Arizona — Uber Not Criminally Liable for Crash: Yavapai County prosecutors are not going to go after Uber for the March 2018 crash in Tempe that killed a pedestrian. However, it is recommended that the vehicle’s “driver,” Rafaela Vasquez be referred to Tempe’s police department for another look.

He was looking at a TV show when the crash occurred and could end up being prosecuted for vehicular manslaughter.

Department staff are available to answer questions through Saturday, March 9 at the Local Assistance Center in Guerneville or by phone at 800-927-4357 following the winter storms and Russian River flooding that inundated 2,600 homes and businesses and damaged or destroyed many automobiles.

“Climate change is driving more extreme weather events than ever, including floods,” said Insurance Commissioner Ricardo Lara. “We want to make sure people have the coverage they need before the next storm puts their home at risk. Having flood insurance may be the difference between recovering quickly from a catastrophic event or suffering devastating financial losses.”

Flood insurance is available through the Federal Flood Insurance Program and must be in force for 30 days prior to a flood, in most cases.

February was the sixth wettest month on record, and it is not too late for homeowners to assess their risk for flooding and ensure they have the coverage they need to protect their home which is typically a family’s most valuable financial asset.

The department has a number of resources to help consumers with insurance coverage or claim questions. Consumers with questions or needing assistance should call the consumer hotline at 800-927-4357.

Source link: The California Department of Insurance

Idaho — Medicare Workshop to be Offered in Genesee: A free Medicare Workshop for individuals turning 65 and those approaching Medicare eligibility will be held Wednesday, March 13, from 5:15 p.m. to 6:30 p.m. at the Genesee Community Library, 140 E. Walnut, Genesee.  Caregivers and all those interested in learning how Medicare works are encouraged to attend.

The workshop will be led by Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance.  SHIBA presenters will introduce the various parts of Medicare and explain some of the vocabulary associated with the program. 

Topics to be covered include:

•  Timeframes for enrolling in Medicare

•  Enrollment periods for Medigap, Medicare Advantage and Prescription Drug Plans

•  How the different parts of Medicare work together – and when they don’t

To register for the workshop, please contact the SHIBA Helpline at 1-800-247-4422.

Montana — Tester & Asbestos Ban: Montana Senator Jon Tester and eight other U.S. Senators have sponsored a bill to ban the mining, importation, use and sale of asbestos. A companion bill was introduced in the House. The number of co-sponsors there totals 21.

Experts say this one has a much better chance of success than previous bills.

In his support of the bill, Tester said, “Montanans know all too well the lasting damage of asbestos exposure — just ask folks in Libby and Troy. Banning this harmful substance will protect our families and prevent future suffering and loss of life.”

More than 200 deaths in Troy and Libby have been linked to asbestos.

He’s joined by Oregon Senator Jeff Merkley who added, “It's outrageous that in the year 2019 asbestos is still allowed in the United States. While the EPA fiddles, Americans are dying.”

While asbestos is illegal in 60-some countries, it is still legal in the U.S.

Source link: Independent Record

Oregon — Prescription Transparency: The Department of Consumer and Business Services is ready to hear about prescription drug price increases from consumers, health insurance companies, and drug manufacturers.

The Prescription Drug Price Transparency Act (HB 4005), from the 2018 Legislative Session, established Oregon’s drug price transparency program. The new law requires prescription drug manufacturers and health insurance companies to report specific drug price increases to the department’s Division of Financial Regulation.

The program staff are ready to hear from consumers as well.

All Oregonians are encouraged to report an increase in the cost of their prescription drugs to the division one of three ways:

Email rx.prices@oregon.gov

Call 888-877-4894 (toll free)

Visit dfr.oregon.gov/drugtransparency (online reporting form available later this month)

We are excited to bring one of the nation’s first prescription drug price transparency programs to Oregonians,” said Andrew Stolfi, insurance commissioner. “It will help people better understand why drug prices increase, and help legislators make informed decisions on how to control rising costs.”

Consumer reports and the pricing of new prescription drugs will be made available as soon as information is received and reviewed. Insurer and drug manufacturer price increase reports will be available later this fall.

The division will provide annual reports to Oregon State Legislature based on the information provided by consumers, and the data reported by health insurers and prescription drug manufacturers.

This program is designed to report drug price increases only. If a consumer has a problem with their health insurance or prescription drug coverage they should contact our consumer advocates at 888-877-4894 (toll-free). To learn more about Oregon’s Prescription Drug Price Transparency Program, visit dfr.oregon.gov/drugtransparency.

Washington — From the Department of Insurance: Surprise billing occurs when you're treated for an emergency or scheduled procedure at an in-network hospital or surgery facility and are seen by an out-of-network provider. In addition to your expected out-of-pocket costs, you also get a bill for the difference between what your insurer has agreed to pay that provider and what they believe the service was worth.

Some types of providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your insurer even though they provide services at an in-network hospital or facility. This practice is also called “balance billing,” however, some balance billing is not a surprise. For example, if you're treated by a provider that you know is not in your plan's network, you shouldn't be surprised to receive a bill for their services, on top of what your plan covers.

Kreidler's proposed legislation - 2SHB 1065/SB 5031 (www.leg.wa.gov) passes the House of Representatives

Commissioner Mike Kreidler has proposed legislation that would prevent people from getting a surprise medical bill when they seek medical services from an in-network facility, but are treated by an out-of-network provider. If an insurer and provider cannot agree on a price for the covered services, they can go to binding arbitration but cannot bill the consumer for the amount in dispute.

