Месечни архиви: April 2015

Connecticut Fee Schedule for Hospitals ASCs Takes Effect

Connecticut Fee Schedule for Hospitals ASCs Takes Effect

Connecticut’s Medicare-based fee schedule for hospital inpatient, hospital outpatient, and ambulatory surgical center (ASC) services went into effect April 1.

Previously, there were no facility fee schedules in Connecticut and employers were liable for the hospitals’ prevailing charges unless the payers have negotiated discounted rates with the hospitals, according to the National Council on Compensation Insurance (NCCI).

Before, there was no facility fee schedule in Connecticut, though there has been one for physician fees, said Laura Backus Hall, NCCI’s state relations executive for Connecticut.

“A part of the facility fee schedule is that hospital outpatient services shall be reimbursed at 210 percent of Medicare’s outpatient fee schedule. That’s one of the features,” Hall said. “Another is that ambulatory surgical center services are to be reimbursed at 195 percent of Medicare’s outpatient fee schedule. And another feature is hospital inpatient services shall be reimbursed at 174 percent of Medicare’s Inpatient Prospective Payment System (IPPS).”

This new facility fee schedule is expected help lower medical costs, as reflected by the recently approved NCCI filing for decreases in advisory loss costs and assigned risk rates.

The NCCI made a law

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Former Maryland Agent Pleads Guilty to Insurance Fraud

Former Maryland Agent Pleads Guilty to Insurance Fraud

Authorities announced that a Hagerstown, Maryland, woman pleaded guilty in the Circuit Court for Washington County to one count of felony insurance fraud having a value of $300 or more.

Maryland Attorney General Brian Frosh announced on April 7 that Lisa Lynn Poffenberger received a six-year sentence, with all but two days suspended, and was placed on five years’ probation.

A joint investigation by the Maryland Office of the Attorney General and the Maryland Insurance Administration revealed that from June 2007 through June 2013, Poffenberger, a licensed insurance agent, stole approximately $20,000 in insurance premiums from at least 20 customers of Charles E. Toms Nationwide Insurance Agency in Hagerstown.

A portion of the misappropriated premiums were returned to the agency during Poffenberger’s scheme and the remaining money was returned after she was fired in June 2013, authorities said.

“Consumers purchase insurance policies to protect against losses, not to have their premiums used to perpetrate a scam,” said Attorney General Frosh. “My office and the Maryland Insurance Administration will continue to work hard to crack down on this type of fraud.”

Source: Maryland Office of the Attorney General


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Connecticut Announces Online System for Adjuster/Appraiser Renewals

Connecticut Announces Online System for Adjuster/Appraiser Renewals

Connecticut Insurance Commissioner Katharine Wade announced that insurance adjusters and appraisers can now renew their Connecticut licenses online using the department’s paperless system operated through the National Insurance Producers Registry (NIPR).

“This will offer greater convenience to the thousands of adjusters and appraisers who have the critical role of processing claims for Connecticut consumers,” Commissioner Wade said. “The Department has already transitioned producers and surplus lines brokers to the online licensing system. The adjusters and appraisers are the final — and largest — block of licensees who will benefit from the enhanced efficiency.”

Insurance adjusters and appraisers must renew their licenses every two years. The department recently mailed notices to the nearly 60,000 adjusters whose licenses expire at the end of June. The entire renewal system, including payment, is now online, the department said. The renewal period is April 10 through June 30.

NIPR is a non-profit affiliate of the National Association of Insurance Commissioners (NAIC) and was created through a public-private partnership to help make the producer-licensing process more cost-effective, streamlined and uniform for the benefit of regulators, the insurance industry and the consumers.


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Trial Ordered for Pennsylvania Family Accused of 20M Insurance Fraud

Trial Ordered for Pennsylvania Family Accused of 20M Insurance Fraud

A judge has ordered members of a Pennsylvania family whose mansion had three fires in five years to stand trial in a $20 million insurance fraud case.

Political fundraiser and hostess Claire Risoldi and her family are accused of living large on trumped-up insurance claims involving their 10-acre “Clairemont” estate in the Philadelphia suburbs.

Bucks County Judge C. Robert Roth’s ruling Wednesday came after six days of testimony in a preliminary hearing.

A jewelry appraiser testified that Risoldi used “salty language” and discussed the Mafia during a meeting over her claims that millions of dollars in jewelry disappeared during a fire.

Defense lawyers say the fires were electrical and have vowed to fight the criminal charges.

Risoldi’s husband killed himself in February. Her daughter, son and daughter-in-law are also charged.


Jewelry Expert Testifies in Pennsylvania Insurance Fraud-Fires Case
Penn. Mansion Fires Spark $20M in Payouts, Suicide, Fraud Case


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Vertafore Microsoft Partner to Provide Agents Access to Dynamics Platform

Vertafore Microsoft Partner to Provide Agents Access to Dynamics Platform

Insurance software provider Vertafore has partnered with Microsoft to give insurance agents access to the capabilities of the Microsoft Dynamics CRM (customer relationship management) platform.

