Contacted by a life insurance company that says you're a beneficiary?

It may not be the scam it sounds like.

We've been hearing a lot lately from consumers who've received letters from life insurance companies saying that they're the beneficiary on a long-deceased loved one's policy.

The letters often include a form that the consumers need to fill out to receive the money, and the form requires them to provide sensitive personal information.

Not surprisingly, many consumers have been skeptical about these letters. But while it may sound too good to be true, the letters may be legitimate. (Keep reading and we'll tell you how to check.)

Here's the background: Until recently, many large life insurers didn't aggressively research whether policyholders had died, even when the person's date of birth suggested that they were almost certainly dead. (This isn't as easy as it sounds, particularly with records that predate the widespread use of social security numbers as an identifier.) Last year, insurance regulators and consumer groups started challenging the insurers to do a better job.

As a result, many life insurers have started checking the names of policyholders against the Social Security Administration's Death Master File. When the companies find an apparent match, they contact the person/s listed as the beneficiary.

But how to be sure that the letter is real? If you live in Washington state, you can contact us at 1-800-562-6900 or reach us 24/7 via our online complaint and information form. We'll get in touch with our contact person at the insurance company who can verify that the letter you received is legitimate.

If you don't live in Washington, here's the contact information for your own state's insurance regulator, who may be able to help.

Insurance agent's license revoked; charged with identify theft

Insurance Commissioner Mike Kreidler has revoked the license of a Federal Way insurance agent who forged documents and stole tens of thousands of dollars from a client.

Cecelia Villanueva, who's been selling insurance in Washington since 1994, has also been charged by the King County Prosecutor's Office with two counts of identity theft. Her arraignment is pending. (She's listed in the court filing as Cecilia Cabasco Sawyer.)

In 2002, Villaneuva, sold an annuity that was ultimately worth more than $148,000 to an elderly woman and the woman's neice. She wrongly listed the neice's ex-husband as the primary beneficiary.

The elderly woman passed away in 2005. According to investigators, Villaneuva got a copy of the woman's death certificate, and forging the ex-husband's signature, she filed a claim with the insurer for the annuity proceeds. She steered the money into a bank account that she'd opened in the ex-husband's name, and repeatedly forged his name on checks.

The bank records show that she spent tens of thousands of dollars on groceries, cell phone service, at a drugstore. One of the largest checks, for $6,000, was simply made out to herself.

Eventually, the neice asked about the annuity. Villanueva claimed that due to the poor economy, the value of the annuity had dwindled to just $83,000.

The insurance company that Villaneuva worked for says it is working with the family to repay the stolen money.

Villanueva's insurance license was revoked under the state's insurance laws barring agents from improperly witholding or misappropriating clients' money, demonstrating untrustworthiness, and for forging signatures.

"I need insurance. Who would you recommend?"

We get this question all the time. And sorry, but we can't steer you to a particular agent, broker or insurer. We're the state agency that regulates the insurance industry in Washington state, and in that role, it's not our place to endorse particular companies or agents.

That said, we do have some online tools that can help you pick who you want to deal with.

We have this agent and company lookup, where you can find local agents, companies that sell specific types of coverage, etc. If you look up a company, you can also see the number of complaints by year. And the agent/broker listings include any disciplinary actions taken against that person.

If you want to find out how many complaints we get about particular insurers, here's our complaint comparison tool. It helps you find out out how insurers compare to one another. You can compare health insurers, for example, or auto, or life, etc.

And because market share varies dramatically, we include a "complaint index" that makes it easier to make apples-to-apples comparisons between different companies.

Lastly, it's always a good idea to double-check by running the name of an insurer, agent or broker through our disciplinary orders database. It goes back to 2002, and includes details on violations, fines, and other orders we've issued.

Limitation Periods in Actions Under the OPCF

Roque v. Pilot Insurance Company, 2012 ONCA 311 (C.A.)