His bill passed the House on March 4 with a strong bipartisan vote of 84-13. It's now in the Senate and must be voted out of the Senate Health and Long Term Care Committee by April 3.

Tell us about your surprise bill

If you or someone you know has received a surprise bill, we’d like to hear from you. Email us your story. We may also follow-up with you to see if you'd like to file a complaint about your surprise billing issue.

See what happened to Jamie Hansen of La Center, WA when she sought emergency care for her son, Ryan.

Source link: Washington Department of Insurance

Arizona

Hand Held Cellphones

 People who’ve lost love ones because of auto crashes caused by people on their cellphones want the Arizona Legislature to ban hand held phones in automobiles. They’ve been ignored year after year. Not this year. The Senate Transportation and Public Safety Committee has passed a bill banning the use of hand held phones while driving.

The vote was nearly unanimous.

As it stands now, texting and phone calling while driving is illegal for teens. It may soon be — if the wave continues — be so for adults, too. Several cities in the state have enacted the ban as well.

AAA of Arizona and the American Property Casualty Insurance Association (APCI) did a survey and 86% said they support a ban.

Source link: Arizona Center

California

Lobbying

 Last year in California — unions, businesses and local governments — spent $361 million — lobbying government. Governor Gavin Newsom got about $50 million.

Pacific Gas & Electric (PG&E) spent $9.9 million. Western States Petroleum Association gave $7.9. Edison International gave $4.2 million and the California State Council of Service Employees put out $4.1 million.

The $361 million is an increase of 5% and $60 million more than what was spent in 2014.

Here’s the amount spent on lobbying state government by each sector in 2018:

Government — $54.9 million

Health — $42. 2 mllion

Utilities — $35.6 million

Manufacturing / Industrial — $26.5 million

Finance / Insurance — $23.7 million

Education — $19.3 million

Oil and Gas — $18.2 million

Professional / Trade — $15.2 million

Labor unions — $12.3 million

Other — $112.8 million

Source link: Sacramento Bee

Idaho

Auto Phone Ban: The Idaho Senate has killed a ban to use handheld cellphones in autos. The worry was farmers in aging pickups might be too affected.

Really.

Republican Sen. Jim Rice of Caldwell is bill’s sponsor. He said, “What this does is it actually protects the primary liberty that we exercise on our roads. The primary purpose on our roads is to exercise our right to travel. … That’s what we design roads for, that’s what their primary use is.”

Source link: Idaho Press

Oregon

Greenlick Out as Chair

 Rep. Mitch Greenlick is a Portland area Democrat who has chaired the House Committee on Health Care for a long time. Last week he attacked two people testifying. It appalled fellow committee members and caused House Speaker Tina Kotek to remove him from the chairmanship of the committee.

He has also been taken off of the House Conduct Committee. Greenlick chaired that one, too.

Lake Oswego Democrat Rep. Andrea Salinas is the temporary chair of the health committee. In her news release on the matter Kotek said, “Representative Mitch Greenlick made a serious mistake during Tuesday’s House Committee on Health Care when he made demeaning comments toward two individuals who were testifying before his committee. We must always strive to do what is best for the people of Oregon and the Legislature as an institution.”

Source link: The Lund Report

Washington

Kreidler Disciplines and Fines

Insurance Commissioner Mike Kreidler disciplined and issued fines in January totaling $5,900 against insurance companies, agents and others who violated state insurance regulations.

Insurance companies

Pacific Blue Health Network, New York City; ordered to cease and desist from selling insurance without a certificate of authority, order 19-0057

Lincoln National Life Insurance Co., Fort Wayne, Ind.; ordered to cease and desist selling insurance through unlicensed producers, order 19-0033

Agents and brokers

Kreidler disciplined the following insurance producers for violating insurance regulations in their dealings with policyholders:

Gregory D. Lone, East Wenatchee, Wash.; fined $3,000, order 18-0443

American Insure All Agency, Inc., Lynwood, Wash.; fined $1,000, order 18-0466

Jeff D. Graham, Puyallup, Wash.; license revoked, order 18-0496

Chandler Parker Widman, Spokane Valley, Wash.; license revoked, order 18-0532

PBI Insurance Agency LLC, Clackamas, Ore., and Jeremy Lowell Rugg, Wilsonville, Ore.; license revoked, order 19-0009

Luke Smith, Clackamas, Ore.; license revoked, order 19-0010

Kreidler disciplined the following insurance producers for violating state licensing laws:

Raymand Luther McGee, Seattle, license revoked, order 18-0516

Leon Brooks, Spokane Valley, Wash.; license revoked, order 19-0035

Tamara Reinecke Wong or Wong & Associates, Portland; fined $250 and license suspended, order 18-0508

Nikia V. Jones, Chicago; license revoked, order 18-0510

Miranda Eaddy, Windsor, Conn.; license revoked, order 18-0511

D Juane Antoinette Anthony, Las Vegas; license revoked, order 18-0521

Stephanie L. Bale, Lockport, N.Y.; license revoked, order 19-0001

Paul McCaskill, Carrollton, Texas; license revoked, order 19-0003

Deborah Lynn Miner, Woodstock, Ill.; license revoked, order 19-0004

Christopher Lee Pounds, Overland Park, Kan.; license suspended, order 19-0006

Justin David Mann, Phoenix; license revoked, order 19-0011

Brent D. Mann, Chandler, Ariz.; license revoked, order 19-0012

Tracy Lawrence, Creve Couer, Mo.; license revoked, order 19-0021

Higginbotham Insurance Agency., Inc.; Fort Worth, Texas; fined $250, order 19-0036

Other organizations

Regence BlueShield continuing education, Seattle; fined $1,400, order 18-0518

Source link: Washington Department of Insurance

Arizona

Uber Crash Lawsuit: Last year Elaine Herzberg was hit and killed by an autonomous vehicle owned by Uber. The suit isn’t against Uber, but against the city of Tempe.

