Mid-Valley Claims Association News Network

January 2019

www.MidValleyClaims.org

Volume XXVI • Number I

Join Your Mid-Valley Claims Association for our First Regular Luncheon Meeting of the New Year!

Serving MVCA Since 1994

Fraud Trends in the Central Valley National Insurance Crime Bureau Supervisory Special Agent to share latest at January 18, 2019 MVCA

More of What’s Inside

Join the MVCA for our First Regular Luncheon Meeting of the New Year!

Friday, January 18, 2019 as we welcome

Special Guest Speaker!!

Supervisory Special Agent, Ken Hutchison National Insurance Crime Bureau

Welcome To The New Year! January, 2019 President’s Message Bryan Harrison

MVCA Holiday Pizza Party Steers Group to a Stronger Future

Dave Wong’s Restaurant

2828 W. March Ln., Stockton

MVCA

2019 Early Bird Membership Extended Through Jan 18 meeting!

Supreme Court denies review of decision upholding Fair Claims Settlement Practices Regulations more at: www.MidValleyClaims.org

Mid-Valley Claims Association News Network • January 2019

2019 MVCA OFFICERS

PRESIDENT

Bryan Harrison

Association News Network (209) 597-8157

VICE PRESIDENT to be determined (209) 597-8157

bryan@associationnewsnetwork.com

SECRETARY

IM PAST PRESIDENT

Brightleaf Textile Restoration

Frontier Adjusters

Liza Wisecarver (925) 455-6000

Sherry Wenograd Retired

liza@blcleaners.com

2019 BOARD MEMBERS Tom Shefchick, PE Shefchick Assocates

Eric Gacutan

Alliance Environmental Group

MVCA CCNC REP: Liza Wisecarver

Budgeting For Growth? The U.S. Small Business Administration recommends budgeting/spending 7% to 8% of your annual gross revenue for marketing and advertising if your business does less than $5 million a year in sales, and your net profit margin after all expenses is in the 10 percent to 12 percent range. Grow Your Brand’s Visibility IN PRINT with the Mid-Valley Claims edition of the Association News Network AND ONLINE, at: MidValleyClaims.org Co m b i n e Pri nt & On l i n e S po n so rsh i ps & S AV E ! Email: bryan@associationnewsnetwork.com or

Call 209-229-8240

Mid-Valley Claims Association News Network • January 2019

MVCA

2019 Upcoming Events

Welcome To The New Year! January 2019 Message from MVCA President Bryan Harrison

As we move swiftly into the new year, 2019 is already beginning to take shape. For the Mid-Valley Claims Association, our core group is working excitedly toward a renewal of spirit, of sorts.

Friday, January 18, 2019 Luncheon Meeting -

Special Guest Speaker from the NICB (National Insurance Crime Bureau - West Region): Supervisory Special Agent, Ken Hutchison National Insurance Crime Bureau

Friday, February 15, 2019 Luncheon Meeting

Friday, March 15, 2019

Luncheon Meeting - Christine Reed, Low Ball & Lynch ReCertification of CDI Fair Claims regulations

Friday, April 19, 2019 Luncheon Meeting

Friday, May 17, 2019 Luncheon Meeting

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New, interested and active individuals and members are beginning to show up, as those who have long supported this organization continue to provide a solid base from which we are able to grow.

Through all my many years of being involved, not only with this great group but the claims industry in general, this is the first time I’ve taken the helm as the President - running the show, as it were. Thus far, I’m greatly encouraged by the responses and interest we are seeing. I like to think my recent tenure as President of the Mountain House Rotary Club helped me considerably with my own growth and abilities to handle this position. I’m seeing where I am able to apply much of what I learned there. Still, there’s much more room for growth moving into the new year.

For our first meeting, Friday, January 18, 2019, we are excited to present a very special guest speaker: Mr. Ken Hutchison, from the National Insurance Crime Bureau. Mr. Hutchison is a Supervisory Special Agent, overseeing six agents out of the Sacramento office. We look forward to his overview on the NICB, and a discussion of the latest trends in Insurance Fraud. I encourage you to not only attend, but invite work associates, clients, and others who might benefit from the info this session will provide.

Our 2019 Membership Drive is in full swing! We have a lot planned in the coming months that will make your involvement well worth the modest membership fee. Please submit your 2019 membership from the site, or bring it with you to the January 18th luncheon. Growing the membership is crucial to sustaining the viability of any organization like this. Joining earns you a discounted lunch rate, and other benefits that will come into play through the year. I want to thank those who have already done so much to keep things rolling as the new year begins to unfold. Looking forward to a banner year for MVCA, and I look forward to seeing you this Friday! Respectfully Submitted,

Bryan Harrison

Bryan Harrison, Association News Network 2019 President, Mid-Valley Claims Association (209) 597-8157 www.MidValleyClaims.org • midvalleyclaims@gmail.com

