Insurance when you're laid off: What to ask for on your way out the door

Nobody wants a layoff notice, but critical insurance moves on your way out the door can help extend your health insurance (and other coverage) and save you thousands of dollars at a critical time.

Insurance.com spelled this out today in an article titled "Insurance smarts during a layoff: 3 must-do moves."

Among the advice:

• Ask for an extension of health care benefits. Ask for the employer to keep you covered for 3-6 months.
• Negotiate with your employer to have them pay COBRA insurance premiums, which can be very expensive.
• Convert group life insurance or group disability coverage to an individual plan, particularly if you're older.

Report: Health costs' rapid rise

The Commonwealth Fund has published a new report looking at state trends in health insurance premiums and deductibles from 2003 to 2010.

The upshot: employees' annual share of premiums increased by 63 percent over those 7 years (and premiums themselves rose 50 percent as well). In Washington state, for example, family health insurance premiums rose from $9,212 to $14,188 during that period. That's a 54 percent increase.

Not surprisingly, given stagnant incomes in recent years, premiums as a percentage of median household income during that time increased dramatically. In 2003, only a single state (West Virginia) had average premiums above 20 percent of median household income. Today, about half the states are in that category.

For a look at premiums (single and family) by state, here's a good interactive map from the report.

The report continues:

 At the same time, per-person deductibles doubled in large, as well as small, firms.

If premium trends continued at that rate, the researchers predicted, "the average premium for family coverage will rise 72 percent by 2020, to nearly $24,000."

Federal health care reform, passed in early 2010 but taking effect largely in 2014, offers the hope of some savings, the report says:

Health reform offers the potential to reduce insurance cost growth while improving financial protections. If efforts succeed in slowing annual premium growth by 1 percentage point, by 2020 employers and families together would save $2,161 annually for family coverage, compared with projected premiums at historical rates of increase.

Colorado couple ordered to stop selling insurance in Washington state

A Colorado couple, Robert W. Ramlet and Patricia Ramlet, has been ordered to stop selling insurance in Washington state.

In 2006, the two sold two life insurance policies in Washington state without being licensed as insurance agents here.

Admissibility of Expert Reports in Small Claims Court

In Turner v. Kitchener (City) [2011] O.J. No. 4803, there was a mid-trial ruling on the admissibility of an expert report in Small Claims Court.

The facts of this case involve a plaintiff who was riding his bike along a recreational trail in Kitchener. It was his regular route and time of travel which put him on the trail at 5:15 am.

Earlier that morning vandals had set fire to a bridge along the trail and after investigating, the police and fire personnel had blocked off the bridge with a wooden barricade and yellow caution tape.

The plaintiff was biking at a relatively high speed for the time of morning, was wearing a helmet but did not have any light affixed to his bike. As the plaintiff approached the barricade, he was not able to see it, and when he did notice it is was too late to stop safely. The plaintiff applied his brakes so hard that he flipped over the bike and suffered injuries.

At trial, the plaintiff attempted to admit into evidence a report from a professional engineer. Defence counsel objected and intended to cross-examine the expert and challenge the admissibility of his report based on the evidence of qualifications.

The deputy trial judge held that the report was admissible. He cited section
27(1) of the Courts of Justice Act which provides the Small Claims Court (“SCC”) with the general authority to “accept and act on lower-quality evidence than would otherwise be permitted under the common law rules of evidence”.

He then examined the SCC Rule 18.02 subsections (1) to (7) and held that the position of defence counsel as he intended to cross-examine the expert is not contemplated by the Rules and that the report had already been admitted into evidence by way of Rule 18.02 (1) to (3). Admissibility of documents under Rule 18.02 is to be determined at the initial stage under Rule 18.02(1) when the document is tendered - “Once the document is admitted, the witness may be-cross-examined using the summons procedure under rule 18.02(4). But since that is cross-examination,the rule presupposes that the report or document is already admitted into evidence. The report or document serves as the examination-in-chief of that
witness.”