Herzberg’s husband and daughter each want $5 million in damages and say the city of Tempe created a dangerous situation when it installed a brick pathway across the median where people aren’t supposed to be crossing.

Source link: Insurance Journal

Idaho

From the Idaho Department of Insurance

A tip from a social media post helped lead to an insurance fraud conviction for a Bingham County resident.  Danielle Collins was sentenced in Bingham County District Court last week after pleading guilty to one count of insurance fraud following an investigation conducted by the Idaho Department of Insurance.

In court proceedings, Collins admitted to purchasing car insurance after damaging her vehicle.  She was placed on three years of supervised probation by Judge Darren B. Simpson and ordered to pay $800 in fines, $245 in court costs, $500 to the Public Defender’s office, and $536 in restitution to the DOI.  She also must complete 100 hours of community service.

Court records show Collins purchased an auto policy through Progressive Insurance on August 25, 2017.  Three days later she submitted a claim for an accident in which her vehicle sustained damage to its front end and both driver’s side tires.  However, Progressive officials discovered a Facebook post dated days prior to the reported date of the accident and claim submission in which Collins asked her friends and followers, “Who gets not one but two flat tires?? Meeee!!  The social media gaffe helped DOI investigators close the case against Collins.

“This is an example of how insurance fraud comes in all shapes and sizes,” said Director Dean Cameron.  “I’m proud of the work of our investigators because every case of fraud, no matter how big or small, adds up and becomes costly for all Idaho consumers.”

Medicare Workshop to be Offered in Idaho Falls

A free Medicare Workshop for individuals turning 65 and those approaching Medicare eligibility will be held Thursday, February 14, from 2 to 4 p.m. at the Idaho Falls Senior Center, 535 W. 21st St., Idaho Falls.  Caregivers and all those interested in learning how Medicare works are encouraged to attend.

The workshop will be led by Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance.  SHIBA presenters will introduce the various parts of Medicare and explain some of the vocabulary associated with the program. 

Topics to be covered include:

  Timeframes for enrolling in Medicare

•  Enrollment periods for Medigap, Medicare Advantage and Prescription Drug Plans

•  How the different parts of Medicare work together – and when they don’t

To register for the workshop, please contact the SHIBA Helpline at 1-800-247-4422.

Montana

Minimum Wage

Montana Democrat Rep. Mary Ann Dunwell of Helena wants the state’s minimum wage to go up from $8.50 an hour to $15. If her bill — HB 345 — gets passed, the wage will go to $12 an hour on July 1st of this year, and rise to $15 on July 1st in 2020.

The AFL-CIO and the Montana Federation of Public Employees and the Montana Department of Labor and Industry are supporting the bill.

Opposing the bill is the Montana Retail Association and the Montana Restaurant Association.

Source link: Independent Record

Oregon

Marijuana Audit

An audit done by the secretary of state’s office has found the inspections conducted in Oregon’s marijuana industry and not up to speed. The state says the testing system is weak and threatens consumers with contaminants.

Just 3% of the retailers have been inspected and just one-third of the state’s marijuana growers. Also — the report said — marijuana regulators are not doing much to address the black market sales.

However, so far, the legal pot market has generated $207 million in taxes for the state coffers.

Oregon’s Innovation Hub

The Department of Consumer and Business Services’ Division of Financial Regulation has opened its Innovation Hub to help insurance, financial, and technology companies bring innovative products, services, and tools to Oregonians.

Experts, thought leaders, and businesses are encouraged to visit dfr.oregon.gov/innovation to connect with the division’s Innovation Liaison and learn more about Oregon’s Innovation Hub.

“We want to engage and collaborate with businesses that are poised to leverage technology in a way that will benefit Oregonians.” said Andrew Stolfi, division administrator. “The Innovation Hub is here to help the businesses we regulate deliver emerging products, and services to Oregon consumers.”

The Innovation Liaison helps companies navigate regulatory guidelines in a way that enables new technology flourish within the state. The liaison helps the division develop and maintain a structure that that can adapt to innovation both now and in the future.

For more information or to connect with the Innovation Liaison visit dfr.oregon.gov/innovation. 

California

Montecito Mudslides: Edison International says poorly designed and maintained debris basins are the reasons for the deadly mudslides that hit Montecito last year.

Over 20 people died. Damages to property is estimated at between $177 million and $204 million. The mudslides happened on January 18, 2018 when the first heavy rain of the season hit the top of the mountain above the city and loosed tons of mud and boulders onto the city.

Edison International has been sued for causing the mudslides because its equipment may have been responsible for the fire at the top of the mountain. The company — and its subsidiary Southern California Edison — countersued and blamed the city, the county and its inadequate infrastructure, and how that infrastructure was maintained.

In its complaint, Edison said, “With this cross-complaint we seek to ensure that there is a comprehensive review of the role many parties may have played in the large and tragic losses suffered by the community during the Montecito mudslides,” the company said. “It is well known that the Montecito area has always been at high risk for mudslides and debris flows. We believe that city, county and state governments, including flood control, water and transportation agencies, failed to ensure that Montecito’s infrastructure was adequate to reduce the impact of such natural disasters.”

