Job openings

We have a couple of job openings:

We're looking for an administrative assistant 4 for a limited-duration position funded by federal grant dollars related to health care reform. This person will perform "a wide range of complex administrative duties related to planning and implementation of organizational change, grant management and program support functions." The job duties include compiling statistical information and preparing written reports for executive managers and the grant funding agency. The position is funded by federal grants through November 2011.

Here's the link to the job posting, but if you want to apply, please do it quickly. Applications are due by 4:59 p.m. this Friday.

We're also looking for a financial examiner 2 to work in our Seattle office. This person will plan and conduct financial examinations of insurance companies and other regulated entities. From the job listing:

This position works with Financial Analysts (certified public accountants, certified financial examiners, and accredited financial examiners), attorneys, and other regulators on a state, national, and international level. This position examines, audits, and verifies specific groups of insurance companies, including bonds and stocks, mortgage loans, real estate, policy loans, premium notes, collateral loans, policy reserves, and capital stock.

For qualifications, pay, and application information, please see this job posting. The deadline for applications is 5 p.m. on Dec. 3.

We're a small state agency -- we have a total of about 200 workers between our Tumwater, Olympia, Seattle and Spokane offices -- that regulates the insurance industry in Washington state. We have a pretty broad consumer-protection mission. We:

• monitor insurers' finances to make sure they can make good on their promises to policyholders.
• license tens of thousands of agents and brokers, and investigates complaints about them.
• scrutinize rate hike requests and makes sure that policies comply with the law.
• go after scams, both from unlicensed insurance companies and by people trying to defraud insurers.

And our consumer advocates and a small army of volunteers field thousands of calls and e-mails from consumers needing help with insurance claims or struggling to find affordable health coverage.

How Washingtonians can file an insurance complaint online

We've launched a new "online consumer complaint center" this week, and we think we're the first state insurance department in the country to offer this kind of service.

The system lets Washington state consumers file complaints against insurers using a new interactive and password-protected web tool.

The idea is to make it more convenient and efficient for consumers to file a complaint with our office. We help with thousands of complaints, but until now, the process has relied on people mailing documents back and forth. We think this will be faster and easier.

What sorts of complaints? They often involve what insurers are covering -- or not covering . We often get calls from drivers whose cars are totalled, and who are unhappy about the payment offered for their vehicle. We try to help with complaints about delayed payments, policies being canceled, getting companies to reopen a claim or negotiate on payment, etc.

At our site, Washington state residents can file a secure complaint online, track its status 24/7, upload documents/photos/etc. related to the case, add comments, and view, print and save information about the case.

Not a Washington state resident? Here's a map with contact info for your own state's insurance department.

Request for proposals re: insurance rate review

We're looking for proposals from firms interesting in participating in a project to improve our review of health insurance rates and to increase public transparency for how health insurance premiums are determined.

Interested in bidding? The full request for proposals document is here.

The estimated time period for the contract is Feb. 16, 2011 to Sept. 30, 2011. We reserve the right to extend it for up to three one-year periods; see the RFP for details. It includs the scope of work, evaluation procedures, minimum qualifications, etc.

All proposals are due no later than 5 p.m. PST on Dec. 27, 2010.

For additional details, see also our general RFP page, and see this news release, which contains more information about the federal grant that's helping pay for the project.

High winds and storm damage -- what insurance covers and what it doesn't

As you probably know if you live in western Washington, high winds swept across much of that part of the state last night, toppling trees and knocking out power to thousands of people.

Every time this happens, our office gets calls from people wanting to know what damage their homeowners/auto/business insurance covers. (We're the Washington state agency that regulates insurance.)

Here are a few common questions:

Am I covered if my car was damaged by falling limbs? If your car was damaged, that damage should be covered under the comprehensive coverage in your auto insurance policy. (If you opted for comprehensive coverage, that is. Some people, to save money, just get liability coverage.)

My yard is covered with branches from the storm. None of them hit the house or my fence, so there's no property damage. But would the cleanup costs be covered in this case? Sorry, probably not. Standard homeowner's policies typically only pay for such cleanup if your property was actually damaged. In other words, your home, garage, fence, etc. would probably have to first be damaged by the debris for the insurer to pay to remove it. Standard policies don't cover the loss of trees or shrubs because of wind.

My business has an awning over the sidewalk, and it's been damaged by the wind. Is it covered? Probably, but check with your agent or insurer to be sure, since business insurance can vary a lot. Also, many business policies have business interruption coverage, which can be very useful if a covered loss forces you to close the business. But there are often deductibles or other limits, so they may not apply if the business interruption is for just a few days.

