We offer free insurance help to Washington state residents. (We won't try to sell you anything; we're the state agency that regulates the insurance industry.)
You can call us at 1-800-562-6900 or e-mail AskMike@oic.wa.gov. We have staff insurance experts who can answer questions or help you file a complaint about an insurance company or agent.
In many cases, you can even track the status of a complaint online, seeing what we send to the company, their response, etc.
(Not a Washingtonian? Contact your state's insurance regulator.)
Here are some real-life examples of the sorts of cases we've handled recently:
-A business owner near Yakima was hosting a business event, but couldn't get a copy of her insurance certificate from her company. With time running out, she had to buy additional coverage to make sure she was covered. She complained to us, and we got the company to refund the cost of the extra coverage.
-An insurer offered $1,695 for a totalled vehicle. We helped get the consumer $3,250 -- plus tax, title and license fees.
-When a Puget Sound man's trip was delayed, boosting his costs more than $7,000, his travel insurance company paid him $3,266. We got them to boost that by an additional $4,035.
-We helped speed up payment on a delayed claim for a mobile home fire. The amount: $74,362.
University Place man pleads guilty to insurance fraud
A University Place, Wash. man has pleaded guilty to felony insurance fraud after lying about the cause of a Pierce County crash that damaged his Jeep.
Warren Gardinier, 22, was sentenced on April 20th to 40 days in jail (concurrent with an unrelated firearms charge) and ordered to pay court fees and a victim penalty assessment.
On Dec. 9, 2009, Gardinier told the Tacoma Police Department that another vehicle had clipped his red 1996 Jeep Grand Cherokee, causing him to spin out of control, into a fence and then into a tree. He and a passenger sustained minor injuries. The vehicle was insured by his 26-year-old sister for liability coverage only. (Liability coverage will pay for damage you cause to someone else or their property, but not damage you cause to your vehicle or yourself.)
Gardinier called his sister. She called State Farm 36 minutes after the wreck and added uninsured motorist coverage.
Five days later, the two told State Farm the damage stemmed from a hit and run collision Dec. 10. State Farm paid $4,523 for the damage to the Jeep.
Unbeknownst to Gardinier and his sister, however, a witness had seen the crash and called 911. The witness -- who followed the Jeep and got the license plate number -- said there was no other vehicle involved. He said that Gardinier's Jeep had been speeding erratically, fishtailing, and driving off the shoulder and across the road. After several swerves, the witness said, Gardinier's Jeep crashed into the fence and rapidly left the scene.
That 911 call took place before Gardinier's sister called State Farm.
Gardinier's sister agreed to pay full restitution to State Farm. When she has paid that in full, an insurance-fraud charge against her will be dismissed.
Warren Gardinier, 22, was sentenced on April 20th to 40 days in jail (concurrent with an unrelated firearms charge) and ordered to pay court fees and a victim penalty assessment.
On Dec. 9, 2009, Gardinier told the Tacoma Police Department that another vehicle had clipped his red 1996 Jeep Grand Cherokee, causing him to spin out of control, into a fence and then into a tree. He and a passenger sustained minor injuries. The vehicle was insured by his 26-year-old sister for liability coverage only. (Liability coverage will pay for damage you cause to someone else or their property, but not damage you cause to your vehicle or yourself.)
Gardinier called his sister. She called State Farm 36 minutes after the wreck and added uninsured motorist coverage.
Five days later, the two told State Farm the damage stemmed from a hit and run collision Dec. 10. State Farm paid $4,523 for the damage to the Jeep.
Unbeknownst to Gardinier and his sister, however, a witness had seen the crash and called 911. The witness -- who followed the Jeep and got the license plate number -- said there was no other vehicle involved. He said that Gardinier's Jeep had been speeding erratically, fishtailing, and driving off the shoulder and across the road. After several swerves, the witness said, Gardinier's Jeep crashed into the fence and rapidly left the scene.