The plaintiff was injured in an automobile accident in 1996. He commenced an action against the defendant driver in 1998 for $1.75 million.  He commenced an action against his own insurer in 2002.   Section 17 of the OPCF provides an.action against one's own insurer under the underinsured provisions of the policy must be commenced within one year from when the claimant knew or ought to have known the quantum of claims exceeds the defendant's motor vehicle liability limits. The plaintiff argued the limitation did not begin to run until his damages were quantified by settlement or judgment.  This interpretation had previously been accepted in Hampton v. Traders General Insurance Company (1996), 27 O.R. (3d) 285 (Gen. Div).  On the insurer's motion for summary judgment, the motion judge dismissed the action.  The Court of Appeal dismissed the appeal, overruling Hampton.  Justice Juriansz preferred the reasoning of Master Dash in McCook v. Subramaniam (2008), 172 A.C.W.S. (3d) 344 (S.C.) at para. 5:

The plaintiff’s case runs from when he has a body of evidence accumulated that would give him a “reasonable chance” of persuading a judge that his claims would exceed $200,000.

Roque had a DAC, medical reports and an economic loss report going back to 1998 and more than two years passed after he knew or ought to have known his claims exceeded $200,000. As a result, the action was statute barred. 

The Court did not accept the plaintiff`s submission that applying s. 17 would amount to a multiplicity of proceedings, since s. 258.4 of the Insurance Act requires an insurer to advise of the defendant`s policy limits.  Where an insurer fails to comply, the Court stated it would be prudent for a plaintiff to commence an action against its own insurer.

This decision should help to provide greater certainty with respect to the timing for claims under the underinsured provisions of the motor vehicle policy. 

My kid's delivering pizzas in his car. Does he need extra insurance?

Sorry, but the answer's usually yes. Most personal auto insurance policies won't cover you if you're getting paid to use your own car to transport people or property for business purposes.

In general, you'll need to buy a business or commercial auto insurance policy if you are a health care worker who occasionally uses your own car to take clients to appointments. The same is true if you use your own car to deliver flowers, newspapers, pizzas, etc.

If you have questions about your coverage -- and policies do differ -- contact your agent or insurance company directly.

Eastern Washington storm damage and insurance claims

Large parts of eastern and northeastern Washington suffered significant storm damage on Friday, when high winds and heavy rains ripped through the region, toppling trees, cutting power lines and damaging cars and homes. Flash floods also damaged some areas.

As homeowners, businesses and vehicle owners pick up the pieces, here are some key things to know about insurance claims:

Direct damage to insured structures by wind, wind-driven debris and falling trees is generally covered under standard homeowners and business coverage.

As for vehicles: If you have comprehensive coverage, that will also generally cover damage to a car or truck from falling limbs, etc.

Immediately contact your agent or insurer, who can help walk you through the claims process. If the damage is severe enough that you cannot remain in the home, your policy may include some coverage for temporary living quarters.

Flood damage is usually only covered if you had flood insurance. Contrary to what many people think, flood coverage is NOT part of a standard homeowners policy. In Washington, the first stop for flood coverage is often the National Flood Insurance Program, a federal insurance program sold through local agents.

As for the damage, be sure to take pictures. Avoid making permanent repairs or discarding damaged property until claims officials can document the damage or loss. If you can safely do it, try to minimize further damage, such as covering broken windows.

Here's a more-detailed list of tips for filing an insurance claim after a natural disaster.

Insurance tips: Sudden discovery...of a longtime problem

Consumers routinely call to file a complaint about denied homeowners insurance claims in which the problem is that they just discovered a long term problem. These tend to be things like mold, rot, mildew or deterioration.

The problem for these homeowners is that Insurance is designed to cover sudden and accidental damage, but not wear and tear for home care and maintenance that any homeowner is expected to address on their own. Some policies may allow coverage for damage caused within a matter of weeks -- and they may mean that plural literally, as in just two weeks -- to be considered sudden and accidental.

Generally, an insurer will inspect the damage to determine if it could have been caused suddenly or over a period of time. An example is mold damage that resulted from a leaking hot water heater, or a refrigerator water line that's been leaking, slowly rotting the kitchen floor joists.