The deputy judge found no merit in the defendant’s objection to the expert’s qualifications. The expert was a professional engineer and his qualifications to provide the opinion evidence were of the highest quality generally seen in civil courts.

- Alison McBurney

Commissioner Kreidler on health care reform, the individual mandate, and rate transparency

Commissioner Kreidler was interviewed by host Austin Jenkins on TVW's Inside Olympia program this morning to discuss health care reform, health insurance costs, and his successful push to release confidential rate information from health insurers.

On the federal Affordable Care Act: "While this act is not perfect, it is the best thing that we have going right now to get our hands around a very serious problem for this country of ours...People are really being hurt...The current system is broken."

On the individual mandate to buy health coverage, starting in 2014: "If you have people opting in when they're sick and out when they're well, it just plain won't work."

On health care exchanges: "It's going to be a lot like online shopping that a lot of people are familiar with. And that's going to be a huge advantage over what we have now."

Additional flood warnings in WA

After overnight rain in parts of the state, the National Weather Service has issued another flood warning, including:

The Nooksack River at North Cedarville (Whatcom County)
The North Fork of the Stillaguamish near Arlington (Snohomish County)
The Deschutes near Rainier (Thurston County)
The Chehalis at Porter (Grays Harbor County)

Minor flooding is expected at some of those locations today or tonight. The Chehalis River at Porter was close to flood stage at 8:45 this morning.

See the link above for details.

Update: (11:41 a.m.) Another warning's been issued, including some other area rivers. The upper reaches of most rivers crested this morning or will crest this afternoon, with crests moving downstream through Thursday.

OPCF 44R - Family Protection Endorsement

The Court of Appeal recently affirmed a lower court decision on the OPCF44R.

In Van Bastelaar v. Bentley, [2011] O.J. No. 4666 (C.A.), the plaintiffs were concerned that the defendant's $1,000,000 policy would be apportioned between four injured parties and there would be a shortfall. As a result, they added their own insurer pursuant to the inadequately insured motorist provisions of their policy. Their policy had a Family Protection Endorsement with limits of $1,000,000. The key provision read as follows:

The insurer's maximum liability under this change form, regardless of the number of eligible claimants or insured persons injured or killed or the number of automobiles insured under the Policy, is the amount by which the limit of family protection coverage exceeds the total of all limits of motor vehicle liability insurance, or bonds, or cash deposits, or other financial guarantees as required by law in lieu of such insurance, of the inadequately insured motorist and of any person any person jointly liable with that motorist.

The motions judge held that "An underinsurer's obligation to pay does not arise until the total amount of insurance held by the tortfeasor at the moment of the accident is less than the family protection coverage liability limit." He concluded that since "the policies of the parties are unevenly matched, so therefore, the underinsurer had no exposure to liability".

The Court of Appeal affirmed the decision.

- Tara Pollitt

Flood warning issued for parts of Lewis, Thurston, Pierce counties

The National Weather Service has issued a flood warning for the:

• Newaukum River near Chehalis (reaching flood stage this evening, continuing through Weds night or Thursday)
• Chehalis River near Doty (this evening)
• Chehalis River at Centralia (late tonight)
• and the Chehalis River near Grand Mound. (late tonight)

"Minor to moderate flooding is expected along the Chehalis and Newaukum Rivers beginning this evening," the weather service says.

In addition, a flood watch remains in effect for the lower reach of the Chehalis River in Grays Harbor County, where the NWS says flooding is possible starting late Wednesday.

Up to 4 inches of rain has fallen in the Chehalis River Basin during the past 24 hours. Another 2-5 inches is expected from now through Wednesday night. For more details, including specific roads and areas likely to flood, click the link above.

Here's the critical part, from our perspective: Flood damage is not covered under a standard homeowners insurance policy. If you want coverage against flooding -- and your lender may require it if you live in a flood-prone area -- you'll need to buy extra coverage.