That 911 call took place before Gardinier's sister called State Farm.
Gardinier's sister agreed to pay full restitution to State Farm. When she has paid that in full, an insurance-fraud charge against her will be dismissed.
Washington state to bar insurer from writing new coverage
(Updated -- see note at bottom of this post.)
Washington State Insurance Commissioner Mike Kreidler has issued an order barring Ability Insurance Company, of Omaha, Neb., from writing new policies in Washington for the next six months.
The order, issued Wednesday, takes effect in 10 days.
The order stems from the company’s failure to honor long-term care coverage that lapsed after a senior citizen with dementia failed to make her payments. In such situations, state law allows a consumer to reinstate coverage within five months of the policy’s lapse.
“Situations like this are exactly why we have this law,” said Kreidler. “It protects people who, through no fault of their own, have lost the ability to keep up with their financial records.”
The suspension does not affect the company’s duties under current policies. The company can also continue to renew existing policies.
In this case, the company on March 20, 2009 sent the woman a notice of non-payment, warning that her policy would lapse unless paid within the next 35 days.
When her daughter called the company about a claim on Aug. 4, 2009 – well within the five-month period – the company failed to tell her that the policy had lapsed. The daughter didn’t learn of the lapsed policy until she checked her mother’s mail in September. This was still well within the five-month period.
Nonetheless, the company refused to reinstate the coverage. It contended that the five-month window started the day the premium was due, not at the end of the 35-day period mentioned in its March 20 letter.
Also Wednesday, Kreidler issued a cease-and-desist order telling the company to stop violating state law in such cases. He is also imposing a $10,000 fine on the company.
The company has the right to demand a hearing.
Update on May 4, 2011: Ability has requested a hearing, which automatically stays the suspension pending the outcome of the hearing.
Second update: On June 6, 2012, Kreidler's order was upheld, meaning that the company's authority to write new business was suspended for six months. The company was also fined $10,000.
Washington State Insurance Commissioner Mike Kreidler has issued an order barring Ability Insurance Company, of Omaha, Neb., from writing new policies in Washington for the next six months.
The order, issued Wednesday, takes effect in 10 days.
The order stems from the company’s failure to honor long-term care coverage that lapsed after a senior citizen with dementia failed to make her payments. In such situations, state law allows a consumer to reinstate coverage within five months of the policy’s lapse.
“Situations like this are exactly why we have this law,” said Kreidler. “It protects people who, through no fault of their own, have lost the ability to keep up with their financial records.”
The suspension does not affect the company’s duties under current policies. The company can also continue to renew existing policies.
In this case, the company on March 20, 2009 sent the woman a notice of non-payment, warning that her policy would lapse unless paid within the next 35 days.
When her daughter called the company about a claim on Aug. 4, 2009 – well within the five-month period – the company failed to tell her that the policy had lapsed. The daughter didn’t learn of the lapsed policy until she checked her mother’s mail in September. This was still well within the five-month period.
Nonetheless, the company refused to reinstate the coverage. It contended that the five-month window started the day the premium was due, not at the end of the 35-day period mentioned in its March 20 letter.
Also Wednesday, Kreidler issued a cease-and-desist order telling the company to stop violating state law in such cases. He is also imposing a $10,000 fine on the company.
The company has the right to demand a hearing.
Update on May 4, 2011: Ability has requested a hearing, which automatically stays the suspension pending the outcome of the hearing.
Second update: On June 6, 2012, Kreidler's order was upheld, meaning that the company's authority to write new business was suspended for six months. The company was also fined $10,000.
How to file an appeal when a health insurer denies your claim
What do you do?
In the past, your options were to pay for the procedure yourself, get another opinion that will be less costly or do nothing. All are bad choices and time is critical.
We've posted a new "appeals kit" designed to help when insurers deny requests to authorize a particular service -- or to pay a claim afterward. The site can help you challenge decisions and appeal denials. We're one of the first states to compile this information into a one-stop, consumer-focused site.
