Around the Western Alliance States – Week of July 3, 2023

California — Lara Awards Fraud Prevention Grants: Insurance Commissioner Ricardo Lara announced he has awarded $50,545,239 in grants to 34 district attorney offices representing 44 counties in California to combat insurance fraud. Under Commissioner Lara’s leadership, these grants, funded through annual employer assessments, support law enforcement efforts in investigating and prosecuting fraud and increase outreach to our communities. Commissioner Lara also awarded an additional $400,000 in grants to protect consumers, the majority of whom are seniors, from abuse involving the sale of individual life and annuity products as part of the Life and Annuity Consumer Protection Program.

“Insurance fraud continues to be a drain on our economy. Partnership between my Department’s investigators and local law enforcement is crucial in fighting fraud and educating the public,” said Commissioner Lara. “These annual grants continue to show my Department’s long-standing commitment to investigating and working with our law enforcement partners to combat fraud and protect consumers, businesses, and the insurance marketplace.”

Since Commissioner Lara took office in 2019, the Department has particularly focused these grants on increasing outreach throughout the state, especially to our state’s diverse and underserved communities. These grants also fund essential outreach programs for individual district attorney offices to deter fraud and increase consumer awareness. Consumers are sometimes unaware of their rights or are reluctant to exercise them. Outreach programs will educate them of those rights and of best anti-fraud practices to protect themselves and their loved ones. Visit our website for information on scams consumers and business may be susceptible to.

The other focus for these grants is combating workers’ compensation fraud. A large part of these grants will go to the investigation and prosecution of medical provider fraud in the workers’ compensation system, protecting Californians who are unwittingly ensnared in schemes to bill for unnecessary or profit motivated medical treatment. A recent example of this type of fraud was the sentencing of former doctor, Julien Omidi, to 84 months in federal prison after a joint investigation with the Department and law enforcement partners found that he defrauded insurance companies by fraudulently submitting nearly $120 million in claims.

Department investigators also work with law enforcement partners to target employer premium fraud, employer defrauding employee fraud, insider fraud, claimant fraud, uninsured employers operating within the underground economy, and exploitation of workers. These investigations level the playing field for honest businesses and discourage future fraudulent activity, and protect all Californians. A recent example of this was the plea agreement reached with Golden Foods Inc. where the company admitted to a litany of labor violations, which includes over $437,000 in stolen wages ultimately paid back to more than 30 California workers.

The grants awarded through the Life and Annuity Consumer Protection Program protect all California consumers through the investigation of life and annuity transactions involving theft, embezzlement, twisting and churning, forgery, material misrepresentations, advanced commission schemes, and identity theft. The successful investigation and prosecution of these insurance crimes play an important role in protecting consumers and deterring fraudulent activities. In a recent investigation, two co-conspirators were convicted of grand theft and ordered to pay a total of $500,000 in restitution to the family of their victim, who they defrauded and convinced to purchase unnecessary annuities.

Oregon — State encourages drivers to review auto coverage, promotes safe summer driving tips: Now that summer has arrived and people are hitting the road for vacations, the Oregon Division of Financial Regulation (DFR) is reminding Oregonians of safe driving tips and to check with your insurance agent or company to review your insurance policies. With changes in driving patterns and potential risks during the summer, it is crucial for drivers to understand policy limits and coverages. DFR encourages drivers to have a conversation with their agent or insurance company to explore coverage options, ensure policies are up to date, and that appropriate protection is in place.

Additionally, it is a good time to ensure vehicles are in good working order by reviewing the following:

Air conditioning: With rising temperatures, maintaining a comfortable driving environment is crucial for both driver concentration and passenger well-being. Drivers should regularly check their vehicle’s air conditioning system to make sure it is functioning optimally. A properly functioning air conditioning system not only provides comfort, but also helps prevent fatigue and promotes alertness while driving. A lack of air conditioning on a hot summer day affects everyone, but is particularly dangerous for people who are in poor health or who are sensitive to heat, such as children and older adults.

Belts and hoses: To ensure safe and uninterrupted travel, drivers should regularly inspect their vehicle’s belts and hoses. Extreme temperatures can cause wear and tear, leading to potential breakdowns. It is recommended for drivers to schedule maintenance checks or consult a qualified mechanic to examine and promptly replace worn-out or damaged belts and hoses.

Tires: Proper tire maintenance is crucial for safe driving, especially during summer when road surfaces can become scorching hot. Drivers should regularly inspect their tires for signs of wear and tear, ensure correct inflation levels, and maintain adequate tire tread depth. Adequate tire condition contributes to optimal traction, better control, and improved fuel efficiency.

Essential vehicle components: Regular maintenance of essential vehicle components is vital to ensure a safe and reliable driving experience. Drivers should regularly check vehicle fluid levels, including engine oil, coolant, and windshield washer fluid. Also, inspect the cooling system, batteries, and wiper blades to avoid potential breakdowns and maintain clear visibility on the road.

Essential supplies: In preparation for long journeys or unexpected situations, it is essential for drivers to stock their vehicle with necessary supplies. DFR suggests including items such as a first-aid kit, flashlight, extra water, nonperishable snacks, a roadside emergency kit that includes jumper cables, tire pressure gauge, work gloves, a change of clothes, emergency blankets, towels, and coats. These supplies can be invaluable during emergencies or when stranded on the road.

“We encourage all drivers to prioritize safety during the summer season by following these essential tips,” said Andrew Stolfi, insurance commissioner and director of the Department of Consumer and Business Services. “By practicing responsible driving habits and taking proactive measures, we can collectively contribute to safer roads and a more enjoyable driving experience for everyone. In addition to taking safety measures, and before hitting the road, drivers should make sure their auto insurance coverages are updated and their current proof of insurance is in the vehicle.”

Washington — Notice of Balanced Billing Protection Act Annual Arbitration Report posted: The Balanced Billing Protection Act (BBPA) (RCW 48.49) protects consumers from balance billing, also called surprise billing, when they receive out-of-network emergency medical services and out-of-network surgical or ancillary services at an in-network hospital or ambulatory surgical facility. The BBPA went into effect on January 1, 2020 and was updated by the Legislature in 2022.

RCW 48.49.050 directs the OIC to submit an annual report regarding BBPA disputes and arbitration to the Legislature by July 1 of calendar years 2020 through 2023.  The report provides information regarding arbitration requests and decisions related to payment disputes between out-of-network health care providers and carriers.  This year’s report provides information regarding arbitration requests and proceedings that occurred during calendar year 2022.

To view the BBPA Annual Arbitration Report, please visit the website.

About PIA Western Alliance

The Professional Insurance Agents Western Alliance is a membership organization promoting and enhancing the success of independent agencies seeking to grow, learn and be heard within the industry.


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