The upshot is this: the longer an underlying problem has existed, the harder it is to successfully claim that the damage was sudden.

Update (9/25/2012): Here's a classic case of this sort of problem.

Rule making starts for essential health benefits

In 2014, when the rest of the Affordable Care Act kicks in, all health plans - whether they're sold inside the new online health exchange or outside - will be required to cover certain essential health benefits.

The essential health benefits will be based on the largest health plan in the small employer market -- Regence's Innova plan and must include all current state mandated benefits.

Specific coverages and any gaps that need to be filled will be determined through the rule making process started earlier this month, but all plans must include the following categories:

• ambulatory patient services
• emergency services
• hospitalization
• maternity and newborn care
• mental health and substance abuse disorder services - including behavioral health treatment
• prescription drugs
• rehabilitative and habilitative services and devices
• laboratory services
• preventive and wellness services
• chronic disease management
• pediatric services, including oral and vision care

A public hearing to determine the specific coverages and any additional benefits that are needed will be held this fall. Check our website for updates or sign up to get rule-making notices.

Duty to Defend - Winter Maintenance Contractor

Minto Developments Inc. v. Carlsbad Paving, 2012 ONSC 1574 (S.C.J.)

Minto brought an application seeking a declaration that Carlsbad and its insurer, Intact, were obligated to provide it with a defence.  Minto was a property owner that was named as a defendant in a slip and fall action.  Carlsbad contracted with Minto to provide winter maintenance on the property.  In the contract, Carlsbad agree to indemnify and save harmless Minto, to maintain a CGL policy with $2,000,000 limits and to add Minto as an additional insured.

Carlsbad refused to assume the defence.  It argued that the claim included allegations of negligence with respect to snow and ice removal, inspection, warning signs, breach of lease agreement and occupier's liability.  Its position was that the majority of the claims did not fall within the scope of coverage and stood on their own.

Justice Kershman held that the true nature of the Statement of Claim was that of a negligence case where the plaintiff slipped on snow and ice in the parking lot.  It therefore fell within the scope of coverage and Intact had a duty to defend Minto. 

Duty to defend issues arise fairly often in slip and fall cases where the property owner hires a contractor to maintain the property.  It is important to look closely at the Statement of Claim to determine the true nature of the claim; the mere insertion of a number of different allegations by the plaintiff will not necessarily be enough to take the claim outside of the scope of coverage.

Insurance tips: What's an "approved" mobile home park?

We've heard recently from a couple of manufactured home owners who didn't know whether they reside in what's known as an "approved park." When they filled out their homeowners insurance application, they checked the "no" box when asked if their home was located in an approved park.

Result: They ended up paying higher premiums than they needed to.

Check with your agent or insurer, but generally, an approved park means that the location must be a:

• planned and named community of manufactured homes,
• which have permanently installed water, electricity and sewage services
• which are collectively managed
• and whose residents recognize common bylaws or rules.

How to find old life insurance policies (and other unclaimed property)

The case: A woman called us last year, trying to track down a life insurance policy that her grandmother had bought in 1971. The policy had been sold by one company to another.

"Makes me wonder how many policies go unclaimed," she said.
A lot. According to the New York Times, hundreds of millions of dollars each year.

So how do you track down a relative's old policy?

Gather as much information as possible: name, insurer and any relevant documents. Try to find the policy itself, which will have a number on it. Make sure you have a copy of the death certificate.

Tip: If you can't find the company, try going through the person's financial records, looking for payments made to an insurer. Also, look through old mail -- the company may have sent periodic statements or billing reminders. If you know which company they had their auto= or homeowners coverage with, consider contacting that company. People often use the same insurer for life insurance.

Then, make sure the company still exists, or if it merged with another company. If you live in Washington state, we can help with this, for free. Call us at 1-800-562-6900. If you live in another state, call your state's insurance regulator for help.

If you can't find any information, even the name of the company, you may want to pay a search company to run your relative's name against insurance industry databases or to contact a large number of insurers directly. Examples include companies like MIB Solutions or The Lost Life Insurance Finder Expert. (Note: mentioning a company or product on this blog ≠ endorsement.)

