers in our state. Amounts may vary, but the average rebate per family is $122.

If you're enrolled with either of these insurers, you should expect to hear from them in the next several weeks. Premium can be refunded in one of the following ways:

• Send a refund check in the mail.
• Deposit a lump-sum reimbursement to the same account that was used to pay the premium.
• Reduce your future premium.

OIC seeks candidates for legal division, consumer protection

We recently posted two job opportunities at our Tumwater office.

The first is an Insurance Enforcement Specialist, a civil service-exempt position in our Legal Affairs division. We are looking for someone to provide legal perspective to employees and to lead agency work groups in specialized areas of insurance law, rulemaking, legislation and strategic planning. This position, along with other staff in Legal Affairs, works on enforcement of state insurance rules and laws and participates in case work, hearings and court proceedings. The person in this position will work closely with assigned counsel from the state Attorney General's Office and will collaborate with representatives from other state agencies and partner organizations.

Candidates must have a degree from an accredited law school, be licensed to practice law in Washington state and have a least six months of administrative litigation experience. Desired qualifications include experience with complex state or federal regulations and familiarity with insurance law, financial examinations, auditing or accounting. The position is open until filled. View the full description and apply at careers.wa.gov.

The second position is a Functional Program Analyst 4 working with the property and casualty unit in our Consumer Protection division. The person in this position will help educate consumers about insurance in Washington and will help consumers resolve disputes with insurance producers. This position acts at the subject-matter expert on insurance and disasters and will support the agency's liaison to the Washington Emergency Management Department. The person in this position will also work with the division's IT liaison on live chat and business processes.

Candidates must have a bachelor's degree or additional qualifying experience substituted year for year and specific experience with consumers, compliance and governments. This position closes on Aug. 4. View the full description and apply at careers.wa.gov. 

Information and resources for people who are affected by Washington wildfires

Wildfires are burning in several areas of Central and Eastern Washington, triggering a state of emergency. As of this morning, according to Washington State Department of Natural Resources, 1,200 homes have been evacuated in 12 towns. Sections of Highway 2 and State Route 20 are closed while crews battle the largest wildfire in the state’s recorded history.

For news and information from agencies and organizations involved in the fire response, follow Gov. Inslee’s wildfire list on Twitter. For breaking news about the fires, follow #waWILDFIRE. Gov. Inslee also has a webpage with Washington wildfire resources.

OIC has tips for filing a claim after a natural disaster and how to find disaster resources.

The Property Casualty Insurers Association of America (PCI) issued guidance to residents who are affected by wildfires in Central and Eastern Washington:

• Policyholders who have lost their homes to the fires are immediately eligible for additional living expense (ALE) coverage which may reimburse for increased living expenses such as, lodging, clothing, toiletries and other necessities. Policyholders who are evacuated for a period of time by state or local officials, and do NOT lose their home, may also be eligible for ALE reimbursement if the home next door is damaged by fire, and civil authorities prevent you from returning to your home. Remember to keep your receipts so it will make the claims process easier.
• Report all damage to your insurance company or agent as soon as you can in order to settle your claim more quickly and accurately.
• Make a list of all of the damage and any resulting expenses. Keep receipts for anything you buy so you can submit them to your insurance company later.
• A homeowner should not throw things away until an insurance company representative has had a chance to assess the damage and make a claim report.

Consumers can also seek help with their insurance or ask insurance-related questions by calling our consumer advocates at 1-800-562-6900 or contacting us electronically.

OIC website, online services are up and running

The Office of the Insurance Commissioner's website, www.insurance.wa.gov, and online services are available after a widepread outage at Consolidated Technology Services, which hosts many state websites and applications. The outage started early this morning and affected several external and internal state agency websites and services.

OIC website, online services are down

OIC's website, www.insurance.wa.gov, is unavailable at this time. That includes our services for insurance licensees. The state agency that hosts our site and applications, Consolidated Technology Services, is aware of the issue and is working on it. We appreciate your patience while we work with CTS to bring back our online services.

If you need to reach us, please call our consumer hotline at 1-800-562-6900.

We will post updates on our social media:

• Twitter: @WA_OIC
• Facebook: WSOIC

State of emergency declared in 20 Washington counties due to wildfires

The Seattle Times today reported a wildfire is burning more than 1,000 acres near Leavenworth and Chelan County, which has led to a 35-mile closure of Highway 2 and created a large plume of smoke visible from downtown Seattle on Wednesday. Check road closures and traffic information at the Washington State Department of Transportation website. There is a statewide burn ban on Department of Natural Resources (DNR) land until Sept. 30.

According to DNR, Western Washington is at moderate risk of wildfire and most of Eastern Washington is at high risk. Here are some tips for preparing for wildfire risk:

• Check your policy to make sure damage from wildfires is covered. Some policies include some coverage for emergency shelter, such as a hotel, if a home is uninhabitable. 
• Review your policy to make sure you have enough coverage. Things like fine art, jewelry and computer equipment may have limited coverage under a standard policy. But you can buy special coverage that gives you more protection for those types of items, called a rider. Contact your insurance agent or broker to ask about supplemental policies.
• Catalog your home’s belongings in case you need to make an insurance claim. The National Association of Insurance Commissioners has a printable home inventory checklist or you can try free iPhone/iPad or Android apps.
• Read some tips to prepare and protect your home. 
• You can help protect a rural home and limit the danger by clearing a natural fire break between your home and surrounding trees, brush and uncut fields. The Federal Emergency Management Agency has information on how to protect yourself and your home before, during and even after a wildfire. 
• Have an emergency kit and a family communication plan. Know the location of your valuable papers, including insurance policy and contact information, mementos and anything you can't live without, so you can evacuate with them, if needed. 
• Here's a list of recommended emergency supplies to keep on hand in the case of an evacuation. 
• Don’t forget about planning for your pets. Ready.gov has tips for pet owners. 
• The Washington Department of Natural Resources has the most recent fire information available on its website and through the @waDNR_fire Twitter feed.