For most homeowners, that means going to the National Flood Insurance Program, a federally run insurance plan that's sold by local agents. But the coverage takes 30 days before it goes into effect. Flood season is long in the Pacific Northwest. If you think you're at risk -- and see the red "One-stop flood risk profile" box check your flood risk and get an estimate of premiums -- definitely consider flood insurance. And don't delay.

Update: (12:02 p.m.) A new alert has been issued for minor flooding along the Puyallup River near Orting and the Deschutes River near Rainier.

Two warranty companies ordered to stop selling in Washington

We issued a cease and desist against Charter Warranty Services of Detroit, MI and TracGuard Services of North Miami, FL, ordering both to stop selling protection products in our state without a license.

Both companies were selling motor vehicle service contracts and protection products guarantees but had not registered with us. In Washington state, all motor vehicle service contract and protection product providers must register with our office.

If they fail to do so, they're required to get a certificate of authority to act as an insurer and get an agent or producer license in order to sell their products.

Don't recognize these two companies, but still wondering if you should get a warranty on your next big purchase? We can help. See if the company is registered before you buy a policy.

And consider these helpful tips on negotiating a price and what to ask before you buy.

Wind warning for tonight

The National Weather Service is predicting gusts of up to 60 miles per hour in parts of Washington state tonight, including San Juan County, western Whatcom County, western Skagit County and the Admiralty Inlet area.

The day after windstorms, we often get a wave of calls from people with toppled trees, debris-damaged cars, etc.

To help, we put together this list of typical questions, including:

Am I covered if my car was damaged by falling tree limbs?
My yard is covered with branches and debris. Will my insurer pay the cleanup costs?
My boat sank from strong winds. Am I covered?
My business' awning was damaged by the wind. Can I file a claim?

Be careful out there.

Sentencing this afternoon for insurance agent who stole $1 million from elderly clients

Former insurance agent Jasmine Jamrus-Kassim is scheduled to be sentenced later today for stealing more than $1 million in retirement savings from several elderly clients. Jamrus-Kassim pleaded guilty last month to 10 counts of first-degree theft.

The King County Prosecutors Office is seeking an exceptional prison sentence of 68 months. The case is State v. Jamrus-Kassim, with sentencing slated at 3:30 p.m. before Judge Sharon Armstrong in courtroom E-847.

From 2007 to late 2009, several of Jamrus-Kassim's clients cashed out large portions of their retirement accounts, apparently thinking they were re-investing the money. In reality, the money went to Jamrus-Kassim, who spent tens of thousands of dollars on a psychic hotline, clothes, jewelry and a trip to Mexico.

An investigation by the Washington insurance commissioner's Special Investigations Unit led to her arrest in March. 

And Bankers Life and Casualty, one of the companies that Jamrus-Kassim worked for, agreed last month to repay the money that Jamrus-Kassim stole. 

Update: As it turned out, sentencing was continued until Dec. 9 after Jamrus-Kassim demanded a new attorney.

McQueen v. Echelon General Insurance Co. [2011] O.J. No. 4563 (Ont CA)

Appeal by the insurer from an award of accident benefits and damages for mental distress.

At trial, the plaintiff sought housekeeping, transportation, costs of medical assessments and damages for bad faith and mental distress.

The insurer made three major arguments on the issue of damages for mental distress:

1. That there was procedural unfairness based on the trial judge’s
consideration of conduct unrelated to rejected claims for statutory
accident benefits;

2. That merely denying benefits does mean that there was bad faith; and

3. That the trial judge lacked jurisdiction to make an award for mental
distress.

The trial judge quickly dismissed the initial two arguments by concluding that the plaintiff was seeking to recover damages for more than the SABS benefits and that this was not a case where the insured simply denied benefits.