Other places to check:

If the policy goes unclaimed for a long time, insurers are supposed to turn the money over to state unclaimed property funds. Run your relative's name through these free, state-run online search sites. There are companies that will offer to do this for you, but you can easily and quickly run the checks online yourself. Here's Washington state's official unclaimed property site. And here's a list of similar official unclaimed property websites in other states.

Tip: Online companies can also search for unclaimed property for you, but with a little time at your computer and the sites listed above, you can do the same thing, for free, yourself.

As for that life insurance case, we helped the woman figure out the current company holding the policy and file a claim.

"This is incredible," she wrote. "We can't thank you enough."
Bonus round: Here are our tips if you're buying life insurance or an annuity.

Homesite Insurance agrees to refund $386,000 in overcharges to policyholders

Homesite Insurance Company of the Midwest has agreed to refund hundreds of thousands of dollars that it overcharged homeowners insurance policyholders in Washington state.

Insurance Commissioner Mike Kreidler is also fining the company $30,000.

Due to a computer issue, the company says, it used rates last year that were different from the rates approved by Washington Insurance Commissioner Mike Kreidler for that time period. The rates it charged had been approved for an earlier period.

As a result, Homesite overcharged 4,504 consumers a total of $386,578. (It also undercharged 2,140 customers $154,241, but those policyholders won't have to pay that.)

The company has agreed to contact the overcharged consumers and issue refunds, plus 8 percent interest, by Sept. 30th.

SABS - Pursuing Litigation without a Mediator's Report

Cornie v Security National, 2012 ONSC 905 (S.C.J.)

This motion involved plaintiffs in four actions who commenced actions against their insurers for statutory accident benefits.

The Insurance Act imposes a mandatory mediation scheme in accident benefits cases.  Rule 19 of the Dispute Resolution Practice Code (DRPC) provides that mediation must be concluded within 60 days of the filing of an application.  Once mediation has failed, the plaintiff may pursue litigation.  In all four cases, the plaintiffs filed mediation applications and after 60 days passed without a mediator being appointed, they wrote to FSCO requesting a mediator's report confirming mediation had failed.  FSCO refused, taking the position that the 60 day period does not begin to run until a mediator is appointed.

The insurers brought motions to dismiss on the basis that mediation had not failed.  Justice Sloan dismissed the motion.  The 60 day period in the DRPC is mandatory.  The plaintiffs did not require a report from FSCO in order to claim that mediation failed through non-compliance with r. 19.  The plaintiffs were therefore able to show that mediation had failed and they were entitled to proceed with litigation.

This decision is a clever way to get around the lengthy back-up taking place at FSCO; however, does it transfer the backlog to the court system?

Wildfire burning near Chelan

The Associated Press (via the Seattle Times) is reporting that 80 firefighters and three helicopters are trying to douse a 250-acre wildfire near Chelan.

Fire crews, we've been told, hope to have the fire mostly contained by tonight.

As the summer fire season begins here in Washington, here are some important tips about wildfire preparedness, insurance and claims:

-Tips on wildfires and homeowners insurance

-More info: Tips on disaster preparedness and filing homeowners insurance claims

-Printable home inventory checklist

-How to contact the Federal Emergency Management Agency (FEMA)

Interesting AP story: Insurers hire firefighters to protect Colorado homes

The Associated Press is reporting that insurance companies have been hiring firefighters and sending them to protect high-value properties threatened by the Colorado wildfires. From the article:

For insurers, hiring their own crew is worth the cost. They spend thousands on well-equipped, federally rated firefighters, potentially saving hundreds of thousands, if not millions, of dollars to replace a home and its contents.

Insurance companies began sending crews to wildfires around 2006, said Paul Broyles, former head of fire operations at the National Interagency Fire Center, which coordinates federal firefighting efforts from Boise, Idaho.

