Landslides: Does homeowners insurance cover that?

There was a large landslide on Whidbey Island early this morning, reportedly knocking one home off its foundation, destroying a road and threatening multiple other homes. Photos from the scene -- like this one, or this one -- are pretty amazing.

Anytime this happens in the rainy Northwest -- and it does happen with some regularity -- we get phone calls from people wondering if their homeowners insurance covers landslides.

The answer: Sorry, but probably not.

Mudslides and landslides are NOT covered by a standard homeowners policy, which is what most people have. So it can be very difficult to collect for losses caused by any form of land movement.

So what can you do if you're worried about a potential landslide affecting your home? You may be able to buy a special rider -- i.e. an add-on -- to your homeowners policy that includes coverage for contents for all perils, including earth movement, unless the policy specifically excludes it. But these types of riders typically only cover the contents of your home, not the structure, and some insurers don't offer this option at all.

For the structure, you may be able to buy separate earth-movement coverage from what's known as the "surplus lines" market, meaning insurers who specialize in risks that the traditional insurance industry doesn't cover. But know that if your home is on a steep hillside, it may be difficult to get this kind of coverage.

For the folks affected by the slide this morning, it would be worth checking with their lenders. Mortgage lenders in some cases require earth-movement coverage as a condition of a loan. Although such insurance protects the lender, rather than the homeowner, it could help if the home is no longer useable.
Complicating things for folks close to a landslide, insurers often declare moratoriums on new coverage until a particular event is completely over. We've seen this with earthquakes (due to the fear of aftershocks) and sometimes during wildfire season in parts of Eastern Washington.

"Wait a minute -- I thought insurance companies can't have waiting periods for pre-existing conditions!"

We’re hearing this a lot these days, because people are aware that the federal health care reform law affects pre-existing condition waiting periods.
For kids under 19, this part of the health care reform law has already gone into effect. So insurance companies cannot apply pre-existing condition waiting periods when kids go on health insurance policies.
Here's where the confusion comes in: the rules are different for adults. But not for long.

Starting Jan. 1, 2014, the same rule that now applies to kids -- no waiting period for pre-existing conditions -- will apply to adults. For now, however, insurance companies can, and do, apply pre-existing condition waiting periods when adults go on policies.

So hang in there. Starting in January, health insurance companies have to cover treatment for pre-existing conditions starting as soon as you go on the policy.

Report: Claims cost of individual health insurance in WA likely to rise 13.7 percent by 2017

A new report by the Society of Actuaries predicts that medical claims costs for individual health insurance plans -- meaning coverage that people have to buy on their own, rather than get through an employer or government program -- will rise 13.7 percent in Washington by 2017. That's substantially less than in many other states.

About 300,000 Washingtonians now buy their own insurance on the individual market. That number's expected to increase sharply next year as people who are now uninsured start buying coverage.

It's too soon at this point to say what the final rates will be. We don't expect to see the first rate proposals for these policies until next month, and premiums include more than just medical claims costs.

There is, however, some good news for many of these folks. The report does not attempt, for example, to factor in the federal subsidies that many people in the individual market will qualify for, starting in January. Under federal health care reform, a family of four earning up to $94,200 could qualify for help paying for their insurance.

Also, under health care reform, the vast majority of policies will cover much more than they do today. It's rare, for example, to find an individual health plan that covers prescription drugs. Many don't cover the birth of a child. Starting in January, most policies will have to cover those things and more.

Lastly, the sad fact is that the individual health insurance market is no stranger to big increases in rates. In 2009 -- well before health care reform -- those policies in Washington rose an average of 16.5 percent. That's in a single year. And the year before that was even worse: an average increase of 18 percent.

Tacoma man arrested for insurance fraud

A 24-year-old man facing multiple charges in an insurance fraud case was arrested this morning by the King County Warrant Team at a residence in Tacoma.

Andre Romeo Zamora Sarmiento was charged last year with second-degree theft, forgery and insurance fraud for allegedly filing altered and fake medical bills after a car accident. He failed to appear for arraignment on Dec. 24, 2012, resulting in the warrant that led to his arrest this morning.

The fraud case involves a November 2011 auto collision in Tacoma. A car turned in front of Zamora's car, cutting him off, and leading to the crash.

Zamora subsequently filed a claim with the other driver's insurer for injuries to his back and $2,542 for vehicle damage to his vehicle. For the medical claims, Zamora filed several bills totalling $14,857.

A subsequent investigation by our anti-fraud Special Investigations Unit revealed that several bills were altered and grossly inflated. A bill for $360, for example, had a "9" added, to make it look like a bill for $9,360. A bill for $33.50 was turned into what looked like a bill for $3,358.80.

All told, Zamora submitted claims for $13,236 more than he actually paid. The insurer paid Zamora $5,497 before discovering that the bills were fraudulent.

Q: "My homeowners insurer sent an inspector to look at my home. Can they do this?"

It is not unusual for home insurers to periodically inspect the homes they insure.

Generally an inspection might be done after years of providing insurance when an insurer may ask if it's still insuring the same risk that it started out with.

