Thursday, January 29, 2009

Farmers New World Life Insurance and HIV

The Spokane Spokesman-Review on Wednesday examined a case in Washington state in which an HIV-positive man was denied life insurance by Farmers New World Life Insurance. Some advocates had hoped that the discrimination case would "open doors" for people living with the virus who are denied life insurance, the Spokesman-Review reports, adding that those hopes were "dashed" by a ruling that said Gerald Hebert -- an employee with the state's Human Rights Commission who issued a complaint with the insurance commissioner's office in 2006 -- was not illegally discriminated against because of his HIV-positive status.

Although the issue of HIV/AIDS-related discrimination is not new, advocates said this case illustrates that the insurance industry fails to recognize the increased life expectancies of HIV-positive people because of advances in antiretroviral therapy. Sid Wolinsky of the San Francisco not-for-profit legal center Disability Rights Advocates said that the "problem" with insurance companies is that they "routinely use grossly outdated statistical material," rarely keep their own data and rely on manuals reinsurance companies provide. Wolinsky said, "That is not to say there is not an increased mortality or morbidity risk for somebody with HIV than for somebody without it. But the risk is such that it can be covered."

According to the Spokesman-Review, insurance companies can deny coverage to a person only if there is sound statistical data that show the person is too risky to insure. Documents show that the Washington state Insurance Commissioner's Office, which led the investigation, had difficulty obtaining such information from Farmers. The Spokesman-Review reports that a Swiss study of people living with HIV found that "successfully treated HIV-positive and hepatitis C-negative patients have a short-term mortality as low as or lower than that of patients with cancer who have been successfully treated -- a group that is able to obtain life insurance."

Marc Brenman -- former executive director of the state's Human Rights Commission -- said that there is reason to believe Farmers routinely violated a state law by denying insurance to people living with HIV. Brenman said that there is "an entire class of people who are not able to purchase life insurance at any price, and it is entirely and absolutely wrong." Farmers denies the claim and said that it applies underwriting grants fairly and consistently (Graman, Spokane Spokesman-Review, 1/28).

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Wednesday, January 28, 2009

Farmers New World Life Insurance Co. denies policy because of HIV?

Fallout goes on after insurer denies policy because of HIV

(Spokesman-Review, The (Spokane, WA) Via Acquire Media NewsEdge) Jan. 28--Disability rights advocates had hoped a Washington state discrimination case would open doors to thousands of people with HIV who are denied what many others take for granted -- life insurance.

But their hopes have been dashed by a behind-the-scenes ruling in Olympia that a Washington life insurance company did not illegally discriminate against a 49-year-old Kitsap County man when it denied him a policy because he is HIV-positive.

Fallout from the case has led, in part, to the recent dismissal of the state's human rights director and a lawsuit against the office of state Insurance Commissioner Mike Kreidler.

Insurance regulators initially appeared ready to sanction Farmers New World Life Insurance Co., state documents show, but later backed off. The Human Rights Commission launched its own investigation, triggering a political showdown, an allegation of collusion and an unfavorable state audit of the commission's involvement in the case.

"There is an entire class of people who are not able to purchase life insurance at any price, and it is entirely and absolutely wrong," said Marc Brenman, the former executive director of the Human Rights Commission who lost his job this month, partly as a result of his role in this discrimination case.

Citing a pending court case and an open investigation, the offices of the insurance commissioner and the Human Rights Commission declined requests for interviews.

Advocates say the issue of discrimination against people with HIV is nothing new, but the Farmers case illustrates the insurance industry's failure to recognize that anti-retroviral treatment has greatly increased life expectancies of those who have the virus that causes AIDS.

"The problem with insurance companies," said disability rights activist Sid Wolinsky, is "they routinely use grossly outdated statistical material." Furthermore, they rarely keep their own data, relying instead on manuals provided by reinsurance companies. "That is not to say there is not an increased mortality or morbidity risk for somebody with HIV than for somebody without it," said Wolinsky, of Disability Rights Advocates, a nonprofit legal center in San Francisco. "But the risk is such that it can be covered."

In Washington, the potential test case grew out of a 2006 coverage denial.

That October, Brenman's office brought to the attention of the insurance commissioner's office a complaint filed by Gerald Hebert, of Poulsbo, Wash., who had been denied life insurance by Farmers New World Life Insurance, a subsidiary of Farmers Group.

Brenman said there was reason to believe Farmers routinely denied insurance to people with HIV in violation of state law.
Farmers has said that the company applied underwriting guidelines fairly and consistently and that the complaint was without merit.

