Around the PIA Western Alliance States – Week of October 5, 2026

California — Governor signs landmark consumer protection package backed by Commissioner Lara: Governor Gavin Newsom has signed nine Department of Insurance-sponsored bills this year championed by Insurance Commissioner Ricardo Lara, delivering major new protections for wildfire survivors, increasing accountability for insurers, modernizing consumer safeguards, and expanding access to critical health care services for Californians.

Several of the new laws grew directly out of concerns raised by wildfire survivors, patients, policyholders, consumer advocates, and community leaders. Their experiences helped identify gaps in existing laws and informed the solutions reflected in this year’s Department-sponsored legislative package.

“When Californians pay their premiums, they deserve more than a policy on paper. They deserve protection that shows up when disaster strikes,” said Insurance Commissioner Ricardo Lara. “From wildfire survivors rebuilding their lives, to families dealing with smoke damage, to patients seeking access to critical health care, these laws turn real experiences into real protections. They reflect years of listening to consumers, identifying gaps in the system, and working with lawmakers to deliver practical solutions that will improve people’s lives.”

Improving Disaster Recovery

The devastating Los Angeles wildfires underscored the importance of ensuring survivors have the resources, protections, and support necessary to recover and rebuild.

SB 876 (Senator Steve Padilla) Disaster Recovery Reform Act — This comprehensive reform package will help homeowners and renters recover more quickly following disasters by:

Doubling penalties during declared emergencies for violations of insurance claims settlement laws

Requiring insurers to pay restitution directly to policyholders when violations occur

Reducing delays caused by the assignment of multiple adjusters

Requiring insurers to offer expanded policy limits so consumers have more time to recover and experience less instances of underinsurance

The law will be implemented in phases beginning January 1, 2027, with additional provisions taking effect January 1, 2028.

AB 1795 (Assembly Member Mike Gipson) Smoke Damage Recovery Act — AB 1795 establishes the nation’s first science-based standards for investigating, testing, and restoring smoke-damaged homes following a wildfire.

The landmark legislation responds directly to concerns raised by wildfire survivors by establishing clear standards insurers must follow when evaluating smoke-damage claims and helping ensure families are not forced back into unsafe homes before contamination has been properly assessed and addressed.

The legislation also incorporates lessons learned from the Lineage Logistics warehouse fire in Boyle Heights by requiring studies by the Department of Insurance and CalOES to evaluate contamination-related insurance gaps and develop recommendations for the Governor and Legislature.

Certain provisions take effect January 1, 2027, with remaining provisions effective January 1, 2028, and July 1, 2029.

AB 1680 (Assembly Member Lisa Calderon) Make It FAIR Act — The privately run FAIR Plan provides last-resort coverage for Californians.

AB 1680 improves oversight of the FAIR Plan by requiring implementation of corrective actions identified through examinations, strengthening operations, improving claims-handling practices, enhancing financial accountability, and reinforcing protections for policyholders.

Improving Insurance Industry Accountability and Consumer Protections

SB 354 (Senate President pro Tempore Monique Limón) Insurance Information and Privacy Protection Act — California’s insurance privacy laws are more than 40 years old and have not kept pace with modern industry practices. SB 354 modernizes consumer privacy protections by increasing transparency and accountability regarding how insurers and third parties collect, use, and share consumers’ personal information.

This new law, which takes effect beginning on July 1, 2028, including a five-year implementation date for licensees to implement their records retention and deletion policies, establishes comprehensive insurance privacy standards that Californians increasingly expect in today’s data-driven economy. SB 354 also extends specified compliance provisions to California insurance producers, including insurance agents, brokers, and wholesale intermediaries starting on January 1, 2029.

SB 1209 (Senator Ben Allen) Insurance Examination Compliance and Accountability Act — SB 1209 closes a significant gap in existing law by providing the Department with stronger enforcement authority when insurers fail to implement corrective actions identified through financial and market conduct examinations.

The law establishes clear compliance timelines, authorizes penalties for noncompliance, creates a formal order-to-show-cause process for violations, and provides stronger tools to ensure corrective actions identified through examinations are fully implemented. SB 1209 also allows insurers to request additional time of at least 30 calendar days, or longer if approved by the Commissioner, to comply. This law will go into effect January 1, 2027.