Man charged after filing $20,000 insurance claim for fake dead cat

OLYMPIA, Wash. _ A Tacoma man is facing attempted theft and insurance fraud charges after filing a $20,000 claim for a fictitious dead cat, using pet photos he lifted off the internet.

“We’ve handled some pretty unusual fraud cases, but this is one of the stranger ones,” said Insurance Commissioner Mike Kreidler.

Yevgeniy M. Samsonov, 29, has been charged with first-degree attempted theft and felony insurance fraud in Pierce County Superior Court. Arraignment is set for July 11.

On March 27, 2009, Samsonov was involved in a minor traffic accident in Tacoma. A driver behind him was stopped at a traffic light when her foot slipped off the brake. Damage to both vehicles was very minor.

Samsonov filed a claim that included chiropractic treatment of soft tissue injuries. The other driver’s insurer, PEMCO, paid him $3,452.

Two and a half years later, Samsonov sought additional payment from PEMCO. He said that in addition to the vehicle damage and medical claim, his beloved cat Tom had been in the car and killed in the accident.

The company issued him a check for $50 to compensate him for the cat.

Samsonov then told PEMCO that he’d paid $1,000 for the cat, who’d been like a son to him. He wanted to be paid $20,000.

He sent the company two photos he said he’d taken of his cat. (See below.)

A PEMCO claims representative did a Google Images search and discovered identical cat images appearing on websites, blogs, Facebook pages, and Wikipedia posts about cats. The two images Samsonov submitted are actually of two different cats. One is named Lacy. Neither belonged to Samsonov.

PEMCO canceled its $50 check and forwarded the case to Kreidler’s anti-fraud unit.

Supreme Court will not hear Giuliani appeal

The Supreme Court of Canada has refused leave to appeal the decision in Giuliani v. Halton.  A link to our commentary on Giuliani is found at http://ontarioinsurancelaw.blogspot.ca/2012/02/minimum-maintenance-standards-ruled.html.  In Giulini, the trial judge held that the Minimum Maintenance Standards did not provide a defence where the snow accumulation  was less than 5 cm (as provided by s. 4 of the MMS for a Class 2 road).  In addition, s. 5 of the MMS did not establish a minimum standard for conditions that had not yet become icy. The Court of Appeal decision is found at: http://www.ontariocourts.ca/decisions/2011/2011ONCA0812.htm.

Giuliani leaves municipalities vulnerable to additional claims.  If the gap in the MMS is to be addressed, it will have to be done through legislation.

Fireworks and homeowners' insurance

Yes, it's tempting to shoot off fireworks around the Fourth of July. Here are a couple of key things to know:

• If fireworks are not legal where you live, you may jeopardize your insurance coverage if someone is injured or property is damaged as a result of your shooting them off.
• On the other hand, fireworks-related damage to your property typically is covered if someone else -- not a family member -- is responsible.

Insure.com also has an article with some more scenarios and tips.

Prescription drugs and Premera

Crosscut's Harris Meyer has a story today about a clash between our office and Premera, one of the state's largest insurers:

Since 2009, Premera Blue Cross’s LifeWise unit has sold a high-deductible plan called Wise Essentials Rx, the only catastrophic-type plan in the state offering drug coverage. Its enrollment quickly zoomed to 45,000. But that plan and Lifewise’s standard plan covered only generic, not brand-name, prescriptions.

Earlier this year, Premera’s two main rivals, Regence BlueShield and Group Health Cooperative, filed requests to switch their standard plans for individuals from full to generic-only drug coverage. Group Health said it doesn’t favor a generic-only benefit but feared its plan otherwise would get swamped with sicker enrollees who couldn’t get brand-name drugs in other plans. All three insurers have reported losing money in the individual market.

Those requests prompted Insurance Commissioner Mike Kreidler to issue an emergency rule in February barring generic-only coverage. He said patients with multiple sclerosis, some types of cancer, AIDS, rheumatoid arthritis and certain forms of mental illness can’t necessarily be treated effectively with generics. The insurers’ moves, he warned, would leave most Washingtonians in the individual market without adequate drug coverage.

Click the link above for more on this situation, and why we responded the way we did.