Insurance Commissioner Mike Kreidler's office, instead of the Human Rights Commission, was asked to investigate the case to avoid the appearance of conflict of interest. At the time, Hebert, a gay rights advocate, was a member of the Human Rights Commission. He resigned in September 2008 after auditors concluded he had misused a state-issued credit card and rental cars.

By that time, though, the complaint over denied coverage already was under investigation.

From the beginning, the insurance commissioner's office had difficulty obtaining information from Farmers New World Life showing a statistical difference in the risk of insuring someone with HIV, documents show. An insurance company can only turn someone down for insurance if it has sound actuarial data to show that a person is too risky to insure.

However, in a Swiss study of people with HIV, researchers found that "successfully treated HIV-positive and hepatitis C-negative patients have a short-term mortality as low as or lower than that of patients with cancer who have been successfully treated -- a group that is able to obtain life insurance."

A December 2006 letter from Marcia Stickler, of the insurance commissioner's legal affairs division, to Brian Kreger, of Farmers, complained about the company's lack of response to repeated requests for the criteria used to refuse insurance to people with HIV.

Farmers "either has and uses such criteria or it does not," Stickler wrote. "It is clear that the company simply denies all HIV-positive individuals outright, without any true analysis of actuarial risk."

In May 2007, Brenman's staff, having kept close tabs on insurance regulators' progress in the case, believed the fact-finding stage of the investigation had concluded. Based on the lack of evidence Farmers had produced in its defense up to that point, the Human Rights Commission charged the company with illegal discrimination.

However, the insurance commissioner's office had reached no such conclusion.

"They were on the verge of making a finding of discrimination, and at the last minute they changed the finding to no discrimination," Brenman said in a recent interview.

In August 2007, Kreidler's office determined material eventually provided by Farmers "demonstrated that a bona fide statistical difference in risk or exposure had been substantiated" and therefore the denial of life insurance to Hebert was fair discrimination.

Brenman demanded to see what evidence Farmers had provided after his office had issued its finding, but received only heavily redacted documents from the insurance commissioner's office. In a December 2007 letter, Kreidler said his office would not turn over the redacted material Brenman's office sought because it contained Farmers' "trade secrets" that had to be protected.

Brenman appealed to the Attorney General's Office, which declined to intervene.

"Because we were not able to examine the data, we were forced to change our finding of discrimination to a finding of 'under investigation,' " Brenman said.

Hebert has since filed a lawsuit in Thurston County Superior Court, seeking the undisclosed portions of the documents under the state Public Disclosure Act.

His Seattle attorney, Jesse Wing, said documents that the insurance commissioner has turned over "strongly suggest" that Farmers did not do an individual determination of the validity of Hebert's application, or the application of any HIV-positive person, before denying them.

Only after Hebert's complaint did the company conduct an analysis, Wing said, and "in a collaborative fashion with the Office of Insurance Commissioner."

"The correspondence shows that rather than holding Farmers to its own analysis, (the insurance commissioner's office) actually worked with Farmers to determine what standards to use," Wing alleged. "This is not in my view consistent with the obligation of the insurance commissioner."

Although the insurance commissioner's office refused comment on the case, in general, a spokeswoman disputed Wing's assertion that it had worked with Farmers in establishing legally acceptable criteria.

"We do not believe the correspondence shows that the OIC worked with Farmers to determine what standards to use," Stephanie Marquis said. "We also do not agree that it was only after Mr. Hebert's complaint that the company conducted an analysis, and we specifically deny that the company conducted its analysis in a collaborative fashion with our agency."

In November 2007, a state auditor's investigation found that Brenman had used his position to expedite and facilitate the investigation into the complaint brought by a human rights commissioner, "contrary to normal agency procedures." Brenman denies the allegation, which has been referred to the state Ethics Board.

On Jan. 9, Brenman was fired by a unanimous vote of the Human Rights Commission, which cited the audit among other "administrative problems," according to commission Chairwoman Yvonne Lopez Morton, of Spokane.

Two complaints of HIV discrimination by insurance companies, including Hebert's, are currently on file with the Human Rights Commission.

Source: tmcnet.com

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Thursday, January 22, 2009

Farmers Insurance had the most complaints lodged against it during the storm season

It happens like clockwork.

Lately, it seems like every winter a storm blasts through Washington state bringing with it rain, wind and property damage.

If your roof gets swept up in hurricane-force winds, if a tree falls on your garage, are you covered by insurance?

Sometimes homeowners think they’re fully covered for things such as roofs, when they’re only really covered on the depreciated value of the roof, a decade after it was put on. Those can be hard, frustrating lessons, and sometimes, when an argument between homeowners and insurance companies gets heated, the state becomes involved.