SB 1206 (Senate Insurance Committee) Insurance Omnibus Bill — The Department’s annual omnibus bill updates insurance law by:

Expanding grounds for inactive licenses

Adjusting insurer investment authority

Strengthening licensing and disclosure requirements

Updating public adjuster rules

Improving workers’ compensation fraud reporting requirements

Modernizing a range of insurance regulatory provisions

This new law will go into effect January 1, 2027.

Expanding Health Care Protections

AB 1798 (Assembly Member Lori Wilson) Safeguarding Genetic Information Act — Genetic testing should lead to better health outcomes, not discrimination. AB 1798 protects consumers by prohibiting life and disability insurers from using certain genetic test results of asymptomatic individuals for underwriting decisions.

The legislation helps ensure genetic testing remains a tool for early detection, prevention, and better health outcomes rather than a basis for discrimination. This law will be effective January 1, 2027.

AB 2011 (Assembly Member Gregg Hart and Senator Scott Wiener) Behavioral Health Parity Protection Act — AB 2011 codifies federal Mental Health Parity and Addiction Equity Act regulations into state law, preserving and strengthening protections that ensure consumers maintain access to mental health and substance use disorder treatment regardless of future federal actions. This law will go into effect January 1, 2027.

SB 1023 (Senator John Laird) — SB 1023 expands access to long-acting injectable HIV pre-exposure prophylaxis (PrEP) by requiring coverage through both medical and prescription drug benefits, helping make treatment more accessible through community clinics and smaller health care providers. This law will go into effect January 1, 2027.

A Record of Reform and Results

Since taking office in 2019, Commissioner Lara has pursued a strategy built on three core principles: Listen to consumers. Modernize regulation. Change the law when necessary.

Through hundreds of town halls, community meetings, workshops, and events in all 58 counties, Commissioner Lara has engaged with more than 150,000 Californians and used those conversations to help shape public policy.

Through the Sustainable Insurance Strategy, the most significant regulatory reform of California’s insurance market in decades, Commissioner Lara updated regulations to better reflect modern catastrophe risk while requiring insurers to expand coverage commitments in high-risk communities.

At least 12 insurance groups have committed to writing more policies in wildfire-distressed areas, while major insurers including State Farm and Allstate have committed to opening new business in the state.

Where regulation reaches its limits, legislation closes the gap. Drawing on his experience as a former state legislator, Commissioner Lara has sponsored 102 bills addressing consumer protection, disaster recovery, climate resilience, health care access, reproductive health care, fraud prevention, and public safety. With 69 bills signed into law, including the nine measures signed this legislative session, Commissioner Lara has compiled one of the most productive legislative records of any California Insurance Commissioner since voters made the office elective in 1989.

A Lasting Foundation for Consumers

“When I became Commissioner, I promised Californians that I would fight for consumers, modernize this Department, and prepare our insurance market for the challenges ahead,” said Commissioner Lara. “These laws demonstrate what is possible when government listens, acts, and remains focused on solving real problems facing the people it serves.”

Idaho — Mandatory Health Care Cost Drivers Data Call: Health Insurers Offering Individual, Small Group, or Large Group Major Medical Coverage in Idaho, pursuant to the authority granted to the Director of the Idaho Department of Insurance (DOI) under Idaho Code §§ 41-219 (Examinations) and 41-247 (Inquiry powers), the DOI hereby issues this mandatory data call to insurers writing major medical health insurance in the state of Idaho.

PURPOSE

The DOI is collecting premium, enrollment, administrative expense, and claims information to conduct an analysis of health care costs in Idaho's commercial health insurance market and the cost drivers from 2022 through 2025. This data will enhance the Department’s understanding of affordability, availability, market dynamics, and insurer exposures, enabling the DOI to fulfill its statutory obligations to regulate the insurance industry and protect consumers. The DOI intends to publish aggregated results in a public report.

APPLICABILITY AND SCOPE

This data call applies to each insurer that reported Idaho comprehensive major medical business in the Health Insurance columns of its MLR Annual Reporting Form for any reporting year from 2022 through 2025. It covers individual, small group, and large group coverage, plus self-funded employer plans the insurer administers.