Source link: Insurance Journal

Idaho

Medicare Workshops to be Offered in Bonners Ferry: A series of three (3) free Medicare Workshop for individuals turning 65 and those approaching Medicare eligibility will be held Friday, February 1 at the Fry Healthcare Education Center, located across from the main hospital building of the Boundary Community Hospital, 6640 Kaniksu St., in Bonners Ferry.  Workshops will be held at 2:30, 4:30 and 6 p.m.

Caregivers and all those interested in learning how Medicare works are encouraged to attend.

The workshop will be led by Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance.  SHIBA presenters will introduce the various parts of Medicare and explain some of the vocabulary associated with the program. 

Topics to be covered include:

•  Timeframes for enrolling in Medicare

•  Enrollment periods for Medigap, Medicare Advantage and Prescription Drug Plans

•  How the different parts of Medicare work together — and when they don’t

To register for the workshop, please contact the SHIBA office at 1-800-247-4422.

Washington

Wildfire Mitigation Plan: Public Lands Commissioner Hilary Franz has unveiled a 10-year, $55 billion wildfire control plan and given it to the Legislature. The plan will add 30-full time and 40 seasonal firefighters to the Department of Natural Resources. It also adds two helicopters to the firefighting air fleet.

A wildfire training academy that can be used by other agencies will also be set up.

Source link: Claims Journal

Commissioner’s Legislative Priority

Click here for Washington Insurance Commissioner Mike Kreidler’s legislative priorities.

Actions by the Commissioner

Insurance Commissioner Mike Kreidler issued fines in December 2018 totaling $192,050 against insurance companies, agents and brokers who violated state insurance regulations.

Insurance companies

Accordia Life and Annuity Co., Des Moines, Iowa; fined $130,000, order 18-0250

Kreidler received 57 complaints about the company in 2016 and 2017 and started an investigation into its practices. The law violations included:

 Failure to maintain full and adequate records of more than 8,600 customer accounts.

Underpaid interest on the death benefit of a policy and failed to correct the problem until the consumer complained to Kreidler’s office. State law requires that insurance companies pay 8 percent interest.

Failed to provide annual statements to 21 consumers.

State Farm Life Insurance Co., fined $10,000, order 18-0410

The company failed to pay the correct amount of interest on death benefits to 1,251 Washington consumers. State law requires that insurance companies pay 8 percent interest.

Kreidler fined the following companies for violating Washington state insurance regulations:

    GPM Health and Life Insurance Co., Spokane, Wash.; fined $2,000, order 18-0468

    Monterey Insurance Co., Monterey, Calif.; fined $30,000, order 18-0490

    American Automobile Insurance Co., Earth City, Mo..; fined $10,000, order 18-0494

    Unified Life Insurance Co., Dallas; fined $4,500, order 18-0529

Agents and brokers

Kreidler revoked the licenses of the following insurance producers:

•  Romaine Smith, Prosser, Wash.; license revoked, order 18-0146

•  Francisca Yadira Rios, Pasco, Wash.; license revoked, order 18-0507

•  Jacqueline Cone, Washougal, Wash.; license revoked, order 18-0515

•  Jodi S. Campbell, Lonoke, Ark.; license revoked, order 18-0475

•  Gary M. Enciso, Long Beach, Calif.; license revoked, order 18-0476

•  Rachel Glover, Collins, Iowa; license revoked, order 18-0477

•  Drucilla Clorene Wilson, Las Vegas; license revoked, order 18-0479

•  Paul B. Wells, Las Vegas, license revoked, order 18-0498

•  Deandre Maze-Carter, Phoenix; license revoked, order 18-0499

•  American Underwriting Services LLC, Kennesaw, Ga.; license revoked, order 18-0503

•  Romeo Evan Fulton, North Riverside, Ill.; license suspended, order 18-0504

•  James Luis Vasquez, Bothell, Wash.; revocation rescinded, license surrendered, order 18-0480

Kreidler fined the following insurance producers for violating state laws:

•  David M. Connolly and David Connolly Insurance Agency, Silverdale, Wash.; fined $500, order 18-0355

•  Ryan M. Focht, Pullman, Wash.; fined $500, order 18-0482

•  Alina Frenkel, Bellevue, Wash.; fined $500, order 18-0483

•  Robert L. Johnston, Spokane, Wash.; fined $500, order 18-0491

•  Paul F. Dent and Griffin Mac Lean, Inc., Bellevue, Wash.; fined $1,000, order 18-0488

•  John C. Haskell, Jr., Mill Creek, Wash.; fined $250, order 18-0397

•  Xandrea Powell, Suwanee, Ga.; fined $250, order 18-0395

•  Terran Watters-Fletcher, Lawrencville, Ga.; fined $250, order 18-0401

•  Benchmark Administrators LLC, Wayzata, Minn.; fined $250, order 18-0429

•  Lawrence M. Koresko, Collegeville, Penn.; fined $250, order 18-0436

•  George Lewis Kengle, Springfield, Ore.; fined $250, order 18-0478

•  Thomas A. Dus, Elyria, Ohio; fiend $500, order 18-0506

Continuing education providers

•  Risk & Insurance Managers Society of Washington, Seattle; fined $800, order 18-0513

Source link: Washington Department of Insurance

California

Regulations on Gender Discrimination in Auto Insurance: California Insurance Commissioner Dave Jones has issued new regulations that prohibit the use of gender in private passenger automobile insurance rating in California. The Gender Non-Discrimination in Automobile Insurance Rating Regulation became effective on January 1, 2019.