In the last few years, countless people on the Twin Harbors have received a crash course in homeowners insurance coverage. Experiences have varied widely, but many have been frustrated by it.

The Daily World recently analyzed complaints filed with the state Insurance Commissioner’s Office resulting from a December 2006 storm and the big December 2007 storm.

A complaint registered with the Insurance Commissioner doesn’t mean an insurance company has done anything wrong, said Eric Mark, the public records manager for the state office. In fact, according to state investigator records obtained by The Daily World, most times insurance companies have not broken any regulatory rules at all.

But while many times rules may not have been broken, some policy holders feel so frustrated they still contact the Insurance Commissioner.

By the numbers

Statewide, Farmers Insurance had the most complaints lodged against it during the storm season, tying Allstate Insurance after the December 2006 storm with 11 complaints and garnering another 11 complaints from the December 2007 storm, for a total of 22.

Allstate had a total of 15 complaints from both storms. Farmers-owned Foremost Insurance had the third-most complaints filed, receiving 10 complaints from both storms.

Farmers’ top status for complaints received by the Insurance Commissioner is actually on par with the complaints the company gets year-round. For homeowner policies in 2007, Washington residents filed 101 complaints against Farmers, which had about a 13 percent market share of the state, the state agency says. In 2006, there were 72 complaints filed against Farmers. In both years, no other insurance company garnered as many complaints.

That compares, for instance, with State Farm Insurance, which had 55 complaints in 2007 and nearly 20 percent of the state’s market share — the highest share of any company. It registered only 43 complaints in 2006. During the past two December storms, just four complaints were filed against State Farm.

A spokesman for Farmers did not return phone calls seeking comment.

It was Farmers that took the Insurance Commissioner’s Office to Thurston County Superior Court in November over a couple of the case files The Daily World sought to review in a public records request for this story. Farmers initially didn’t want the state to release any of the information contained in two of the files, citing “trademark” protections. But during the court hearings, the company eventually changed its point of view and with a judge’s blessing released redacted information.

Mark, the public records manager for the Insurance Commissioner’s Office, says it’s been a couple of years since an insurance company has contested a public records request in court.

Some complaints

Complaints range from frustrated homeowners to cases that may be bound for court.

Sharon Longwith — one of the few people who allowed The Daily World to print her name for this story — said she thought she had a rock-solid policy that would have covered her house in all kinds of situations.

But she told The Daily World that Farmers partially denied a claim she and her husband filed with the insurance company following the December 2007 storm.


The storm had soaked the south side of her home, but she says the company wouldn’t pay for all of the damage “because the storm didn’t put a hole in my wall.”

That’s why she filed a complaint with the insurance commissioner’s office. When that didn’t help, she turned to FEMA for help. And when FEMA turned her down, she was able to find some financial assistance through the U.S. Department of Agriculture’s rural development program.

“Without the U.S. Department of Agriculture, I think we’d still have damage today,” Longwith said last month. “They gave us the money to hire a contractor, to repair the damage and are truly unsung heroes. I don’t think many people know they can get help through them.”

But some folks aren’t as lucky as Longwith.

A Rochester couple filed a complaint against Farmers following the December 2007 storm because the water around their home had risen to such a level that they actually had to be evacuated. The couple is named in the state documents but asked The Daily World not to identify them.

In their initial complaint letter to Insurance Commissioner Mike Kreidler, they wrote, “The flood water destroyed our insulation and heating ductwork completely, the skirting is waterlogged and will also need to be replaced. Our home has a cold-dampness inside and we have been using space heaters 24/7 to keep the cold/damp air at bay. This has resulted in a high electric bill; $191.00 for December. You can see the water in the floor ducts throughout the house.”

Their complaint wasn’t that Farmers wouldn’t cover their damage, but that the company was taking too long to respond. In the end, according to the Insurance Commissioner’s Office, the homeowners decided to get FEMA involved.

In Raymond, a homeowner called his insurance company, Foremost, while his power was still out, following the wind blasts of the 2007 storm. He wanted to set up a time for an adjuster right away because his home was soaked from so much rain.

“I asked if I could remove the closet carpet because of rain saturation and was told NOT to touch anything until the adjuster saw the damage,” wrote the complainant, whose name has been redacted from the state report. “I told her that the water will move through the area and she said this was ‘Due Process’ and that I needed to adhere to it.”

He was also concerned because when an adjuster did come out, the adjuster allegedly didn’t look under tarps on the roof or do an adequate inspection, resulting in a lower-than-expected settlement offer, according to the complaint.

