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 and Facebook pages. 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.

California Insurance Commissioner vs Blue Shield CA (Follow Up)

I wanted to post a follow up to my earlier BLOG of July 3rd concerning California Insurance Commissioner Dave Jones disapproval of the Blue Shield Life & Health CDI plan closures.

I spoke with Blue Shield today and we are pending official notification from the insurance company in regard to Mr. Jones' announcement. I will provide information via a new BLOG post once I have it.

In the meantime I wanted to provide a link to the CDI web site and Dave Jones official press release regarding this issue. The official announcement provides a more detailed explanation of the decision.

Dave Jones Blue Shield Press Release

Dave
www.an-insurance.com

CA Insurance Commissioner Disapproves Blue Shield CA Plan Closures

California Insurance Commissioner Dave Jones announced today that he has disapproved the announced health plan closures by Blue Shield Life & Health. See my previous blog "Blue Shield To Close and Replace Most Individual Health Plans in California" from April 17th.

The CDI (CA Dept of Insurance)originally disapproved the plan closures in March, 2012, and requested additional information be provided by Blue Shield by June. The CDI reviewed the information and sustained the disapproval of the plan closures citing a lack of size of the remaining open block for pooling so as not to create a "death spiral" with the closed block.

All of Blue Shield's new PPO plans are registered with the CA Dept of Managed Healthcare (DMHC) leaving only one PPO plan from Blue Shield Life & Health.

Additionally the Commissioner notes that one specific health plan, the Vital Shield 2900 PPO has insufficient provision for 20,000 members as it offers no plan transfer right without medical underwriting.

I have yet to receive anything from Blue Shield CA regarding this decision by the CDI and will advise as soon as I receive any information from them. Until then, the closed plans are not available to new health insurance purchasers in California.

Dave
www.an-insurance.com

Product Safety Commission

MSN Health recently published on their website a great article about firework safety.  We wanted to post this article as both a way to wish you a Happy Fourth of July and to make sure you keep it a safe Fourth of July.  Here is the article.  To go directly to their site click here or read below:

Fourth of July Safety Tips

By Hank Bernstein, D.O., Harvard Health Publications

Each year, especially during the early summer weeks around the Fourth of July, thousands of people are treated in emergency departments for fireworks-related injuries. While some are minor, many of these injuries are serious, for example, resulting in burns or blindness. In 2008, seven deaths from fireworks-related injuries were reported; perhaps these could have been prevented.

Children should never be allowed to use fireworks! Of the 9,800 fireworks-related injuries reported to the U.S. Consumer Products Safety Commission (CPSC) in 2007, almost half occurred in children under the age of 15.

All fireworks are dangerous—even sparklers—which cause the majority of fireworks-related injuries to children under the age of 5. Sparklers burn at very high temperatures (up to 2,000 degrees Fahrenheit), sending out sparks that can easily set clothes on fire and cause permanent eye damage.

Because the risk of injuries when using fireworks is so high, the American Academy of Pediatrics (AAP) supports a nationwide ban on the private use of any and all fireworks. Instead, families should attend public fireworks displays, which are much less dangerous.

While a few states have banned all consumer fireworks, most have not. Until every state bans fireworks, the CPSC and the National Council on Fireworks Safety recommend taking the following safety precautions to make it less likely that someone will be injured by these potentially dangerous devices:

• Never allow children to touch fireworks of any kind, including sparklers even after they have "gone off". It can be hot, or even explosive and debris from fireworks can be extremely dangerous.
• Older teens should only be allowed to use fireworks under close adult supervision.
• Fireworks must never be used while drinking alcohol or using other drugs.
• Obey all local laws.
• If allowed in your area and you choose to do so, buy fireworks only from reliable sellers.
• Store fireworks in a dry, cool place.
• Only use fireworks outdoors and always have a good amount of water close by (a garden hose and a bucket), in case of emergency.
• Read and follow label directions.
• Light only one firework at a time.
• Never hold any part of your body directly over the firework while lighting it.
• Be sure all other people are out of range before lighting fireworks.
• Never throw or point fireworks at anyone.
• Never light fireworks in a container, especially a metal or glass container.
• Never light fireworks near a house or building, dry leaves or grass, or any other materials that can catch on fire.
• Never re-light a "dud" firework. Instead, wait 15 to 20 minutes, then soak it in a bucket of water and throw it away.

Information contained in this article was adapted from the American Academy of Pediatrics and the Consumer Product Safety Commission.

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.

What was at stake in the ruling for Washington state

Earlier this month, we put out a report detailing what was at stake for Washington state -- down to the county level -- if the Affordable Care Act was thrown out by the Supreme Court.

The upshot was that more than 800,000 Washingtonians stand to get coverage through the Medicaid expansion OR to get subsidies to help them and their families pay for private insurance.

In addition, the report details the reforms, most of them largely unnoticed by the average person, that have already taken effect. Among these: Young adults can now stay on their parents' health coverage up to age 26, kids can't be denied insurance because they're sick, small businesses get tax rebates if they provide health coverage for workers, no caps on lifetime benefits, etc.

The most significant reforms will take place in 2014, including the state's new health care exchange, an online marketplace to shop for and compare insurance -- as well as a way for lower- and middle-income families to get substantial help paying for it.

The full report is at http://www.insurance.wa.gov/legislative/reports/Whats-at-stake.pdf.