The data call does not apply to short-term health plans, student health plans, Medicare Advantage, Medicare Supplement, Medicaid managed care, stand-alone dental or vision coverage, or other excepted benefits.

DATA REQUESTED

Insurers must report the information specified in the Excel reporting template, Idaho DOI Health Cost Drivers Data Call Template, following the instructions and data dictionary contained in the template. The template is available at https://doi.idaho.gov/industry/rates-and-forms/health. It requests:

Exhibit A: premium, incurred claims, expenses and taxes, and enrollment counts, statewide, taken from the lines of the MLR Annual Reporting Form identified in the template;

Exhibit B: enrollment and billed premium by subscriber ZIP code and county;

Exhibit C: claims by service category, by subscriber ZIP code and county;

Exhibit D: medical claims by primary diagnosis code; and

Exhibit E: pharmacy claims by National Drug Code.

The data call covers Idaho experience for calendar years 2022 through 2025. Claims are reported on an incurred basis and must include payments made through at least July 31, 2026.

REPORTING DEADLINE

Completed data submissions, following the format specified in the reporting template and instructions, are due no later than November 16, 2026.

REPORTING PROCEDURE

Submission Method: Data must be submitted electronically to the DOI Health Survey mailbox at HealthSurvey@doi.idaho.gov. Insurers may utilize secure file transfer methods and encryption as needed.

Reporting Template: Insurers must use the reporting template without changing its tab names, column headers, or column order. A data tab that exceeds Excel's row limit may be submitted as a CSV file with the same column headers and order.

MLR Annual Reporting Forms: Each submission must include a copy of the insurer's filed MLR Annual Reporting Form for Idaho for each reporting year from 2022 through 2025, in Excel format.

Reconciliation and Attestation: The template's Reconciliation tab compares the exhibits to each other and to the insurer's MLR reporting. Insurers must explain each flagged difference and complete the attestation on the Carrier Info tab.

Data Limitations: If an insurer cannot provide any of the data as requested, it must report what is available and describe the limitation on the Carrier Info tab rather than delay its submission.

Questions regarding the scope, requirements, template format, or technical specifications should be directed to the DOI Health Survey mailbox at HealthSurvey@doi.idaho.gov.

CONFIDENTIALITY

Sections 41-227, 48-801, and 74-107, Idaho Code, provide for the confidentiality of trade secret and examination information obtained by or disclosed to the DOI and exempt such information from public disclosure under Idaho's public records law. The DOI will publish only aggregated results that do not identify any insurer, provider, or member.

COMPLIANCE

Failure to provide a timely and complete response to this mandatory data call may subject the insurer to administrative action by the DOI, including penalties as provided under Idaho Code Title 41.

This Bulletin is not new law but is an agency interpretation of existing law, except as authorized by law or as incorporated into a contract. Requests for additional information or other inquiries regarding this Bulletin can be directed to the Deputy Director, Wes Trexler at weston.trexler@doi.idaho.gov.

Idaho — DOI Fraud Unit Exposes Fake Invoice in Fire Claim: The Idaho Department of Insurance (DOI) announced today that Justin Tate, of Rupert, Idaho, has been convicted of felony insurance fraud following an investigation by the Department’s Fraud Unit. Tate was found guilty by a Minidoka County jury on July 8, 2026.

The case began on August 5, 2023, when Tate filed a house fire claim with Farm Bureau Mutual Insurance Company after the total loss of his home located in Rupert. As part of the claims process, Tate later provided Farm Bureau with an invoice for $10,657.19, which he claimed was issued by “Tates Rents” and covered tractor rental, labor, fuel, consumable items, and related charges.

Farm Bureau raised concerns about the authenticity of the invoice, prompting the DOI Fraud Unit to investigate. On September 26, 2024, investigators contacted Tates Rents to verify the document. The company confirmed the invoice was not theirs, provided a sample of legitimate invoices, and stated no rental account existed for Tate or the property address listed. The investigation further determined that Tate had not rented any equipment from the company.

Following Tate’s conviction, he was sentenced on September 22, 2026, in Minidoka County. The court imposed a three‑year prison sentence, which was suspended in favor of three years of supervised probation. Tate was ordered to serve 10 days in jail and must pay restitution and associated fines.