“My priority as Insurance Commissioner is to protect all California consumers, and these regulations ensure that auto insurance rates are based on factors within a driver’s control, rather than personal characteristics over which drivers have no control,” said Insurance Commissioner Dave Jones.

This is not the first regulatory action Commissioner Jones has taken to prevent gender-based discrimination in California’s insurance industry. In 2012, the Commissioner promulgated regulations that prohibit and prevent the denial of coverage or denial of claims for medical services based upon an insured or prospective insured’s actual or perceived gender identity. Prior to his election as Insurance Commissioner, then Assemblymember Jones authored legislation (Assembly Bill 119, in 2009) to prohibit gender-based discrimination in the pricing of health insurance. Thanks to that law, California eliminated gender-based pricing in health insurance before that became the national standard under the Affordable Care Act.

The Commissioner’s Gender Non-Discrimination in Automobile Insurance Rating Regulation mandates that all automobile insurance companies operating in California file a revised class plan that eliminates the use of gender as a rating factor.

Source link: California Department of Insurance

New Regs on Average Medical Service Contract Rate: Under the leadership of Insurance Commissioner Dave Jones, the California Department of Insurance adopted new regulations to implement provisions of Assembly Bill 72 (Chapter 492, Statutes of 2016). These regulations relate to the average contracted rate that a non-contracted medical professional will be paid when an insured seeks medical services at an in-network medical facility and is treated by an out-of-network provider. These average contracted rate regulations were approved by the Office of Administrative Law (OAL) and go into effect on January 1, 2019.

AB 72 protects consumers from surprise medical bills when they go to an in-network health facility and receive care from an out-of-network provider without specifically consenting to out-of-network care. The law also establishes a payment amount of 125 percent of the Medicare rate or the average contracted rate in that geographic region for that out-of-network medical service, whichever of the two is greater. These new regulations issued by the department provide the methodology for determining the "average contacted rate" for the medical service that insurers must use to reimburse non-contracting medical professionals. This will reduce disputes between insurers and medical providers about reimbursement rates for non-contracted medical care by providing a clear methodology for rate calculation for commonly billed services at in-network medical facilities.

Under these new regulations, the average contracted rate will be the average of the contracted commercial rates paid by a health insurer for the same or similar health care services in the baseline year (2015) in the geographic region in which the service was provided, with the rate then adjusted for inflation based on the date the medical service was provided.

"These regulations were carefully crafted to provide a fair way of calculating the average contracted rate for medical services in a given geographic region in those circumstances in which a patient inadvertently receives care from an out-of-network provider. Insurers are required to maintain an adequate provider network to ensure timely access to care for their policyholders and when patients are forced to go out-of-network at an in-network facility, the patient should not have to pay more for their care and the providers should be reimbursed fairly," explained Commissioner Jones.

The consumer protection in AB 72 that prevents policyholders from surprise medical bills for non-emergency care went into effect on July 1, 2017, and ensures that when consumers seek medical care at a facility in their insurer's network, but receive care from an out-of-network medical provider, they only have to pay their in-network cost sharing. The law also called for the Insurance Commissioner to set up an Independent Dispute Resolution (IDR) system that providers can use if they do not believe they have been paid fairly under the law. The IDR program was developed by the department for use by medical providers and insurers starting in September 1, 2017.

Source link: California Department of Insurance

Supreme Court Decision Fair Claims

 After a decade of legal wrangling over the regulations that implement the Unfair Insurance Practices Act (UIPA), the California Supreme Court let stand the decision of California Court of Appeal, 4th Appellate District, upholding the Insurance Commissioner's Fair Claims Settlement Practices Regulations, which prescribe how insurance companies must process insurance claims. The regulations are the foundation in determining the number of violations committed when assessing fines against insurers that have committed unfair claims practices.

Department of Insurance examinations of PacifiCare's claims-handling uncovered evidence of numerous unfair claims practices-which included wrongful denials for life-saving treatment for people battling serious illness and claim payment denials for providers and hospitals-all because the insurer was focused on maximizing profits through what it called "efficiencies" after the 2015 botched $9 billion acquisition of PacifiCare by UnitedHealthcare. The Department examinations also uncovered evidence the company was well aware of the egregious issues.

Under the Insurance Code, these unfair acts or practices include misrepresenting what medications or treatments an insurance policy covers, failing to promptly pay claims where liability is reasonably clear, and forcing claimants to file lawsuits to get full payment, and other acts. The Insurance Code allows the commissioner to impose fines of up to $5,000 each time an insurer commits an unfair act or practice on a consumer, or up to $10,000 each time if the insurer did so willfully.

"UnitedHealthcare purchased PacifiCare and imposed cost-cutting measures that destroyed PacifiCare's claims-handling processes and its arguments in litigation that insurance companies should be allowed to willfully harm consumers as long as they don't do it too often, reflect a gross disregard of the lives and well-being of the consumers who paid for the promise of coverage," Commissioner Jones said. "Customers have no choice but to rely on the integrity of their health insurance companies. PacifiCare breached that trust. By any measure, 908,000 violations reflect a general business practice of violating consumer protection laws. I am delighted the Supreme Court has rejected further challenges to the insurance commissioner's authority to punish insurance companies for knowingly harming even one consumer."

Based on departmental examination results and following an administrative hearing that took three years, Insurance Commissioner Dave Jones found PacifiCare committed 908,547 separate violations of the UIPA, and he imposed fines aggregating $173,603,750 in penalties. On behalf of PacifiCare, UnitedHealthcare sued the commissioner, arguing that none of its harmful conduct violated the Insurance Code.