The company might ask your agent to do a site inspection, or might hire an independent company to do site inspections and write reports about what they see, such as maintenance, property/landscape care, and any dangerous conditions that might increase the chance of a loss or injury at your home or on your premises.

There are no insurance laws that prohibit site inspections. Of course you’ll want to set up an appointment so you can be there when the site inspection is made. If a site inspection is made on a ‘drive by’ basis, there is a chance that a report may not be accurate, as you won’t be there to answer questions about any issues that could cause an inspector to be concerned, maybe unnecessarily. If you have questions about the process, we recommend that discuss the issue with your agent.

Job opening: Deputy insurance commissioner for legal affairs

Due to a retirement, we're recruiting for one of the top jobs at the Office of the Insurance Commissioner: the deputy commissioner for legal affairs.

The person will be responsible for forming the agency's legal positions related to enforcing compliance with the state insurance code and related federal laws, including matters related to insurers, agents, brokers and unauthorized insurance transactions.

He or she will manage a division of 20 employees and serve as general counsel for the insurance commissioner. The division includes staff attorneys and investigators who support the agency's consumer protection mission.

For more, including detailed responsibilities, requirements, salary and application process, please see the full job listing.

Insurance questions: "What's an `examination under oath,' and do I have to take it?"

Q: "My insurer asked me to attend an `examination under oath.' Can they make me do this?"

A: The company has the right to request that you be examined under oath, but it's your decision whether to actually attend and participate. So you can refuse. But keep reading.

Here's the big caveat: As the insured person, you have a responsibility to cooperate with your insurer during an investigation and to provide support for your claim. If you refuse to attend an examination under oath -- these are often known by the shorthand "EUO" in insurance documents -- your insurer has the right to deny your claim and close their case based on what they will call non-cooperation.

The upshot: We recommend that you attend an examination under oath and that you cooperate with your insurer in support of your claim.

After your insurer has the information it's requested and has completed the exam, then it's their responsibility to provide you with a timely coverage decision. If they deny your claim, they need to clearly explain to you why they made that decision.

If you live in Washington state and have insurance questions or want to file a insurance complaint, you can reach us by e-mail or call us at 1-800-562-6900. You can also file a complaint 24/7 through our new online complaint form.

If you live in a different state, here's how to reach your state's insurance regulator.

"An accident drove up my insurance rates, but I wasn't at fault. What's up?"

Some auto insurers base their rates only on at-fault accidents, but others take into consideration all claim activity, whether you were the one at fault or not.

Insurers operate on the statistical principle  that people with current claim activity represent a higher future potential risk than those who have no claims.

Here's the good news: insurers compete against each other, and in Washington we have a particularly vibrant auto insurance market. And rates can vary considerably from company to company, even among similar policies. So -- as we say often -- it really can pay to shop around for alternatives.

"I got the check for my car repair, but it doesn't include all the damage."

Q: "The insurance claims adjuster sent me a check for my car repair, but what if there are added repairs that still need to be made?"

If there is other accident-related damage that was missed in the initial estimate, then have the repair shop call the claims adjuster to verify the damage and authorize repair.

Here's the key part, though: That call has to happen before repairs are made, since the adjuster must verify that the damage is related to the covered accident.

If there is no verification and repairs are made, you may be responsible for paying the added costs.

Jury convicts Spokane man of fraud in case of $200,000 patio cover

A Spokane jury this afternoon convicted a Spokane man of insurance fraud and attempted theft after a snow-damaged patio cover worth about $4,000 mushroomed into a fraudulent insurance claim for nearly $200,000.

Keith R. Scribner, 48, will be sentenced April 16th in Spokane County Superior Court. Both the charges are felonies.

In late July 2009, Scribner's mother, Marilyn Warsinske, filed a claim with Liberty Mutual insurance. She said a patio roof at a home she'd purchased had collapsed due to the weight of snow some 6 months earlier. The policy covered "like kind and quality" replacement. Her son, she told the company, would handle the claim.

Scribner told the insurance company that patio cover was an extensive structure, spanning the entire length of the patio and wrapping around the home's chimney. Claims officials, inspecting the site, wondered why was there no flashing or holes in the masonry. Scribner said that house painters must have made repairs.

He sent the insurance company three bids to replace the cover based on his description. The bids ranged from $195,586 to $213,815.

Claims officials asked Scribner for any photos of the roof prior to the damage or after it collapsed. Perhaps some were taken during a home appraisal prior to the purchase, they suggested. Scribner said there were no photos and was no appraisal.

But a claims handler discovered an aerial photo of the home on a real estate website. It showed a much smaller patio cover than Scribner claimed.

The company launched a fraud investigation and notified Insurance Commissioner Mike Kreidler's anti-fraud Special Investigations Unit.

As it turned out, there had been a home appraisal, the investigators discovered. In fact, Keith Scribner met with the appraiser. And the appraisal included photos of the patio cover. A real estate agent interviewed by investigators described the cover as being "small and nothing special or significant."

The home's previous owner also provided photographs of the structure. It was originally canvas. When that because troublesome to remove each year, the homeowner bought a polycarbonate cover. Cost: About $300.