“Our investigators work diligently to verify claims and safeguard Idaho consumers,” said Dean L. Cameron, Director of the Idaho Department of Insurance. “This conviction serves as a clear reminder that submitting false information to an insurance company is a serious crime with real consequences.”

The Idaho Department of Insurance reminds consumers that insurance fraud is a serious crime that impacts all Idahoans through increased premiums and resource strain on insurance providers. The Department remains committed to investigating fraudulent activity and protecting the integrity of Idaho’s insurance system.

For more information or to report suspected insurance fraud, visit the Idaho Department of Insurance website at doi.idaho.gov.

Idaho — Idaho Department of Insurance Appointed Rehabilitator for Idaho School Benefit Trust: On September 24, 2026, in the Fourth Judicial District Court, Ada County, an Order of Rehabilitation, case number VC01-26-17631, was issued appointing Director Dean Cameron of the Idaho Department of Insurance (the “Department”) as Rehabilitator of the Idaho School Benefit Trust.

The Director, through his authority and powers as Rehabilitator, and in compliance with Chapter 33, Title 41, Idaho Code, will henceforth oversee all operations of the Trust.

The acts of the Rehabilitator are reportable to and supervised generally by the District Court. The Rehabilitator’s actions are separate and maintained with strict controls apart from the Department’s ongoing examination of the Trust, which was called on August 3, 2026. Whereas the Rehabilitator will control the Trust going forward, the examiners continue to investigate the underlying cause(s) of the Trust’s hazardous financial condition.

The Department will be expressly clear as to the capacity from which it is communicating in these separate roles. In both respects, the Department remains committed to providing complete information on the underlying causes of the Trust’s condition as soon as they are reasonably verified and publicly disclosable.

As Rehabilitator, member schools and school districts of the Trust should understand and remember the following:

The Rehabilitator’s first purpose, pursuant to Idaho Code § 41-3301(4), is to protect the interests of the insureds. For the Trust this includes the participants – the teachers, employees, eligible retirees, and their dependents.

The Department, as Rehabilitator, will of course continue to inform and work with every school district. At the same time, the Rehabilitator must act in compliance with and follow Idaho law to enforce the contractually agreed upon terms of the Trust and the Participation Agreements that every member school district executed. This includes a responsibility to pursue the collection of debts and other legal remedies when appropriate and when doing so protects the interests of the participants.

Rehabilitation of the Trust will be conducted with as minimal interference as possible.

The day-to-day claims processing and servicing of all policies will continue to be performed by Blue Cross of Idaho as the Trust’s third-party administrator in the 2025-2026 plan, and as the insurer for the group’s 2026-2027 plan. This will ensure the greatest continuity of coverage for participants. School district questions can be sent to Blue Cross of Idaho at ISBTAcctTeam@bcidaho.com. Please include the Rehabilitator at ISBT@doi.idaho.gov.

Beyond paying claims as promised, the expenses and contracts of the Trust are being reviewed and scrutinized by the Rehabilitator. Any uneconomical, unnecessary, or otherwise avoidable costs will be curtailed or eliminated wherever fiduciarily conducive. If a school district or participants notice any interruption to their coverage or benefits, which the Department intends to minimize, they should contact the Rehabilitator at ISBT@doi.idaho.gov.

Any savings, recovered funds, or accrued amounts resulting from the Rehabilitator’s actions will ultimately be returned to the employer members of the Trust on a proportional basis; equitable to how their contributions have been assessed.

The Department is not assessing any fees to the Trust for its services as Rehabilitator, nor for the examination.

The District Court’s Rehabilitation Order reinforces the importance of executing the Trust’s cure, which includes borrowing surplus to cover its shortfall and pay claims. In turn, contribution calls were issued by the Trust and those funds will ultimately repay the borrowings that were issued.

The surplus note has been fulfilled, enabling the Trust to pay claims. School districts that have responded expeditiously and appropriately, without any prior contributions in arrears, are seeing their participants’ claims processed.