Mid-Valley Claims Association News Network • January 2019

MVCA Holiday Pizza Party Steers Group to a Stronger Future By Bryan Harrison

The pizza was really great, and the company in attendance even better, as the Mid-Valley Claims Association celebrated the season December 14, 2018. Michael’s New York Style Pizza Cafe proved a great setting for the intimate crowd that turned out. In lieu of a speaker, the focus was on driving donations to help the fire victims from the Butte County Camp Fire. There was also considerable discussion about the schedule of association events for 2019, and some great enthusiasm for strengthening the organization. 2019 Event Coordinator, Eric Gacutan, of Alliance Environmental, spoke of not only a golf tournament, but the second annual MVCA Bowling Tournament, as well as some other events in the works. A big Mid-Valley Claims thanks to all those who have donated to the Disaster Relief Fund established by Rotary District 5220 as a non-profit 501c(3) corporation to facilitate getting money directly in the hands of those affected by the fire. 100% of proceeds will be delivered to the President of the Paradise Rotary organization, to be disseminated where most needed. In addition to individual member donations, MVCA is contributing net proceeds from the September Bowling Tournament, as well. The total should be more than $1,000.

Eloiza Ramos, with Truex Insurance, near right, with James Bolin, of 9-1 Plumbing, and Alex Guillen, of Golden Bear Insurance

Eva Hanifi, of Go Mini’s with Tami Umland of RMC

Eric Gacutan, of Alliance Environmental/Airtek

M i d - Va l l e y C l a i m s A s s o c i a t i o n

2019 Early Bird Membership! The Mid-Valley Claims Association depends on membership dues as a main source of sustainability. As a thank you to your dedication to this organization, MVCA is offering an “early-bird” membership discount, for both individual and corporate memberships. Join for 2019 at the old rate of just $25 per person for individuals, or $100 for Corporate membership, up through the first meeting of the year January 18, 2019. Rates will increase to $35 and $150, respectively, thereafter. As a member of the MVCA, you are encouraged to get involved! Beyond attending the regular luncheon meetings and other events the organization produces throughout the year, help is needed on committees and, ultimately, on the board of directors. You can play a part in helping to shape a positive future for MVCA. For more information and ways in which you can possibly contribute, speak with one of your MVCA officers or board members today! You can have a say! Sign up NOW at: www.MidValleyClaims.org

Individual Membership Just $25 per person ($35 after Jan 18, 2019)

Corporate Membership Just $100 five (5) people or more ($150 after Jan 18, 2019)

Matt Weaver, of Patriot Environmental, and Beth Ossino, of Golden Bear Insurance Residential & Commercial Reconstruction 24 hour emergency service

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Mid-Valley Claims Association News Network • January 2019

Join Your Mid-Valley Claims Association for our First Regular Luncheon Meeting of the New Year!

Fraud Trends in the Central Valley National Insurance Crime Bureau Supervisory Special Agent to share latest at January 18, 2019 MVCA

Join the Mid-Valley Claims Associatino for our first luncheon meeting of the new year as we welcome special guest speaker from the National Insurance Crime Bureau, Supervisory Special Agent Ken Hutchison. This luncheon will be held at Dave Wong’s Restaurant, at 2828 W. March Lane in Stockton. Check-in time is 11:30am, with the luncheon running from noon until 1pm.

Supervisory Special Agent Ken Hutchison has been with the NICB going on ten years, since 2009. He works out of their Sacramento office, supervising six NICB Agents in Northern California. Prior to joining the Nat’l Insurance Crime Bureau, Mr. Hutchison was with the Califonria Highway Patrol for some 32 years. Mr. Hutchison’s presentation will provide an overview of the function of the NICB, as well as addressing the latest issues and concerns happening in the world of insurance fraud. Plan now to attend, and please invite your work associates and others involved in claims handling. This promises to be a most informative and fascinating session. Please note, also: Paid 2019 members receive a significant discount on the lunch cost. Sign up on our site: www.MidValleyClaims.org.

Join the MVCA for our First Regular Luncheon Meeting of the New Year!

Friday, January 18, 2019 as we welcome

Special Guest Speaker!!

Supervisory Special Agent, Ken Hutchison National Insurance Crime Bureau @

Dave Wong’s Restaurant

2828 W. March Ln., Stockton 11:30 a.m. check-in Noon - 1:00 p.m. luncheon

Just $22 for all 2018 & 2019 Paid Members $28 for Non-Members/guests or Those with No Reservations

Secure Your Spot Now at: www.MidValleyClaims.org

If you suspect fraud activities, contact NICB in the following ways. All tips can be anonymous: • Text the keyword "FRAUD" to TIP411 (847411) • Call 800.TEL.NICB (800.835.6422) Monday through Friday 7 a.m. to 7 p.m. CST • Report fraud online using the form at: https://www.nicb.org/how-we-help/report-fraud • Download the NICB Fraud Tips App for iPhone/iPad: https://itunes.apple.com/us/app/nicb-fraud-tips/ id492578733?mt=8

Join MVCA or Renew your Membership for 2019 Now! Please Sign-Up online NOW at:

www.MidValleyClaims.org

Mid-Valley Claims Association News Network • January 2019

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Deadline for submissions is January 25, 2019