The partnership is designed to improve customer-facing interactions and give agents data that can be accessed from anywhere at anytime. The capabilities, which will be integrated into the Vertafore Agency Platform and mobile offerings, will extend to Dynamics CRM pipeline management, prospect & opportunity tracking, email campaign and other CRM capabilities.

A recent report by Novarica found that insurance professionals are starting to deploy CRM-driven campaigns that share customer data across the distribution, underwriting and service channels. CRM deployments are expected to increase in 2015, with 21 percent of respondents planning to integrate them into their business.

Microsoft Dynamics’ deal with Vertafore allows agency customers to leverage the Dynamics platform to build out a sales force automation application that is integrated with the Vertafore Agency Platform. This gives agents a complete view into the policy lifecycle, and allows them to track prospects and use this extended information to increase customer conversion rates.

The Dynamics announcement comes on the heels of last week’s announcement that Microsoft will offer special discounts to Vertafore customers on the Microsoft Surface Pro 3, HP, and Toshiba Tablets.

A recent survey by Channel Harvest Research, found that over the next two years, insurance agents expect a significant increase in tablet-based applications over smart phone apps, especially for display-oriented tasks like sales presentations and training. A quarter of agents expect tablet use to increase for sales purposes and 22 percent expect tablet use to increase for accessing training tools.

Theo Beack, CTO of Vertafore says the company will continue collaborating with Microsoft to innovate legacy processes and identify more efficient ways to bring enterprise technology to the insurance industry.



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NYC Officials Cheer 3B Federal Grant for Sandy Aid

NYC Officials Cheer 3B Federal Grant for Sandy Aid

New York Mayor Bill de Blasio and Sen. Chuck Schumer praised the Federal Emergency Management Agency for authorizing $3 billion in federal funding to repair and protect city housing developments damaged by Superstorm Sandy.

It is the largest single block grant in the agency’s history.

The money will used at 33 developments damaged by the 2012 storm.

Many of those suffered basement flooding which damaged boilers and electrical and mechanical equipment, leaving some buildings without heat or power for weeks.

De Blasio called the grant “transcendent” during a Tuesday news conference in a hard-hit Brooklyn neighborhood.

Repair work at the housing projects will begin this summer and will take between 18 – 36 months, de Blasio said. A development in Coney Island in Brooklyn will be the first to undergo the overhaul.


What Agents Should Know About Flood Insurance Changes in Effect April 1
NYC Gets $116M Reimbursement for Sandy-Related Fixes
New Jersey Moving to Demolish Hundreds of Sandy-Damaged Homes
New York Lawmakers Pass Tax Relief Bill for Sandy Victims


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ISO Introduces Endorsements to Address Ridesharing Policy Gaps

ISO Introduces Endorsements to Address Ridesharing Policy Gaps

ISO has introduced two new personal auto coverage options for ridesharing drivers when they’re logged in but don’t have any passengers – an issue that has been the subject of controversy among insurance companies and those outside the ridesharing community.

The endorsements provide two options for personal auto insurers to offer coverage to drivers participating in ridesharing services or transportation network companies (TNCs). One coverage option would apply from the time the drivers log in to the TNC platform via a mobile device until they’ve accepted a ride request. The other would apply from when they log in to the TNC platform up until a passenger occupies their vehicle.

“Personal insurers may want to provide coverage options to ridesharing drivers without requiring them to buy a commercial auto policy,” said Beth Fitzgerald, president of ISO Insurance Programs and Analytic Services. “Our new endorsements will allow insurers to easily add ride-sharing coverage for TNC drivers to their customers’ personal auto policies.”

ISO said it began filing these endorsements recently on a multistate basis, along with rating rules and relativities for insurers to help price the two coverage options under a personal auto policy.

“As ridesharing is still a relatively new issue in insurance, it may be difficult for carriers to identify and rate the risks of ridesharing drivers,” said Patrick Woods, vice president of Actuarial Products and Operations at ISO. “Our rating tools are designed to help them offer coverage that specifically addresses each driver’s individual risk profile.”

According to a recent white paper by the National Association of Insurance Companies, insurance companies have been increasingly under pressure to offer coverage for ridesharing companies. State insurance regulators are helping state legislators consider how to best address the insurance gaps associated with TNCs. Legislation is also currently pending in at least 35 states.

The NAIC paper, Transportation Network Company Insurance Principles for Legislators and Regulators, says policy endorsements are being developed specifically for personal auto providers to close gaps for TNC drivers willing to purchase them. ISO’s new endorsements may fall into this category.

Several companies are now offering coverage options in certain states, but each policy addresses different issues facing ridesharing drivers:

GEICO has launched its ridesharing policy in Maryland and Virginia and plans to roll it out across the country, according to its CEO.
Farmers introduced coverage in Colorado in January.
Regional insurer Erie Insurance Co. launched coverage in Illinois and Indiana late last year.
USAA released a pilot insurance product in Colorado in January that provides drivers with coverage from when their apps are turned on until they are matched with a passenger.
MetLife Auto & Home partnered with Lyft to provide a “complete” auto insurance policy for Lyft drivers in Colorado.