In the case above, you'd have several choices:
- File an urgent appeal with your health insurer.
- If the insurer still says no, you can appeal to an independent third-party group made up of health care professionals. They can overrule your insurance company and make it pay. (Over the last three years, nearly 1 in 4 appeals that were sent to an independent review organization by a health plan ruled in favor of Washington consumers.)
- You can sue.
- Or you can file a complaint with our office.
Check it out.
(Corrected two links. Thanks to Public Data Ferret for the heads-up.)
How to find old life insurance policies (and other unclaimed property)
"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.
- 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. Here's Washington state's official unclaimed property site. And here's a list of similar official unclaimed property sites 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.
8 things to know about pet insurance -- and what's it cost?
1) What's it cost? Here in Washington, according to rates filed with our office:
3) Look for exclusions. Insurers consider hereditary conditions pre-existing conditions and may exclude them or limit coverage. They may also exclude or limit coverage for incurable conditions like diabetes or cancer.
4) Qualifying: A vet may have to examine your pet and certify its health before you can insure it.
5) The rules can change when the policy renews. If your pet's treated for something, some insurers may consider that a pre-existing condition when the policy renews, meaning they'll exclude coverage for it.
6) And they can change based on your type of pet. Exclusions may vary by type of pet and breed.
7) Who pays the bills? Some companies will pay the vet directly, but often you'll be responsible for the full amount at the time of treatment.
8) Which vet? Some insurers will require you to use a specific network of vets.
For more specifics, please see our pet insurance page.
- Coverage for cats ranges from $83 to $926 a year; most policies are $150-$250 annually.
- Coverage for a dog ranges from $107 to $1,059 a year, but most coverage is between $225 and $400 annually.
3) Look for exclusions. Insurers consider hereditary conditions pre-existing conditions and may exclude them or limit coverage. They may also exclude or limit coverage for incurable conditions like diabetes or cancer.
4) Qualifying: A vet may have to examine your pet and certify its health before you can insure it.
5) The rules can change when the policy renews. If your pet's treated for something, some insurers may consider that a pre-existing condition when the policy renews, meaning they'll exclude coverage for it.
6) And they can change based on your type of pet. Exclusions may vary by type of pet and breed.
7) Who pays the bills? Some companies will pay the vet directly, but often you'll be responsible for the full amount at the time of treatment.
8) Which vet? Some insurers will require you to use a specific network of vets.
For more specifics, please see our pet insurance page.
Two agents lose their licenses for misappropriating clients' money
Insurance Commissioner Mike Kreidler has taken action against two insurance agents who misappropriated thousands of dollars from their clients.
• Nancy M. Bishop, of Puyallup, has been notified that the insurance commissioner’s office refuses to renew her insurance license. She has been barred from doing insurance business in Washington and ordered to repay consumers more than $131,000.
A state examination of Bishop’s business records revealed that she violated state insurance laws in dozens of instances, including repeatedly accepting premium payments for policies that did not exist, and keeping the money herself. She also wrongly kept some clients’ refunds and issued false certificates of coverage.
The examination found that Bishop owes dozens of Washington consumers more than $131,000, including overcharges and misappropriated funds.
The violations, according to Kreidler’s order, show Bishop to be “untrustworthy and a source of injury and loss to the public and not qualified to be an insurance producer in the state of Washington.”
• Isaac Mayanja, an agent in Redmond, has had his insurance license revoked.
In 2010, a state investigation determined that Mayanja sold at least 19 unapproved annuities to Washington residents. He also repeatedly engaged in the unauthorized withdrawal of clients’ funds, including forgery and misappropriation of their money.
Specifically, he submitted withdrawal forms totaling $15,570 for several clients’ annuities, changing their addresses on the forms to his own address and then transferring the money to his own personal bank accounts.In both cases, the agents have the right to demand a hearing. The orders take effect immediately.
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