In regards to the allegation that there was merely a denial of benefits the appeal judge agreed with the trial judge on the following points:

• The insurer had a duty to act in good faith in all its dealings with the
insured and had an additional duty not to inflict unnecessary mental
distress. Fidler v. Sun Life Assurance Co. Ltd. 2006 2 SCR 3 (Fidler);

• That the insurer repeatedly refused to provide benefits noting that they
were not “reasonable and necessary”, but never provided and reasons why
they were not reasonable and necessary;

• That damages were warranted because benefits were denied contrary to
medical recommendations;

• That the insurer took an adversarial approach to the plaintiff in the
beginning;

• That the one object of the insurance contract was to secure the plaintiff’s
peace of mind and that it was within the reasonable contemplation of the
parties that breach of peace of mind promise would bring about mental
distress; and

• That the plaintiff’s mental distress was palpable and accepted her evidence
that the change in her emotional and psychological conduct was the result
of her relationship with the insurer.

In regards to the jurisdiction argument, the insurer argued that the plaintiff was not a party to the insurance contract since it was her husband’s policy, and therefore, she was not entitled to claim for damages for mental distress.

It was further argued that Fider was distinguishable because Fidler dealt with LTD benefits not SABS benefits and that consequently, peace of mind cannot have been a contemplated term.

The appeal judge held that the reasoning in Fidler applies to an insured person under an automobile policy, whether the person is the named party or not.

“Mental distress to anyone insured under the policy upon breach would
have been within the reasonable contemplation of the insurer and the
insured and, thus, damages are recoverable pursuant to the basic
principle of compensatory damages.”

….

“People purchase motor vehicle policies to protect themselves from
financial and emotional stress and insecurity. An object of such
contracts is to secure a psychological benefit that brought the prospect
of mental distress upon breach within the reasonable contemplation of
the parties at the time the contract was made.”

In the end, the appeal judge affirmed all aspects of the trial judge’s decision only modifying the total awarded under the transportation head of damages as the trial judge provided inadequate reasons for the amount.

- Alison McBurney

Are insurers looking at your Facebook page?

There's an interesting article in Insurance & Technology, detailing the ways in which insurers could use -- and in some cases, are starting to use -- the information you post on your social media sites.

"When placed in public areas of users' profiles, these photos -- not to mention location information and personal statements in status updates -- represent data insurers can potentially use for claims and underwriting purposes,"

writes I&T's Nathan Golia, citing an October report from consulting firm Celent.

In a summary of the report, ABA Banking Journal called social media "a huge marketing and engagement potential for insurers," adding that:

"Most insurers are currently involved in only defensive actions. Celent expects that over the next three years, companies familiar with social media will being to apply social data to their buisinesses," and looking for vendors to help them capture, store and analyze social media data.

Insurance Networking News also reports that:

Celent predicts that social data will be incorporated into core underwriting and claims processes over the next three years and become standard inputs into risk evaluation and settlement activities."

In other words, your insurer may not be reading your Facebook profile or Tweets yet. But it may be soon.

Tacoma landlords charged with insurance fraud

A Pierce County couple and an acquaintance of theirs have each been charged with one felony count of insurance fraud.

William Harold Dummitt and Carole A Dummitt-Dombrowski rent out a cottage behind their home in Tacoma. On Nov. 25, 2010, the cottage had a water leak. The Dummitts submitted a claim to their insurer, USAA.

But they allegedly inflated their loss by claiming they’d been getting more rent from the cottage than they did – and to try to prove that by forging a renter’s signature on a false rental agreement.

Their acquaintance, Philip R. Burgess, told an investigator that he’d moved into the cottage on Dec. 1, 2010 and had to move out because of the sudden leak. But when the leak actually happened – Nov. 25, 2010 – Burgess was actually living in Portland, Ore.

Arraignment is scheduled for Nov. 18.

Update: (Feb. 1, 2012): William and Carole Dummitt each pleaded guilty to one count of false claims or proof in an insurance claim. Both were ordered to pay $1,200 in costs and assessments, and were each sentenced to 3 days in jail, which was converted to 24 hours of community service.

Sheikh v. Pinheiro 2011 ONSC 6143

We thank M. Edward Key of O’Donnell, Robertson & Sanfilippo for this contribution to our blog.