PacifiCare argued that insurers are immune from fines for committing these unfair acts, even if the insurer did so intentionally, unless the commissioner is also able to show that the insurer knew it had committed the acts frequently enough to constitute a "general business practice." The court of appeal rejected the argument, stating: "PacifiCare's interpretation of section 790.03(h) is not only internally problematic, it stands in contrast to virtually every other statute the Legislature has enacted in connection with (1) enforcement of the Insurance Code against insurers generally; (2) enforcement of the UIPA in particular; and (3) the imposition of administrative penalties against insurers in other contexts."

The court also rejected PacifiCare's argument that the commissioner must prove an insurer had "actual knowledge" of its illegal conduct and held that it was within the commissioner's authority to hold the insurer responsible if its agents or employees were aware of facts that would cause a reasonable person to know of the violations. The court also found the commissioner's reasoning was sensible in that restricting the definition of "knowingly" to one particular individual's actual knowledge would fail to take into account that many people handle a claim, and an unfair practice can be committed by cumulative acts, not simply the intentional act of one person."

Further, the court of appeal also upheld the commissioner's interpretation that an insurer's "willful" violation of the act may be established by showing a purpose or willingness to commit the act and agreed that penalties for willful violations do not need to require a showing that the insurer intended to violate the law or injure someone. The court held, "As the Commissioner points out, he engaged in an extensive, formal rulemaking process in the course of promulgating these regulations. That careful consideration, combined with the Commissioner's expertise in the area, weighs in favor of according significant deference to the Commissioner's interpretation of the terms, and we do so."

Source link: California Department of Insurance

Wells Fargo Settlement

 Wells Fargo has agreed to pay a $10 million penalty as part of a settlement agreement with the California Department of Insurance. This settlement resolves the department’s accusation alleging improper insurance sales practices related to Wells Fargo’s online insurance referral program. The improper practices resulted in consumers being signed up and charged for insurance products without their consent.

“The Department of Insurance’s investigation found that Wells Fargo was signing up and charging customers for insurance without their consent,” said Insurance Commissioner Dave Jones. “Banks and other financial institutions should never be allowed to prey on their customers’ trust without being held accountable.”

Wells Fargo has agreed to not transact any new business during the remaining term of its two insurance licenses, which expire in July and September 2020, respectively. The company also agreed to not apply for a license for at least two years following the expiration of their current licenses. Wells Fargo has provided restitution to all California consumers who were charged premiums, bank fees and other direct monetary losses connected to the unauthorized insurance policies.

$5 million of the penalty is due immediately. If the company ever seeks to return to the California insurance marketplace, it will then pay the remaining $5 million penalty. The Department may also decline to issue a new license.

In November 2017, the department served on Wells Fargo an accusation seeking revocation of Wells Fargo’s insurance license for improper insurance sales practices. The accusation was the result of an investigation opened at the direction of Insurance Commissioner Dave Jones, which found that from 2008 to 2016, Wells Fargo customers were issued approximately 1,500 insurance policies without their knowledge or permission. In some cases, employees told consumers to enter their personal information on a policy application merely to receive a quote, but Wells Fargo employees later submitted the application to the insurer to purchase the policy without the consumer’s permission.

Source link: California Department of Insurance

Idaho

Drunk Driver Interlock Law

Starting this year ignition interlock devices are required for the vehicles of all drivers getting a first-time drunken driving conviction. The device will be connected to the vehicle for one-year.

In the past, the blow-into-a-mouthpiece device was only required for repeat offenders.

Source link: Insurance Journal

Nevada

Marijuana Sales: The Nevada Department of Taxation says marijuana sales in the state are quite brisk. October’s figures were released late last year and sales hit $42 million. That means $8.24 million in tax revenue for the state.

Sales from July through October of 2018 were almost half of the projected sales for the entire year.

Revenues are expected to go even higher since the state issued 61 more dispensary licenses in December bringing the total to 65.

Source link: Insurance Journal

Oregon

Off Duty Pot Use for State Workers

The Oregon Legislature is considering a bill that will make it illegal to fire an employee who fails a marijuana drug test if they used marijuana while off the clock.

The rationale is that it is unfair to penalize an employee for using a substance that is legal to use in the state.

Senate Bill 301 will not allow employees to use marijuana if their collective bargaining agreement says they cannot do that even while not working. So exemptions are in the bill for labor agreements, workers who are under the influence while working or from federal jobs that require employees to have a drug free workplace in order to receive federal dollars.

Source link: Insurance Journal

From the Department of Insurance: The Oregon Division of Financial Regulation recently adopted the following rule: ID 39-2018: Establishes reimbursement rates for out-of-network services provided at in-network health care facilities

Rules affected: OAR 836-150-0010, 836-150-0020, 836-150-0030, 836-150-0040, 836-150-0050, 836-150-0060

Rule Summary: Clarifies the purpose, statutory authority, and applicability for OAR 836-053-1600 to 836-053-1615. Adopt definitions of: anesthesia conversion factor; base units; base rate; CMS; CPT; CPI adjustment; director; geographic rating area; modifier adjustment; out-of-network reimbursement; physical status units; Q modifier adjustment; and time units. Adopt formula for out-of-network reimbursement for non-anesthesia-related claims. Adopt formula for out-of-network reimbursement for anesthesia-related claims.