Pursuant to the terms of the Trust document and the Participation Agreement that every participating school executed, the plan administrator is holding and not paying the claims of covered employees and dependents of delinquent school districts. It is imperative that every school district’s leadership recognize the harm that is inflicted on their participants if they are in arrears or have not selected either a lump sum or monthly payment plan. The monthly selection does require an executed Addendum to the Participation Agreement for the monthly payments to be legally collected without being delinquent.

As Rehabilitator, the Department must follow the law and the terms that school districts agreed to. Rehabilitator authority does not circumvent the contractual terms agreed to between the Trust and schools, nor can the third-party administrator collect sums and pay claims for districts that are delinquent. Delinquent districts should contact the Rehabilitator at ISBT@doi.idaho.gov immediately.

The Trustees and contracted vendors to ISBT are not excused from their responsibilities. In fact, they are enjoined by the District Court Order of Rehabilitation from transactions or actions that might waste assets of the Trust.

The Trustees will continue to serve, but their decision authority is vested in the Rehabilitator. No actions may be taken without the express written permission of the Rehabilitator. Likewise, vendors and contractors to the Trust cannot alter their services or obligations to participants without written consent. Note that no parties are absolved from fully cooperating with the examination of the Trust.

The duty of the Rehabilitator is to take actions appropriate to reform and revitalize the Trust, as set forth in Idaho Code § 41-3314(2). Appropriate enforcement and repercussions are also under the authority of the Department.

Every member school district of the Trust should know that the Department is aligned first and foremost to protect the covered participants, and secondly to identify and disclose how the Trust became financially hazardous.

Communication from the Trust has been limited to date, in part, because of the Department’s intervention upon learning of the Trust’s insolvency. As Rehabilitator, the Department is fully committed to keeping broader and more consistent channels of communication open with the school districts. The Department welcomes your questions and inquiries, with the understanding that it must abide by, and can only share what is permissible under the law.

Legitimate concerns and frustration are understandable. Unfortunately, some parties have been motivated to point fingers and make unfounded accusations, which is harmful to the overall investigation process. The Department respectfully asks all parties to allow for due process and the Department’s authority granted under Idaho Insurance Law to run its course. If there has been any wrongdoing, abuse, or inappropriate depletion of funds from the Trust, the Department’s examination will identify and verify them. Thereafter, the law charges the Rehabilitator with the recovery, if any. Should the Department discover administrative or criminal violations, the Attorney General and law enforcement will be involved, where appropriate.

The Idaho Department of Insurance is very committed to promptly resolving the issues and investigating the causes of the shortfall. The Department is grateful to the member districts who have signed the agreements and are assisting in that effort. The Department is also grateful to Blue Cross of Idaho for being willing to provide the Trust with the funds to pay the claims of the participants.

Idaho — Idaho Department of Insurance Releases Final 2027 Premium Rates for Individual and Small Group Health Plans: The Idaho Department of Insurance has finalized 2027 premium rates for individual and small group health insurance plans. On average, premiums will increase by 12% in the individual market and 12% in the small group market. Each carrier’s detailed justification for its 2027 rate changes is available on the Department’s website: https://doi.idaho.gov/consumer/RateReview/.

“Despite national pressures and ongoing medical inflation, Idaho’s health insurance market remains highly competitive and stable. Our average rate increases are still lower than many states, giving consumers more choices and lower premiums,” said Director Dean Cameron.

Idaho’s 1332 State Innovation Reinsurance Waiver remains a significant factor in moderating individual market premiums. The waiver kept 2025 premiums 20% lower than they otherwise would have been, and for 2026, the reduction was 18%. In 2027, the waiver will continue offsetting the cost of high‑expense medical claims, helping keep premiums considerably lower than they would be without it. The impact of the waiver for 2027 is a 16% reduction.

Open enrollment for coverage starting January 1, 2027 runs from October 15 through December 15, 2026. Idahoans seeking coverage should visit the state’s health insurance marketplace, Your Health Idaho, at yourhealthidaho.org to compare and select from more than 143 medical plans and 22 dental plans. Shoppers can find out whether they qualify for a tax credit or other savings that lower monthly premiums and out‑of‑pocket expenses such as co‑pays and prescription costs. These savings are available only through Your Health Idaho.