Even though the state investigator didn’t find that the company did anything wrong, just the mere fact that the Raymond man complained seemed to speed up the process for him, according to the documents obtained by The Daily World.

Then there’s another incident in Raymond, which may very well end up in court.

A Raymond man, whose name has also been redacted from the state reports, complained to the Insurance Commissioner’s Office because Safeco Insurance had denied his claim. During the December 2007 storm, the rain had saturated the ground around his home to the point that the foundation shifted.

Safeco claimed that the foundation shift was caused by an “earth movement, meaning the sinking, rising, shifting, expanding or contracting of earth, all whether combined with water or not,” and so the claim isn’t covered under the homeowner’s policy.

According to notes from the state investigator, “Safeco seems to think that if 50 percent or more of the damage wasn’t caused by the wind, they won’t pay on anything.”

Amid the documents released to The Daily World is a report filed by an expert hired by the insurance company saying all the damage was caused by the “earth movement” while the Raymond man has documents on file from an engineer that indicate that when the ground was softened, it was the wind that blew the foundation off, which should then be covered.

The state investigator said there was nothing she could do and recommended the man contact an attorney, which she later noted he did.

Know your policy

But the term “earth movement” is one that should be remembered by everyone seeking insurance, according to Hoquiam Mayor Jack Durney, who also owns Durney Insurance in Hoquiam, and was willing to review some of the Insurance Commissioner files with The Daily World.

“There isn’t a regular home policy out there that covers earth movements,” said Durney.

And those who are concerned that their foundation may slip because of soggy ground may just be out of luck.

“A lot of the Harbor here is built on fill,” Durney said. “And there are places where earthquake insurance coverage just won’t take.” Or, if a policy can be found, it won’t ever be affordable because of the high risk factor.

Typical homeowner’s insurance won’t cover flood damage, either, Durney notes. A number of the complaints filed with the Insurance Commissioner’s Office had to do with flooding, but nearly every time the state had to reject the complaint because there was no flood policy.

Homeowners concerned enough about flooding need to buy such a policy through the National Flood Insurance Program, independent from any other policy, Durney said.

Durney also found that one of the biggest complaints he hears is the difference between a policy that covers the “actual cash value” of, say, a damaged roof, compared to a policy that will fully cover the cost to repair a roof.

“There’s such a huge difference both in the premium the homeowner pays and the amount of coverage that results,” Durney said.

With “actual cash value,” the homeowner will only be compensated with what the roof is worth in today’s dollars. That’s often thousands of dollars less than what it will cost to get a new roof.

The homeowner is stuck with the bill for whatever the difference is. Don’t like that idea? Durney says take a look at your policy to make sure it’s not there and contact your insurance agent to change policies right away.

“I would be more inclined to say that although there can be a big difference in premium, it is well worth it because the ‘replacement’ policy will do just that — hire a contractor to repair or replace the damaged part of the home. ‘actual cash value’ is much like the collision coverage you have on a car in that depreciation is taken into consideration. So, if you have a roof that is in bad repair and is old, the insurance company will only pay you the depreciated value — much like an old car that you wreck.”

Planning on renovating the home? A new homeowner’s policy may be your best bet, Durney also advises.

“The trick with insurance policies is making sure what you want is in your policy before a disaster happens,” Durney said. “That means asking lots of questions and having an agent or someone who can actually give you answers.”

That way insurance holders won’t be on their last legs with no one else to go to but the Insurance Commissioner — or an attorney.

Want to see more complaints or file one? Visit https://fortress.wa.gov/oic/complaints/

Got an Insurance Commissioner question? Call the Insurance Consumer Hotline at 1-800-562-6900.

By The Numbers

Complaints after Dec. 2006 & 2007 storms:

Farmers 22

Allstate 15

Foremost 10

Hartford 4

Liberty Mutual 4

State Farm 4

Safeco 3

Pemcu Mutual 3

Balboa 2

Grange 2

Metropolitan Property & Casualty 2

Mutual of Encumclaw 2

USAA Casualty 2

Zurich American 2

Amco 1

American Alternative 1

American Family 1

American Federation 1

American Security 1

American States 1

Amica Mutual 1

California Casualty 1

Canfield & Associates 1

Contractors Bonding & Insurance 1

Country Mutual 1

Esurance 1

Guideone Mutual 1

Homesite 1

Lexington 1

Mt. Hawley 1

North Pacific 1

QBE 1

Standard Fire 1

Truck Insurance 1

Source: thedailyworld.com

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