Now hiring: Insurance Technician 1

We are accepting applications for an Insurance Technician 1 in our Tumwater office. This is an entry-level position for someone who is interested in getting experience working with insurance regulation.

Duties include:

• Examining and evaluating insurance company filings.
• Updating insurance company information in our database.
• Doing preliminary preparation of financial analysis of insurance filings.
• Assisting managers with preliminary data gathering for reports and projects.
• Posting information to OIC's intranet and external website.
• Assisting with public disclosure requests.
• Customer service.
• Other duties as assigned.

This position requires three years of clerical experience and knowledge of Microsoft Office software. Applications are due by close of business on July 22. Read more about this position or apply at careers.wa.gov.

STP ride means extra traffic, road closures

This weekend is the Seattle-to-Portland bicycle ride, when an estimated 10,000 bicyclists will take to the roads and trails that span the 200-mile route. An estimated 80 percent of the riders will camp overnight in Centralia, which is the midpoint on the ride. The rest will finish the ride in one day. Ouch.

Drivers in and between Seattle and Portland should be extra alert for cyclists this weekend. There are many road closures related to the ride and there is likely to be heavy traffic at both ends of the ride. Here are some insurance considerations for drivers and cyclists alike.

What happens if there is a collision between a cyclist and a car?

Auto insurers are required by law to offer personal injury protection (PIP) when you buy an auto policy. It covers, up to certain limits, expenses like medical bills, loss of wages and loss of services. PIP applies no matter who is at fault—so even if the accident isn’t the driver’s fault, PIP will pay for covered expenses. You don’t have to purchase PIP, but if you don’t reject it in writing, your insurance company has to add it to your policy and charge you for it. If you aren’t sure if you have PIP, contact your agent or broker. You can read more about PIP, including who it covers and certain exclusions.

Cyclists who have PIP on their own auto policies could also invoke their own coverage, but it would be secondary to the driver’s PIP.

What happens if my bike is damaged or stolen during the ride?

Bicycles typically are covered under homeowner and rental polices if they are stolen, lost or damaged in a residential fire. If the damage is related to a collision with a vehicle, the driver’s auto policy may cover the loss if the collision was the driver’s fault. If you own several very expensive bikes, you may want to talk to your agent or broker about coverage options and whether there are policy limits on bicycles.

Best of luck to all of the riders and be safe, whether you are driving or riding.

New rule repeals transplant waiting periods for health insurance

A new rule took effect July 3 to eliminate waiting periods for transplants. Before the change, insurance companies could impose a waiting period for transplants of no longer than 90 days. 

OIC undertook emergency rulemaking to bring state insurance rules into alignment with the federal Affordable Care Act. Under the ACA, transplants are one of the essential health benefits, which are required benefits under the Affordable Care Act.

The new rules don’t require health insurance plans to modify their policies mid-year, but they do require plans to identify and notify enrollees who may be affected by this rule change. Starting in 2015, health plans will remove transplant waiting periods from policy language.

This rule change was widely supported by insurers, medical providers and consumer advocates. You can find the concise explanatory statement with the comments and the final rules on our website.

Do you have emergency management experience? Apply at OIC!

OIC is hiring an Emergency Management Program Specialist 3, who will be responsible for the agency's emergency preparedness and for building and maintaining strategic partnerships to minimize impacts to agency business and consumers resulting from major emergencies and disasters. The Emergency Management Program Specialist 3 is the agency’s expert in all matters related to continuity of operations, emergency management planning and interacting with state and federal emergency management agencies and programs.

The person in this position is responsible for agency disaster recovery, and providing day-to-day operational support and assistance for facilities as well as serving in a back-up capacity for telecommunications and facilities matters.

Required qualifications include a bachelor's degree; and three years' experience working with government statutory and/or regulatory requirements, emergency management planning and exercises. Desired qualifications include experience working with state and federal emergency management agencies, experience developing continuity of operations plans and experience working with decision-makers. This position is open until filled.

View the full job description or apply: Emergency Management Program Specialist 3

Before you hit the water, make sure your boat is covered

Boating is a popular pastime in Washington state, with 157 miles of coastline and more than 453 water recreation sites run by the state Department of Fish and Wildlife and 19 marine parks run by the state Parks Commission. 

No matter what type of boat you own, you should talk to your agent about getting it insured against a loss. Small boats, such as canoes and kayaks, may be covered by your homeowner policy. Larger boats and personal watercraft, including Jet Skis®, likely require their own policy. Read more about boat insurance. Your best bet is to contact your agent or broker, or find one if you don’t have one. 

The state has a website for boaters, boat.wa.gov, run by the state Recreation and Conservation Office. It has information about mandatory boater education, boating safety requirements, registering your boat and trailer, and information about fishing and recreational boating.

Don’t forget, many places where you launch a boat require a state Discover Pass, a Natural Investment Permit or some other form of a launch or moorage permit.
  

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