Licensed, certified agents are available to assist consumers at yourhealthidaho.org. For help navigating the application process or general questions, Idahoans may also call 855‑944‑3246.

In 2027, Idaho consumers will have coverage options from seven individual‑market carriers: Blue Cross of Idaho, Moda Health Plan, Molina Healthcare, Mountain Health CO‑OP, Regence Blue Shield of Idaho, Select Health, and St. Luke’s Health Plan. Seven dental carriers will also continue offering plans statewide.

Oregon — The Oregon Division of Financial Regulation recently announced the following permanent rulemaking: ID 17-2026: Prescription Drug Price Transparency program updates

Rules: 836-200-0505, 836-200-0515, 836-200-0520, 836-200-0530, 836-200-0531, 836-200-0532, 836-200-0533, 836-200-0535, 836-200-0545, 836-200-0555

Summary: In addition to updating the rules to reflect the 2025 court decision, the department also clarified requirements, updated a reporting threshold, and added minor data collection points to allow program staff to verify accurate reporting. The changes to the rules include:

Adding a clarifying definition for “drug;”

Correction of internal references;

Reverting annual price increase reporting from voluntary to mandatory per court judgment;

Clarifying language about the timing of data reporting;

Adding examples of factors that may contribute to price increases;

Updating the threshold for reporting new prescription drugs; and,

Adding minor data collection points to allow for DPT program staff verification.

Filed: September 22, 2026

Effective: October 1, 2026

Oregon — Wildfire Emergency Order Extension: The Director has determined that the circumstances and conditions described in the Order still exist and that those circumstances and conditions warrant an extension of the effective period of the Order.

Accordingly, pursuant to ORS 731.870(2), the Director hereby extends the effective period of the Order for a period of 30 days (subject to further extension under ORS 731.870(2)) from the date of this Second Order Extending Wildfire Emergency Order.

https://bit.ly/4rSZKo6

Oregon — The Oregon Division of Financial Regulation recently announced the following permanent rulemaking: ID 16-2026: List of Prosthetic and Orthotic Devices under ORS743A.145

Rules: 836-052-1000

Summary: Establishes list of prosthetic and orthotic devices; prohibits internal or separate limits or caps on prosthetic and orthotic devices, other than the lifetime policy maximum, when permitted by law; defines when coverage for prosthetic and orthotic device is provided through a managed care organization.

Filed: September 17, 2026

Effective: January 1, 2027

Washington — Kuderer fines USAA, Allstate $230,000 for claim handling violations: Washington state Insurance Commissioner Patty Kuderer has fined two major property and casualty insurance companies a total of $230,000.

Kuderer’s office fined USAA Casualty Insurance Co. $140,000 for unfair or deceptive acts or practices in how it handled auto claims and fined Allstate Vehicle and Property Insurance Co. $90,000 for claim handling violations and for not following the OIC’s premium change transparency rule.

“We take our role as a consumer protection agency seriously,” Kuderer said. “These orders, and the actions we’ve taken against insurers for failing to meet their obligations to policyholders when processing their claims, are a testament to that work.”

Kuderer’s office has also updated state rules for minimum claim handling standards. Those changes take effect on Oct. 18.

From April through August, Kuderer’s office issued $495,200 in fines for violations of insurance laws.

USAA fined $140,000 for unfair claims handling

Kuderer’s office fined USAA $140,000 for unfair or deceptive acts or practices in how it handled auto claims.

In June 2024, the OIC reviewed some of USAA’s auto claims after finding 445 claim complaints from consumers between 2019 and 2024. The OIC reviewed 125 complaints filed from January 2023 to April 2024 and found at least one potential law or rule violation on 31 of the associated auto claims.

USAA confirmed 19 of those violations, which included:

Not responding to consumers and acting timely on their claims (11 violations).

Not using reasonable standards and investigating consumers’ claims within the legal timeframe (11 violations).

Not completing investigations of claims within the 30-day legal timeframe (four violations).

Refusing to pay claims without a reasonable investigation (five violations).

Failing to include all applicable taxes and fees in a claim settlement (one violation).

Not letting a consumer know they needed more time to determine if their claim should be accepted (one violation).