Filed: December 19, 2018

Effective: January 1, 2019

Documents:

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id39-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id39-2018_ho-rec.pdf

Appendix A: Non-anesthesia reimbursement base rate — https://dfr.oregon.gov/laws-rules/Documents/OAR/div53-1605_exA.pdf

The Oregon Division of Financial Regulation recently adopted the following rule: ID 38-2018: Implementing the Oregon Reinsurance Program

Rules affected: OAR 836-150-0010, 836-150-0020, 836-150-0030, 836-150-0040, 836-150-0050, 836-150-0060

Rule Summary: Explains the purpose of the Oregon Reinsurance Program. Defines benefit year, department, reinsurance eligible claim, reinsurance eligible issuer and reinsurance payment. Lists the reporting requirements and payment processes to receive reinsurance payments. Establishes the attachment point, reinsurance cap and coinsurance rate for the benefit years 2018 and 2019. Describes how and when reinsurance payments are to be made. Describes the duties of the Oregon Reinsurance Program administrator.

Filed: December 19, 2018

Effective: January 1, 2019

Documents:

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id38-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id38-2018_ho-rec.pdf

The Oregon Division of Financial Regulation recently adopted the following rule: ID 37-2018: Update to adoption of the Valuation Manual for principle-based reserving

Rules affected: OAR 836-031-0605

Rule Summary: Designates the version of the Valuation Manual insurers must use in establishing principle-based reserves beginning January 1, 2019, and confirms that the operative date of the Valuation Manual is January 1, 2017 under section 16(2) of Oregon Laws 2015 chapter 547.

Filed: December 19, 2018

Effective: January 1, 2019

Documents:

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id37-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id37-2018_ho-rec.pdf

The Oregon Division of Financial Regulation recently adopted the following rule: ID 36-2018: Adoption of 2018 annual and 2019 quarterly statement blanks and instructions for insurers

Rules affected: OAR 836-011-0000

Rule Summary: Amended annually to prescribe the statement blanks and applicable instructions then in effect.

Filed: December 19, 2018

Effective: January 1, 2019

Documents:

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id36-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id36-2018_ho-rec.pdf

The Oregon Division of Financial Regulation recently adopted the following rule: ID 35-2018: Update to morbidity standards for valuation of individual and group health insurance policies

Rules affected: OAR 836-031-0270

Rule Summary: The rule sets forth the minimum standards to be used by insurers for the valuation of specified benefits, and the computation of contract reserves and claim reserves, for individual and group health insurance policies.

Filed: December 19, 2018

Effective: December 19, 2018

Documents:

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id35-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id35-2018_ho-rec.pdf

Establishment of Oregon Prescription Drug Price Transparency Program, reporting requirements, fees, civil penalties

Rules affected: OAR OAR 836-053-0473, 836-200-0500, 836-200-0505, 836-200-0510, 836-200-0515, 836-200-0520, 836-200-0525, 836-200-0530, 836-200-0535, 836-200-0540, 836-200-0545, 836-200-0550, 836-200-0555, 836-200-0560

Need for Rules:

The Prescription Drug Price Transparency Act (2018 Oregon House Bill 4005, enrolled at 2018 Oregon Laws, Chapter 7) directs the Department of Consumer and Business Services (DCBS) to establish a reporting program for prescription drug manufacturers and health insurance carriers to increase the transparency of prescription drug pricing in Oregon. This program will be known as the Oregon Prescription Drug Price Transparency program. The law directs DCBS to engage in rulemaking to define key terms and timelines, and empowers DCBS to establish fees, adopt a schedule of civil penalties for violations and adopt any other rules necessary for carrying out the provisions of Section 2 of the law.

The proposed rule establishes:

•  Definitions for key terms including “new prescription drug,” “net annual increase,” “one month supply” and “course of treatment” that clarify the circumstances when a report is required;

•  Form, manner and content requirements for reports from drug manufacturers;

•  DCBS’s supervisory expectations of participating drug manufacturers, including good faith standards;

•  Timelines for DCBS to request additional information relating to drug manufacturer reports, and for manufacturers’ responses;

•  DCBS’s process for adjudicating trade secret claims from drug manufacturers;

•  Timelines for DCBS to make drug manufacturer reports publicly available, subject to applicable trade secret exemptions;

•  DCBS’s process for receiving notices from consumers about prescription drug price increases;

•  Establishing an annual $400 fee for drug manufacturers, as well as an additional surcharge fee for manufacturers that file reports with DCBS;

•  Adopting a schedule of civil penalties for drug manufacturer violations; and

•  Requirements for information on drug pricing to be provided by health insurance carriers in rate filings.

The proposed rules are necessary to ensure that the program is administered in a fair and equal manner for all participating drug manufacturers and health insurance carriers, to minimize the administrative burden and cost of the program for the state and the industry, and to achieve the program’s purpose of providing notice and disclosure of information relating to the cost and pricing of prescription drugs in order to provide accountability for prescription drug pricing.

Filed: December 28, 2018

Public hearing: January 22, 2019, 10:00 a.m.

Last day for public comment: February 1, 2019, 5 p.m.

The agency requests public comment on whether other options should be considered for achieving the rule's substantive goals while reducing the negative economic impact of the rule on business.

For more information on this proposed rule and others, please visit the Division's website:

dfr.oregon.gov/laws-rules/Pages/proposed-rules.aspx

Washington

The Department of Insurance Issues Fines: Insurance Commissioner Mike Kreidler disciplined and issued fines in November 2018 totaling $700,500 against insurance companies, agents, brokers and others who violated state insurance regulations.

Insurance companies

Dental Health Services, Seattle; fined $500,000, order 18-0437

Kreidler fined the dental insurer for:

•  Failing to identify and process 23 policyholders’ appeals.