The plaintiff was going westbound in her vehicle and the defendant taxi driver was travelling northbound in his taxi. They collided at an intersection. The defendant taxi then went on to collide with a southbound vehicle. That southbound vehicle did not collide with the plaintiff’s vehicle.

None of the drivers appeared to be hurt. They all went to the same Collision Reporting Center and filled out very detailed collision reports. There was no question who was driving what vehicle.

On the second anniversary of the collision, the plaintiff brought an action against the driver of the southbound vehicle, believing that he was the taxi driver. Essentially, the plaintiff got the other two drivers confused.
Two years after that (i.e. four years after the collision), the plaintiff commenced a separate action against the real taxi driver after realizing the mistake.

The taxi driver brought a motion for summary judgment on the basis that the action was limitation barred.

The plaintiff argued that there was a genuine issue regarding when the plaintiff knew or ought to have known the true identity of the driver that hit her vehicle. The motion judge made short work of that argument. In particular, for strategic reasons, the plaintiff did not swear an affidavit regarding the state of her personal knowledge of the issues, and the motion materials only included affidavits from their lawyers. The judge determined that the information was readily available in the form of the Self Collision Reports.

Alternatively, the plaintiff argued that there was a genuine issue for trial on the basis that she could not "discover" that her injuries were likely to satisfy the Insurance Act threshold until 2 years before she started the second action.
The motions judge rejected the plaintiff's argument. The trial judge considered that the medical evidence was clear that it was "reasonably discoverable" that the plaintiff's injuries met the threshold more than two years before the second action was commenced.

The motion judge looked not only at medical reports, but also relied on the fact that the first Statement of Claim (issued exactly 2 years after the accident) alleged that she sustained "serious and permanent injuries." The motion judge stated at paragraph 47 of his reasons that, "While this action was mistakenly directed against the wrong defendant, this assertion by the plaintiff in the Statement of Claim is akin to an admission that, by at least that time, if not earlier, the plaintiff viewed her injuries from the accident as serious and permanent, and that they had thereby discovered their potential cause of action."

Statutory Duty of Care

Morsi v. Femer Paving Ltd. [2011] O.J. No. 3960

This is an appeal from a trial decision that held York Region and Femer Paving Ltd each 25 % liable for a single car motor vehicle accident. The deceased was driving in excess of the speed limit, ignoring speed and construction signs and lost control of his vehicle when the road surface changed from fresh pavement to gravel.

The trial judge held that the plaintiff was 50% to blame for the accident, leaving the defendants with the other 50%.

York Region and Femer Paving appealed the decision.

York Region’s main submission was that after the trial Judge correctly stated the main issue and the test for resolving the issue …

“Whether at the material time Major Mackenzie drive was in a state of repair that was reasonable in the circumstances such that users of the road, exercising ordinary care, could travel upon it safely.”

… that he did not apply the test to the facts of the case.

“The evidence of Detective Stock and the Varicom tests as well as the evidence of Constable Herbert and the various engineering experts establishes that if Mark Morsi had operated his vehicle at the posted speed or even a speed modestly above it, he would have been able to successfully negotiate the transition area.”

The Ontario Court of Appeal found the driver to be reckless having accelerated to 117 km/h through a long curve and straightaway and ignoring two 60km/h speed signs, a reverse curve sign, a 40 km/h advisory sign and two construction signs. This was not a driver exercising ordinary care.

The appeal was allowed and the action by the driver’s family was dismissed.

- Alison McBurney

Tired of being suprised by health rate changes?

Now you can sign up to get notified by e-mail whenever your health plan wants to make a rate change - and when we've made our decision.

A newly enhanced website, built with grant funds from Affordable Care Act, allows you to search rate requests for individual and small employer health plans, sign up to get an e-mail when your health plan wants a change, and make a public comment about requests still under review.

Eight requests are pending and eight decisions have been made - see the full details for yourself.