After the OIC reviewed a complaint in March 2024 and found the company didn’t include the applicable taxes and fees in its settlement offer, the OIC requested information on how many of USAA’s total loss settlements over the previous two years had the same issue. The company reviewed its data and issued payments on 158 claims, totaling $88,241, within two months of the review. USAA also reported that it corrected the issue to prevent it from happening again.

Allstate fined $90,000 for claim handling violations

Kuderer’s office fined Allstate $90,000 for claims handling and premium transparency violations. In June 2024, after receiving a high number of complaints from consumers about how their claims were handled, the OIC reviewed some of Allstate’s claims.

The OIC reviewed 108 claims from a database of 3,040 and found nine of those claims contained a total of 16 violations.

The violations included:

Not using reasonable standards for claim processing and payment (eight violations).

Not responding to consumers and acting within the legal timeframe on their claims (three violations).

Not completing investigations within the 30-day legal timeframe (two violations).

Misrepresenting important facts when issuing a payment to a consumer for much less than its own estimate (one violation).

The OIC’s review also showed the company did not include the required premium change transparency language on home insurance declarations for 86,705 policies — 86,136 of which had a premium increase on renewal. The policies were issued between April 15, 2024, and April 22, 2025.

The Insurance Commissioner’s premium change transparency rule went into effect on June 1, 2024, but at that point companies were required to send renewal notices 45 days before the renewal date. The law was updated, with the renewal notice requirement extended to 60 days, in 2025.

Washington — Kuderer fines insurers, producers $495,200: Washington state Insurance Commissioner Patty Kuderer’s office fined insurance companies, agencies and producers $495,200 between April and August of 2026 for insurance law violations.

The two largest fines were levied against USAA Casualty Insurance Co. ($130,000) and Allstate Vehicle and Property Insurance Co. ($90,000) for violations in how the companies handled policyholders’ claims.

The total included another $215,000 in fines against 19 companies and $20,250 in fines against nine agencies and producers.

Company fines

Alaska National Insurance Co., Anchorage, Alaska; fined $40,000 (order 26-0133).

The company charged garage rates that were not approved in its filings, impacting three policyholders, and failed to file its hired and non-owned rates before using them, impacting 2,298 policyholders.

Express Scripts, Inc., Wilmington, Del.; fined $35,000 (order 26-0034).

Express Scripts, a healthcare benefit manager, did not report seven previous administrative and disciplinary actions from multiple state regulators in its initial application for registration and did not report a complete accounting of its administrative and disciplinary actions in subsequent annual filings. The company also did not report material changes to the OIC within the required timeframe and provided incorrect, incomplete, or false information to the OIC.

Providence Health Plan, Portland, Ore.; fined $30,000 (order 26-0018).

Providence incorrectly denied 51 claims for physical therapy and occupational therapy services between January 2023 and August 2024. Providence incorrectly denied 40 of those claims because prior authorization approval was not obtained from Providence’s health care benefit manager, eviCore Healthcare MSI, LLC. Providence incorrectly denied 10 other claims due to medical necessity. Providence reprocessed the 51 impacted claims and paid $11,719.97 to the members and providers.

Amguard Insurance Co., Omaha, Neb.; fined $30,000 (order 26-0107).

The company issued policies with incorrect rating factors in 852 instances and issued policies with superseded forms in 546 instances.

Unitrin Auto and Home Insurance Co., Dewitt, N.Y.; fined $35,000 (order 26-0109).

The company used incorrect rating factors on 2,576 home insurance policies between 2019 and 2023, impacting 1,844 homeowners.

First National Insurance Co. of America, Portsmouth, N.H.; fined $25,000 (order 26-0097).

The company did not timely process consumers’ auto claims and related investigations and did not respond to their communications within the required timeframe on 19 claims between January of 2023 and July of 2024.

New York Marine & General Life Insurance Co., New York, N.Y.; fined $7,500 (order 26-0096).

The company used and issued rates that were not approved in its filings in 256 transactions with 245 policies, which caused overcharged and undercharged premiums. The company returned and waived, respectively, the difference.

Medical Review Institute of America, LLC, Dover, Del.; fined $5,000 (order 26-0061).

The company did not report a material change and did not file contract forms or amendments within the required timeframe.