Click here for our page with tips and storm-related Q&As re: insurance.

If you have damage and have questions or problems with your insurer (and live in Washington state), call our consumer affairs hotline at 1-800-562-6900. It's not a phone tree; it's staffed by live people.

Look for some more wind gusts tomorrow. Weather Underground is predicting a south wind 15-25 mph in Seattle and Olympia, and a lighter 10-15 mph in Tacoma.

If you've lost power, here are Puget Sound Energy's updates on progress restoring power, including a handy map of outages and progress.

And if you want the state version of a worst-case scenario survival guide, here's the link (it's a 5-meg pdf, sorry about that) to the Emergency Management Department's "Emergency Resources Guide." It tells you what to do in case of a pandemic, a terrorist bomb, biological weapons attack, or if you're trapped in debris (tap on a pipe). It's got questions to ask someone making a bomb threat, and what to avoid eating after a radioactive "dirty bomb" goes off, etc. etc. etc.

From our case files...

A sampling of recent cases our consumer advocacy staff has handled in the past few days (We get many consumer calls a day; these are very typical of the sorts of cases we deal with):

• A driver got into an accident with a business' truck in Seattle. The truck backed into his car. Yet the business' insurer initially offered to pay for only 70 percent of the nearly $2,400 in damage. The man complained to us. We contacted the insurer, which reviewed the case -- including photos provided by the car's owner -- and agreed to pay for all the damage.
• A Vancouver woman whose insurer wanted to cancel her policy due to a deteriorating roof asked for our help. We helped her get the company to renew the policy and keep her covered.
• An Issaquah man wanted to remove his daughter, who is a college student in another country, from his auto policy. The company refused. We asked them to review the decision. He got a $563 discount as a result.

If you live in Washington and need help with an insurance company, agent or broker, give us a call at 1-800-562-6900 or e-mail AskMike@oic.wa.gov. We won't send you to a phone tree try to sell you anything -- we're the state government agency that regulates the insurance industry in Washington state. We'll do our best to help.

One wrong denial for contraception coverage leads to company reprocessing nearly 1,000 other claims -- and paying $148,000

One consumer's call to our Insurance Consumer Hotline meant good news for nearly a 1,000 additional insurance consumers. A woman sought our help when coverage for her prescription contraceptive was denied by her insurance company. It turned out that the insurer had been violating a rule Insurance Commissioner Mike Kreidler enacted back in 2001. It had to pay her claim and reprocess 984 claims of other enrollees previously denied, making payments totaling more than $148,000.

From Jan. 1, 2002 to May 25, 2010, the insurer had repeatedly denied payment, under a variety of different codes. Among them: "Condition not covered by this contract", "This service for this condition is not covered by your plan", and "Medical necessity for this service or supply has not been established." The contraceptives in question were IUDs, and the requested coverage was payment for removal of the devices.

Of the 985 claims, only 3 women appealed the decision -- and all the denials were upheld.

But one of those women decided to contact our office. And that led to getting those years' worth of claims, for hundreds of women, paid.

Here's the rule: In Washington, all state regulated health plans that have comprehensive prescription drug coverage must cover prescription contraceptives. Want to know more? Here's a page describing your rights under this state law.

If you've got an insurance question or problem and you live in Washington, don't be afraid to call us for free help. We're at 1-800-562-6900 or AskMike@oic.wa.gov.

Note: Post updated to reflect what kind of contraceptive and service was involved.

Update on Chubb fine and suspension: Suspension is stayed pending hearing

On Monday, we called for a $534,000 fine for Chubb & Son and a 9 month suspension of six of its subsidiaries (which would mean that they couldn't write new business; existing policies would remain in force, and renewals could still be done). The companies' attorneys yesterday demanded an adminstrative hearing on both matters. So the suspension, which was slated to take effect Nov. 18, is stayed for now.

In response to some media queries, here's a list of recent enforcement actions we've taken against these companies. All include the same sort of violations -- improper documentation of decisions about rates -- that led to these latest two orders. (All our disciplinary orders, including those for insurers, insurance agents, brokers, etc., are posted online here.)

2000: $67,000 fine for multiple violations, including failure to provide proper documentation for why credits and debits were applied to certain policies. The fine was actually $135,250, but about half ($67,625) was suspended so long as a compliance plan was followed to fix the problems.

2003: The balance of that fine -- $67,625 -- was imposed, after numerous violations continued, despite the compliance plan. From the 2003 order: "The company’s pattern of a continued high rate of filing and other violations are indicative of a systemic problem."

