Issaquah woman pleads to 3 felony charges in insurance fraud case

An Issaquah woman has entered a modified guilty plea to 3 felony counts of using false claims or proof in an insurance claim.

Linda Ann Rose, 67, is scheduled for sentencing in King Couny Superior Court November 19th.

On Nov. 13, 2004, Rose was involved in a parking lot collision. An SUV backed out of a parking stall and struck Rose's rented Ford Mustang. Photos of both vehicles show minimal damage, but Rose claimed that she suffered severe back injuries as a result of the collision. In 2007, her attorney demanded $656,874 from the SUV owner's insurer, and subsequently filed a personal injury lawsuit in the case.

Investigators from the Washington Insurance Commissioner Mike Kreidler's Special Investigations Unit subsequently concluded that Rose knowingly provided altered medical records to her attorney, and that she had had an injured back "well before" the accident.

Kreidler re: health insurance rates: "I share your frustration"

Our office continues to hear from people unhappy with health insurance rate hikes.

These can be particularly severe when you bump up into the next five-year "age band." Health insurance, which varies dramatically by age, is priced in 5-year groups. In other words, turning from 58 to 59 won't increase your rates more than usual, but turning from 59 to 60 will. These increases -- coming on top of annual rate hikes -- can be a very tough burden on folks who find themselves paying more and more for fewer and fewer benefits.

Washington state Insurance Commissioner Mike Kreider has issued an open letter to the state's health insurance consumers. From it:

Many of you have contacted me about your frustration at the rising costs of your health insurance. You’re tired of seeing your premium and out-of-pocket costs increase, at the same time you lose benefits. I don’t blame you for being mad. I share your frustration and take your concerns very seriously.

Kreidler said that his authority remains too limited, and that he'll be asking state lawmakers for more power to protect consumers and new rules to increase transparency, so people can see the details of what actually goes into an insurer's rate request. From the letter:

You deserve to know how your premium dollars are being spent and what's driving the cost increases.

The good news is that relief is coming; the bad news is that in many cases it won't be until 2014. That's when major provisions of the new federal health care reform law take effect, including a health insurance "exchange" where it's easy to comparison-shop, subsidies to help make insurance affordable, and rate caps based on a percentage of salary.

Here's a link to the full text.

Cease and desist order issued to ShieldStar Home Warranty

Washington state’s insurance commissioner on Tuesday ordered a New Jersey home warranty company to stop selling unauthorized service contracts in Washington.

ShieldStar, doing business as ShieldStar Home Warranty and http://www.shieldstar.com/, has sold at least 21 home warranty service contracts in Washington, according to a cease and desist order posted on Insurance Commissioner Mike Kreidler’s website.

This is the third cease and desist order that Kreidler has issued against a home warranty company in the past several months. (The other cases were unrelated to this one.)

In ShieldStar’s case, the contracts cover parts and labor necessary to fix major appliances and systems in the consumer’s home. But neither the company nor several affiliated individuals named in the report are registered in Washington as a service contract provider.

The company has been ordered to mail a copy of the Kreidler’s cease-and-desist order to all its customers in Washington and to report all premiums charged for Washington policies.

The company has the right to demand a hearing. The order is effective immediately.

Update: (12/8/2010) If you purchased a ShieldStar Home Warranty, we want you to know that the cease and desist order does not prevent the company from fulfilling the terms of your contract. Your current contract with ShieldStar is valid under its usual terms and conditions.

Similarly, the order does not prevent the company from providing a refund when requested by a Washington consumer.

If you have any questions or need any assistance with this or any other insurance-related matter, please feel free to call our consumer protection staff at (800) 562-6900

Statistics from our consumer advocacy hotline...

We received nearly 13,000 calls last month to our free hotline for Washington residents with problems or questions involving insurance. Along the way, we helped consumers recover $776,937 in delayed/denied claims and similar problems.

We have experts in a wide variety of insurance matters, and we can often help resolve difficulties getting claims paid, help you find health coverage, etc.

We're not an insurer, agent or broker. We're the state agency that regulates the insurance industry in Washington state. We tend to get between 11,000 and 15,000 calls a month.

Got a problem or question? Give us a call: 1-800-562-6900 or e-mail us at AskMike@oic.wa.gov.

Storm headed for western WA, rain and high winds Saturday night and Sunday

The National Weather Service has issued a "special weather statement" for much of western Washington late this weekend. From it:

A potent storm will slam into the region Saturday night and Sunday, resulting in locally heavy rain and strong winds, especially on the coast. Another blast of strong winds impacting a larger part of the area is possible on Monday.

If you experience damage and have insurance questions, try our winter weather information, which covers common insurance questions about everything from sinking boats to fallen trees to power outages.

Washington residents with insurance questions or problems can also call our consumer advocacy staff at 1-800-562-6900. We'll try to help.