R Street Institute has also reported that major insurers are ready to strike a deal to support transportation network companies’ compromise language.

ISO, a Verisk Analytics business, provides statistical, actuarial, underwriting, and claims information and analytics.

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Family Sues Over West Virginia School’s Use of Walking as Discipline

Family Sues Over West Virginia School’s Use of Walking as Discipline

A student’s family is suing West Virginia’s Berkeley County Schools over a school’s use of walking as a form of discipline.

The lawsuit says Mountain Ridge Intermediate School’s policy violates state law prohibiting corporal punishment.

According to the lawsuit, the practice involves requiring a student to walk from one light pole on campus to another, usually for 15 to 30 minutes.

The Journal reports that Neva Savage and William Savage filed the lawsuit in February in Berkeley County Circuit Court. It has since been moved to federal court. Also named as defendants are the Board of Education, the superintendent, the school’s principal and a teacher.

Attorneys representing the school officials have asked the court to dismiss the lawsuit.

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Freedom Industries West Virginia Sign Spill Site Cleanup Agreement

Freedom Industries West Virginia Sign Spill Site Cleanup Agreement

Freedom Industries and West Virginia regulators have signed an agreement for cleaning up the site of a 2014 chemical spill in the Elk River that prompted a tap water ban for 300,000 people for days.

The agreement announced Tuesday by the West Virginia Department of Environmental Protection will be done through the agency’s Voluntary Remediation Program.

Previous agreements required Freedom to remove all contaminated soil and groundwater from the site, which is about 4.8 acres. In bankruptcy filings, company officials have said the voluntary remediation program will be less expensive, lessening Freedom’s burden for cleaning the site.

The agreement sets deadlines for Freedom to submit cleanup reports and work plans to the DEP. The company’s first deadline is April 20, when it must submit a report on an initial site investigation and interim measures taken so far. A work plan for a human health and ecological risk assessment is due in the third quarter of 2015. A remedial action completion report must be submitted in the second quarter of 2016.

All plans and reports must be approved by the DEP.

Freedom also must preserve all records required by the agreement, along with any other documents used to prepare the records, for at least three years.

If Freedom withdraws from the voluntary program, it is still required to clean up the site under a November 2014 consent order with the DEP.

Mark Welch, Freedom’s chief restructuring officer, was in meetings Tuesday and not immediately available for comment.

Freedom filed for Chapter 11 bankruptcy eight days after the Jan. 9, 2014, spill. About 7,500 gallons of a coal processing chemical leaked into the river from Freedom’s storage site in Charleston, about 1.5 miles from West Virginia American Water Co.’s drinking water intake.

Freedom and four former company officials are scheduled to be sentenced in June on federal pollution charges. On Tuesday, federal prosecutors asked the U.S. District Court in Charleston to delay sentencing for two defendants.

In court filings, prosecutors wrote that plea agreements with William Tis and Charles Herzing say they’re willing to provide testimony in the cases against fellow former Freedom officials Gary Southern and Dennis Farrell.

Southern and Farrell have pleaded not guilty. Southern also faces fraud charges related to Freedom’s bankruptcy case.

Prosecutors say Tis and Herzing should have their sentencing rescheduled until after the October trial of Southern and Farrell.

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Tennessee Judge Comp Benefit Limits for Undocumented Workers Unconstitutional

Tennessee Judge Comp Benefit Limits for Undocumented Workers Unconstitutional

A Nashville judge has found to be unconstitutional a state law that limits the amount of workers’ compensation benefits laborers living in the country illegally can receive.

The ruling stems from the case of a Guatemalan man whose left arm was severely injured when he fell and it was run over by a lawnmower.

In a ruling issued last month, Davidson County Chancellor Russell Perkins said the U.S. Constitution gives the federal government the authority to set immigration policy and not the state legislature. Perkins also noted that a 2012 U.S. Supreme Court decision, which struck down an Arizona anti-immigrant law, noted that the constitution gives the federal government “broad, undoubted power over immigration.”

Perkins found that the legislature, by limiting the benefits to the workers, intended to establish what amounts to a state immigration policy, but that could not trump federal law. He also said the state law, which limited the amount of money employers would potentially pay, could encourage employers to hire workers who are living in the country illegally.

“This undermines the goals of federal immigration law by providing a potential incentive for employers to circumvent the law,” the ruling said.

The opinion noted that Nashville-area company Commercial Services employed Carlos Martinez knowing that he was in the country illegally.

As a result, he said Martinez, a 39-year-old who had made about $400 a week working for the company, is entitled to $45,000 in benefits.

It’s not clear whether the state will appeal.

The state Attorney General’s office said in a statement that it is reviewing the decision and considering the options.

This was a test case used to deliberately challenge state law, said Martinez’s lawyer, Brian Dunigan.

A lot of the workers are performing dangerous work, and employers aren’t willing to help them when they get hurt, he said.

“We see a lot of people being taken advantage of in this area, and so we’re hopeful that we can push back against some of these unfair laws,” Dunigan said.

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