Arch Insurance Co., Kansas City, Mo.; fined $5,000 (order 26-0039).

The company issued policies with incorrect construction types, rate types, and protection classes.

Praetorian Insurance Co., Harrisburg, Penn.; fined $5,000 (order 26-0044).

The company applied incorrect construction year assignments and incorrectly listed the number of building units on renters’ policies, resulting in 49 policies with incorrect rating factors applied.

Dentists Insurance Co., Sacramento, Calif.; fined $5,000 (order 26-0144).

The company used rates that were not approved in its filings

DTG Operations Inc., The Hertz Corp., Thrifty Car Rental; The Woodlands, Texas; fined $5,000 (order 26-0142).

The company, on two occasions, told Washington consumers that they were required to purchase rental car insurance, and did business under an unregistered trade name without notifying the OIC.

UnitedHealthcare of Washington, Inc.; Seattle, Wash.; fined $5,000 (order 26-0027).

UnitedHealthcare issued adverse benefit determinations or limited access to gender-affirming care in 50 claims, without assigning those claims to a health care provider with gender-affirming treatment experience to review and confirm the appropriateness of those determinations.

Stillwater Insurance Co., Santa Barbara, Calif.; fined $3,500 (order 26-0103).

The company incorrectly applied sprinkler credits and construction type rating factors, which resulted in premium errors.

American Dental Examiners, Inc.; New Rochelle, N.Y.; fined $3,000 (order 26-0050).

The company did not report a material change and file contract forms and amendments electronically within the required timeframe.

Brown & Brown Insurance Services, Inc. and Hays Companies, Inc.; Tampa, Fla.; fined $2,500 (order 26-0014).

The companies did business under an unregistered trade name and failed to notify the OIC.

Metropolitan Life Insurance Co., New York, N.Y.; fined $2,000 (order 26-0051).

The company did not file contract forms and amendments electronically within the required timeframe.

Metropolitan Life Insurance Co., New York, N.Y.; fined $1,500 (order 26-0101).

The company did not file large group negotiated rates within the required timeframe.

Agency and producer fines

Jacob Collins, Spokane, Wash.; fined $6,500 (order 26-0084).

Collins submitted five mortgage insurance applications on a consumer’s behalf without authorization. The producer then did not reply to one of the consumer’s questions and did not respond to the OIC’s initial inquiries within the required timeframe. Collins appeared to have electronically added the consumer’s signature on an application without their authorization.

Collins reports they have improved their compliance procedures to ensure applications are authorized correctly. Collins’ insurance license was also placed on probation for two years, and they were ordered to complete 10 hours of ethics training.

Noelle Otersen, Liberty Lake, Wash.; fined $3,000 (order 26-0085).

Otersen used their own cell phone to provide signature authorization for consumers’ life insurance applications and did not respond to questions from the OIC within the required timeframe. Otersen was also ordered to complete 20 hours of ethics training.

Robyn M. Roberts, Lawrenceville, Ga.; fined $2,500 (order 26-0117).

Roberts sold insurance without a license on five occasions and did not inform a consumer of their settlement options.

InsuranceHub Leavitt Agency, Inc.; fined $2,500 (order 26-0118).

On five occasions, the agency knowingly accepted insurance business from someone without a license and didn’t affiliate the person with the agency.

Sherry A. Johnson, Ephrata, Wash.; fined $2,000 (order 26-0040).

On six occasions, Johnson listed consumers as “married” on their auto policy applications without documentation.

Citlally Mancilla and Perpetuus Insurance Agency, San Antonio, Texas; fined $1,500 (order 26-0134).

Mancilla tried to sell insurance to two Washington residents before obtaining the required license. The agency failed to affiliate individual licensees authorized to represent the agency and allowed unlicensed individuals to sell insurance on its behalf.

PracticeProtection Insurance Services, LLC; Jacksonville, Fla.; fined $1,500 (order 26-0135).

The company didn’t affiliate all of its individual licensees or ensure its producers were appropriately licensed, accepted business from an unlicensed producer, and allowed unlicensed people to sell insurance.

Mathew William Nicholas, Newport Beach, Calif.; fined $500 (order 26-0045).

Michael Lawson, Dallas, Texas; fined $250 (order 26-0046).