Home Owner's Insurance Policy - Learn More And Save Money

We bought all our life insurance. Sometimes they do so indiscriminately. There are times when people go to buy a house and the owner, the administrative official policy of insurance is just something that is needed to make soft close race. Domestic policy protects the largest asset that the majority of us will buy and what makes sense to learn the basics. The homeowner's policy AM has multiple benefits and features and is probably the best policy and more affordable than ever purchase. It is clear that there is a misconception about what homeowner insurance, administrative officers covers and what does not. The homeowner's policy administrative officers protecting us against the dangers our house. The dangers are unforeseen events such as fires or explosions. The housing policy does not cover maintenance issues. This is where the misunderstanding. The craft badly damaged or buying a trader is not covered by the owner, the AM policy. Such coverage would make a great host, the policy of administrative officers unavailable.

The insurance policy homeowner is very complete. It protects all your personal property, along with housing. Most policies are written on a replacement cost basis. That means that in case of total loss of your home and its contents will be replaced by type and quality of materials. Shopping for a homeowner's policy AM is much easier. Make sure you have your current declarations page. You can either go online or contact a local agent. It is best to combine a car and house quote for various politicians discounts available.

There are lots of additional riders that you can buy the owner of a home, the administrative officers. If you have items such as jewelry, artwork and collectibles then you can program with one type of risk, all coverage. There are plenty of new features, as approved by identity theft and coverage of day care home. The insurance policy homeowner is one of the largest insurance purchases you will ever make. Don, AOT sold short. Explore all possibilities to cover their assets. Use higher deductibles to reduce the premium for that may cover some of their most valuable assets with regular riders.

Cease and desist order issued against Choice Home Warranty

Washington State Insurance Commissioner Mike Kreidler today issued a cease and desist order against CHW Group, Inc., doing business as Choice Home Warranty and http://www.choicehomewarranty.com/.

The company is believed to have sold at least 92 home warranty service contracts to Washington residents. The contracts cover repair or replacement on major systems and appliances in the person's home, and promise that Choice Home Warrant will pay for repair or replacement of those that fail.

The problem: the company isn't authorized to transact insurance in Washington state. Nor is it registered here as a service contract provider.

Kreidler ordered the company to mail a copy of the order to all Washington home warranty service contract customers. The company must also report to the state how much it's collected in premiums from Washington consumers.

The company has the right to demand a hearing. The order takes effect today.

We'll post a link to the order shortly.

Updated: As promised, here's the link.

Which insurers sell individual insurance plans in Washington?

• Asuris Northwest Health
• Group Health Cooperative
• Group Health Options
• Kaiser Foundation Health Plan of the Northwest
• KPS Health Plans
• Lifewise Health Plan of Washington
• Premera BlueCross Individual Plans
• Regence BlueCross BlueShield of Oregon
• Regence BlueShield
• Time Insurance Company

 

To see who's selling coverage in your county, click here.

 

And to look at their rates, click here.

Kreidler orders Regence to cover children

Washington State Insurance Commissioner Mike Kreidler this morning ordered Regence BlueShield this morning to stop illegally denying insurance to children, effective immediately.

“Regence is in clear violation of state law that prohibits insurers from denying insurance to people on the basis of age,” said Kreidler. “I was shocked and deeply disappointed when Regence announced its decision last week to stop selling insurance to kids.”


The Affordable Care Act requires all health plans to cover kids with pre-existing conditions. However, to accommodate the insurance industry’s concerns that people would only enroll their children when they became sick, the federal government let states create a special open enrollment period.

Kreidler issued an emergency rule creating a special enrollment period from Nov. 1-Dec. 15. During this time, anyone looking for an individual health plan for their families or just their children can enroll their kids without having to take a health screen.

But Regence Blue Shield, the largest health insurer in the individual market, notified Kreidler on Sept. 27 that, effective Oct. 1, it would no longer sell individual health insurance policies to kids.

Here's a link to the full press release.

Update: And here's the response from Regence, which says it was shocked and disappointed by the order. From their press release:

It is important to stress that our eligibility changes do not apply to those insured members covered under small or large group policies. We've been very clear that we will insure kids during open enrollment periods when the child is not the sole subscriber -- and we will do so regardless of health status.

Tacoma woman with history of slip-and-fall claims charged with theft

A Tacoma woman who has repeatedly claimed to have slipped and fallen in grocery stores has been charged with theft and attempted theft after claiming to have fallen in two different stores within about 15 minutes.

Brenda J. Johnson, 50, is scheduled to be arraigned today in Pierce County Superior Court. She has been charged with first-degree theft and first-degree attempted theft.

Johnson said she was near check stand No. 2 at a Tacoma Safeway store on Sept. 18, 2009 at 11:46, buying peaches, when she slipped on some liquid and fell, injuring her wrist and ribs. Neither the cashier nor any other employee could recall any such incident.

On the same day at about noon, Johnson said the same thing happened in the frozen food aisle of a Tacoma Fred Meyer store.

In both cases, she said, she was embarrassed and quickly left. She filed claims with both stores, showing medical care and prescription drug receipts totalling more than $5,500.

A subsequent investigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit indicated that she apparently submitted virtually identical medical receipts to each store, including an 8-page emergency room report that was missing some pages.

Medical records obtained through a search warrant indicated that the treatment was unrelated to a fall at either store. The records also showed that there been no expense to Johnson for the care.

The investigation also revealed that Johnson has filed at least five auto-accident medical claims and at least half a dozen slip-and-fall injury claims.