2007: We imposed a $250,000 fine for ongoing violations. Chubb & Son agreed to fully comply with a compliance plan, including multiple self audits, to fix the problems.

2010: We call for a $534,000 fine, based on hundreds of violations. The companies call for a hearing.

2010: Commissioner Kreidler orders a 9-month suspension of six Chubb subsidiaries' ability to sell new coverage. The companies call for a hearing.

Job openings

Due primarily to some federal health care reform grants (and one employee who left for a sunnier climate, think of that), the Washington state insurance commissioner's office has a few job openings. Most are limited-duration posititions based on grant money.

Here they are. Click on the position for details about requirements, salary, duties, application process, etc.

Functional Program Analyst 4: Deadline for applying is Nov. 12. These staff advocate on behalf of consumers to ensure that they're being fairly treated by their insurance carriers and by helping educate consumers about insurance. This person will help develop and test online tools to help consumers. This is a project position funded by federal grant dollars, and the grant period runs from Oct. 15, 2010 to Oct. 15, 2011.

Investigator 3: We're looking for a senior investigator to investigate suspected violations of state insurance law. From the job announcement: The Investigator 3 position is an advanced investigative position responsible for conducting complex investigations from the initial discovery of suspected violations, through the prosecution of those involved in illegal activity. Deadline for applying for this job is Nov. 16.

Communications Consultant 4: This is another project job, funded by a federal grant that runs from Oct. 15, 2010 to Oct. 15, 2011. This person will work with our Consumer Protection division to develop and manage communications strategies for consumer assistance and education. Deadline for applying is Nov. 19.

Management Analyst 5: Another project job, with the same grant timeline as those listed above. This would be a project manager position, leading a diverse project team. See the link for much more information on technical details, duties, etc. Deadline for applying: Nov. 19.

Kreidler calls for $534k fine against insurer, issues order to suspend six subsidiaries from writing new coverage for 9 months

Washington State Insurance Commissioner Mike Kreidler on Monday issued an order that would suspend the insurance certificates of six companies, effective Nov. 18. The move – which does not affect existing policies or renewals – would bar the companies from writing new coverage for 9 months.

Kreidler is also proposing a $534,000 fine, contingent on a hearing, against the parent company, Chubb & Son.

The suspension order includes Federal Insurance Company, Pacific Indemnity Company, Great Northern Insurance Company, Executive Risk Indemnity, Inc., Vigilant Insurance Company, and Northwestern Pacific Indemnity Company. All are property and casualty insurers. All are wholly owned subsidiaries of Chubb & Son. The policies affected are all commercial policies.

“It’s highly unusual for us to suspend a company’s certificate to sell insurance. But we’ve repeatedly tried to work with Chubb and its subsidiaries to fix a number of ongoing violations of state law,” Kreidler said in a press release. “Some of the problems that triggered this decision have been recurring for a decade.”

A key issue is Chubb’s repeated failure since 1998 to properly document the reasons for charging higher or lower rates on certain policies.

Repeated examinations and a series of company self-audits ordered by Kreidler since 2007 found hundreds of violations of state law, including numerous recent ones. In some cases, more than half the sample files checked had violations. The $534,000 fine amount was based on 534 violations of state insurance law, at $1,000 per violation.

Chubb can appeal the suspension. The suspension order does not affect the companies’ obligation to honor policies issued prior to the effective date of the suspension. Nor does it affect their authority to renew existing policies. But it would prohibit them from selling new policies during the nine-month period of the suspension.

Note: We'll add a link to the press release shortly. Done. And we added a link up above to the hearing notice re: the fine.

Update: Chubb has demanded a hearing on both the fine and the suspension. See our post re: that here.

New health plans for small businesses

Small businesses in Washington state looking for health insurance for their employees should check out the new federally-funded Health Insurance Partnership (HIP). This is a new program administered by the state's Health Care Authority that provides small employers access to the same health insurance coverage available in the commercial market, but at significant savings.

The health plans available through the partnership include:
Kaiser Foundation Health Plan of the Northwest, Group Health Cooperative, Regence BlueShield, and Asuris Northwest Health and vary based on annual deductibles ($500-$5,000), co-pays, co-insurance, and prescription drug coverages.

Small employers (up to 50 employees) who don't currently offer health insurance qualify for the program if at least 50 percent of their employees are considered low-wage (their monthly wage doesn't exceed 200 percent of the Federal Poverty Level).

Also, premium subsidies of up to 90 percent are available to employees who qualify based on their family income. Get the details here.