An architect told a state fraud investigator that he'd met with Scribner in 2008 -- months before the snow collapse -- to discuss plans to replace the deck cover with new, larger one.

A local company, provided with measurements and photographs of the original structure, drew up replacement bids at the request of a state fraud investigator. The bids: $3,913 and $4,782.

Hearing: Proposed acquisition of Western United Life Assurance

Commissioner Kreidler has scheduled a 10 a.m. hearing on March 21 to consider a request to acquire Washington-based Western United Life Assurance Company.

Central United Life Insurance Company is proposing to acquire common shares of Western United Life Assurance Company from Western United's current owners, Global Life Holdings Inc. The acquisition would allow Central United to acquire all common shares of Western United and become its controlling entity.

Central United Life Insurance is an Arkansas stock life insurer with its headquarters in Houston, TX. It has been licensed in Washington since 1974. It writes mainly life and accident and health policies in Washington. Western United Life Assurance is a Washington stock life insurer with its headquarters in Spokane, WA and was established in 1963. Western United writes mainly annuity considerations in 16 states.

Any interested parties may submit letters of support or concerns or objections and/or may participate in the hearing by appearing in person or by telephone at no charge.

For more on this hearing, please go to our hearings archive and look forWestern United Life #13-0033. There you'll find details on how to participate in the hearing and view all documents filed in this matter.

"My agent said I had `full coverage' but won't pay my claim. What gives?"

Q: My agent said I had "full coverage," but when I turned in a claim, I was told that the claim was excluded. What's going on?

In insurance, there's rarely any such thing as "full coverage." Virtually all (if not all) insurance policies have conditions, limitations and exclusions.

It's critical to find out what those conditions, limitations and exclusions are before buying a policy and before you have a claim.

If an agent won’t explain the conditions, limitations and exclusions, then find one that will. If you don’t ask, then you may be surprised and angry when you are told there is no coverage.

What does insurance have to do with climate change?

A lot, as it turns out.

Last year, three states -- Washington, California and New York -- surveyed dozens of major insurance companies about what they're doing to adapt to risks posed by climate change, a potential game-changer for insurers' investments and the risks they take on.

An independent climate-change group, Ceres, this morning released its analysis of the responses to that survey.

Of the 184 companies surveyed, Ceres concluded that only 23 of the companies had comprehensive climate change strategies. "Those companies provide a roadmap for the rest of the industry as it begins to wrestle with the issue," the report's authors wrote.

"Why do I have to do the insurance company's work to get my claim paid?"

This is another question that we hear a lot. Whether or not you are dealing with your own insurer or someone else’s insurer, be prepared to be involved in the claim.

Here's why: Processing a claim is rarely one-sided, and your participation is needed.

You may be asked to provide information, statements, photos, receipts or other things to support your claim.

You may be asked to attend what's called an "exam under oath" or go to an independent medical exam to verify claim details and injuries.

In order to promote a resolution to your claim, we recommend that you actively be involved, ask questions, and be ready to help with processing your claim.

What you can do when your health insurer says no

Little-known fact: When your health insurer denies a treatment or won’t cover a bill, that’s not necessarily the final answer. In most cases, you can appeal that decision.
Even if the insurer says no, consumers can often appeal to an independent group with the power to overrule the company. Nearly a quarter of Washingtonians who do that end up winning.
Our office has posted an easy-to-use guide to filing appeals on its website at www.insurance.wa.gov/your-insurance/health-insurance/appeal. Since we're the insurance regulator for Washington state, it's designed for Washington residents, but many of the tips apply more broadly.
The guide has been recently overhauled to make it easier to use. It includes step-by-step tips, examples, and downloadable letters that consumers can fill out and send to their insurer.
We also experts on staff who can help Washington state consumers with their appeal. They can be reached at 1-800-562-6900 or AskMike@oic.wa.gov.

And if you don't live in Washington state, here's a handy map showing how to contact your state's insurance regulator.

Large health insurer surpluses could help ease premiums

The News Tribune of Tacoma and the Bellingham Herald this morning ran an op-ed column by Commissioner Kreidler, talking about the fact that -- under current law -- our rate reviews of health premiums have to ignore the billion-dollar surpluses that some non-profit health insurers are sitting on.

From the op-ed:

Two of this state’s largest insurers – Premera Blue Cross and Regence BlueShield – are sitting on surpluses totaling $2.2 billion. In fact, their surpluses grew almost a quarter-billion dollars in the first nine months of 2012 alone.


As the state’s insurance regulator, I review insurance premiums. If they’re unjustifiably high, I tell companies they cannot charge that much. This is a critical protection for Washington consumers.

But here’s the elephant in the room: Under current law, I am barred from taking those surpluses into account when I review rates. This is despite the fact that regulators in nearly a dozen other states, including Oregon, have the authority to do so.

We're seeking legislation -- House Bill 1349 -- that would allow us to take surplus into account when the rates are reviewed.

By factoring surpluses into rate reviews, I can help protect consumers from sticker shock in their health care premiums, while still ensuring that carriers are financially healthy. It would be a tragedy – both for the economy and for individuals – if lawmakers chose to put the interests of insurance companies ahead of their constituents.