•  Failing to identify and process 342 grievances from policyholders.

•  Erroneously canceling polices.

•  Double-charging 492 policyholders a total of $56,351. The company refunded the money with an additional $5,635 in interest.

•  Failing to deliver enrollment materials to 76 policyholders.

In addition to the fine, Kreidler will prohibit the company from selling new policies for at least 12 months. After the probationary period, the company can ask Kreidler to allow it to sell policies if it completes compliance and corrective action plans to the commissioner’s satisfaction. Kreidler is suspending $400,000 of the fine and will impose additional penalties if the company fails to comply with the terms of the order.

Kreidler previously took action against Dental Health Services in 2017 and 2018. Kreidler fined the company $400,000 for mishandling consumer complaints and other issues.

American Pet Insurance Co., New York City; fined $10,000, order 16-0127

Kreidler imposed $10,000 of a suspended fine against the pet insurance company for failing to follow the compliance plan it agreed to in July 2016. The plan includes a self-audit, which revealed that one policyholder was charged the incorrect premium and eight policyholders did not receive the required 30-day notice for a rate change. Kreidler previously suspended $100,000 of the $250,000 to ensure compliance with the terms of the order. This is the first portion of the suspended fine that Kreidler has imposed on the company.

Kreidler disciplined the following companies for violating state insurance regulations:

•  Country Mutual Insurance Co., Bloomington, Ill.; fined $50,000, order 18-0409

•  Nationwide Agribusiness Insurance Co., Des Moines, Iowa; fined $25,000, order 18-0425

•  Amica Mutual Insurance Co., Lincoln, R.I.; fined $20,000, order 18-0424

•  Zurich American Insurance Co., New York City; fined $20,000, order 16-0107

•  Horace Mann Insurance Co., Springfield, Ill.; fined $10,000, order 18-0408

•  Garrison Property & Casualty Insurance Co., San Antonio, Texas; fined $10,000, order 18-0433

•  Stillwater Insurance Co., Santa Barbara, Calif.; fined $10,000, order 18-0474

•  Allied World Specialty Insurance Co., Wilmington, Del.; fined $3,500, order 18-0458

•  Amica Mutual Insurance Co., Lincoln, R.I.; fined $3,000, order 18-0444

Agents and brokers

Kreidler disciplined the following insurance producers for violating state insurance regulations:

•  Michelle F. Boyer, Parker, Colo.; fined $2,500, order 18-0390

•  Rashun Mann, Mansfield, Texas; fined $500, order 18-0380

•  Reed Jeff Insurance Agency and Jeffrey Reed, Silverdale, Wash.; fined $250, order 18-0363

•  Steele Group Insurance Agency, Inc., and Kelly S. Steele, Eugene, Ore.; fined $250, order 18-0416

•  Gentry Partners Ltd.; Greenwich, Conn.; fined $250, order 18-0440

•  Bruce Gilchrist, San Carlos, Calif.; fined $250, order 18-0396

•  Larry P. Chinn, Memphis, Tenn.; license revoked, order 18-0398

•  Kathy Ann Graham, Fort Pierce, Fla.; license revoked, order 18-0427

•  Andrea Godoy, Clovis, Calif.; license revoked, order 18-0428

•  Tiana Tam, Everett, Wash.; probationary license issued, order 18-0438

•  Kiara Munguia, Las Vegas; license revoked, order 18-0445

•  Juan Alberto Porras, Phoenix; license revoked, order 18-0430

•  Glenn Chavious, Hull, Mass.; license revoked, order 18-0431

•  Bijan Richards, Omaha; license revoked, order 18-0432

•  April Holmes, Mesa, Ariz.; license revoked, order 18-0435

Other organizations

•  Credit Acceptance Corp., Southfield, Mich.; fined $30,000, order 18-0426

•  Kreidler fined the company for selling nearly 10,000 guaranteed asset protection waivers to Washington consumers via car dealerships without being registered.

•  Device Doctorz of Clermont LLC, dba Insure Apple, Oviedo, Fla.; ordered to cease and desist, order 18-0462; fined $5,000, order 18-0463

A Washington state consumer complained to Kreidler’s office when Insure Apple denied his claim for the loss of his iPhone. Upon review, the commissioner found the company sold insurance without a license in Washington state. Altogether, it illegally sold 37 policies for $4,436 in premiums.

Source link: Washington Department of Insurance

Workers’ Compensation Price Drop

The Washington Department of Insurance said the price for workers’ compensation is going to fall for most businesses in 2019.

Department L&I Director Joel Sacks said the drop will average about 5% and will be the largest drop in over 10-years. “We’re seeing fewer injuries on the job and we’ve made improvements in helping injured workers heal and return to work. That’s good news for workers and employers, and it’s helping us significantly lower workers’ compensation costs,” Sacks said.

Employers will pay about $58 less per employee. The drop for workers will average about $6 year. Estimated total premium savings for businesses in the state will be about $136 million in 2019.

Of course all of this changes from industry to industry. Some will pay more. Others less.

•  Building and construction workers’ premiums will decrease by 9%

•  Agricultural workers’ and food processors’ premiums will drop by 2%

•  Healthcare workers’ premiums will fall by 4%

•  Forest products workers’ premiums will go down 6%

•  Government workers’ and school employees’ premiums will see a 3% drop

•  Restaurant and hotel workers’ premiums will fall an estimated 6%

Not all areas will see a drop:

•  City and county law enforcement officers’ premiums will rise by 8%

•  City and county firefighters’ will see a 6% hike

Source link: Chinook Observer