The Mid-Valley Claims Association News Network© is a production of Association News Network, Inc. Published monthly as a free service to the MVCA with a commitment and dedication to the promotion and betterment of this professional organization. The views and comments expressed within the articles herein do not necessarily reflect the views of A.N.N., Inc. or MVCA. We assume no responsibility for any opinions and/or statements offered by contributing authors to the publication. Acceptance of advertising material does not constitute endorsement of the products or services offered. We reserve the right to reject any advertising copy or placement. We encourage industry support of this professional organization - its monthly newsletter publication and web site. Go to: www.MidValleyClaims.org Please email articles for consideration to: Bryan Harrison, President/Publisher

For Advertising opportunities and info, contact: Lynna Harrison, Customer Service Manager

Bryan@AssociationNewsNetwork.com Lynna@AssociationNewsNetwork.com 925.708.5569 925.785.7021 © 1994-2018, all rights reserved • Association News Network, Inc. • www.AssociationNewsNetwork.com 2455 Naglee Rd. #263 . Tracy, CA 95304 • 209.229.8240

Mid-Valley Claims Association News Network • January 2019

Supreme Court denies review of decision upholding Fair Claims Settlement Practices Regulations LOS ANGELES, CALIF. — After a decade of legal wrangling over the regulations that implemented the Unfair Insurance Practices Act (UIPA), the California Supreme Court let stand the decision of California Court of Appeal, 4th Appellate District, upholding the Insurance Commissioner’s Fair Claims Settlement Practices Regulations, which prescribe how insurance companies must process insurance claims. The regulations are the foundation in determining the number of violations committed when assessing fines against insurers that have committed unfair claims practices. Department of Insurance examinations of PacifiCare’s claims-handling uncovered evidence of numerous unfair claims practices-which included wrongful denials for life-saving treatment for people battling serious illness and claim payment denials for providers and hospitals-all because the insurer was focused on maximiz-

ing profits through what it called “efficiencies” after the 2015 botched $9 billion acquisition of PacifiCare by UnitedHealthcare. The Department examinations also uncovered evidence the company was well aware of the egregious issues. Under the Insurance Code, these unfair acts or practices include misrepresenting what medications or treatments an insurance policy covers, failing to promptly pay claims where liability is reasonably clear, and forcing claimants to file lawsuits to get full payment, and other acts. The Insurance Code allows the commissioner to impose fines of up to $5,000 each time an insurer commits an unfair act or practice on a consumer, or up to $10,000 each time if the insurer did so willfully. “UnitedHealthcare purchased PacifiCare and imposed cost-cutting measures that destroyed PacifiCare’s claims-handling processes. Its arguments in litigation that insurance

MV Claims Association takes lead with Camp Fire Relief Fund-raising effort Relief efforts to help the tens of thousands of victims of the Butte County Camp Fire have been dramatic and sweeping, with people and organizations reacting and assisting in so many ways. “After looking into numerous quality outlets, we decided to funnel funds through the Disaster Relief Fund Corporation a 501c(3) non-profit established by Rotary Int’l District 5220 in the central valley,” stated MVCA Secretary, Liza Wisecarver. “100% of funds will be forwarded through the Rotary District 5220 Disaster Relief Fund, to be administered by Paradise Rotary President Brian Gray and Past District Gov Pam Gray,” stated the district announcement. Donations may be made through the Mid-Valley Claims Association site, at: www.MidValleyClaims.org/events/2018/1812.html.

companies should be allowed to willfully harm consumers as long as they don’t do it too often, reflect a gross disregard of the lives and wellbeing of the consumers who paid for the promise of coverage,” Commissioner Jones said. “Customers have no choice but to rely on the integrity of their health insurance companies. PacifiCare breached that trust. By any measure, 908,000 violations reflect a general business practice of violating consumer protection laws. “I am delighted the Supreme Court has rejected further challenges to the insurance commissioner’s authority to punish insurance companies for knowingly harming even one consumer.” Based on departmental examination results and following an administrative hearing that took three years, Insurance Commissioner Dave Jones found PacifiCare committed 908,547 separate violations of the UIPA, and he imposed fines aggregating $173,603,750 in penalties. On behalf of PacifiCare, UnitedHealthcare sued the commissioner, arguing that none of its harmful conduct violated the Insurance Code. PacifiCare argued that insurers are immune from fines for committing these unfair acts, even if the insurer did so intentionally, unless the commissioner is also able to show that the insurer knew it had committed the acts frequently enough to constitute a “general business practice.” The court of appeal rejected the argument, stating: “PacifiCare’s interpretation of section 790.03(h) is not only internally problematic, it stands in contrast to virtually every other statute the Legislature has enacted in

connection with: (1) enforcement of the Insurance Code against insurers generally; (2) enforcement of the UIPA in particular; and (3) the imposition of administrative penalties against insurers in other contexts.” The court also rejected PacifiCare’s argument that the commissioner must prove an insurer had “actual knowledge” of its illegal conduct and held that it was within the commissioner’s authority to hold the insurer responsible if its agents or employees were aware of facts that would cause a reasonable person to know of the violations. The court also found the commissioner’s reasoning was sensible in that restricting the definition of “knowingly” to one particular individual’s actual knowledge would fail to take into account that many people handle a claim, and an unfair practice can be committed by cumulative acts, not simply the intentional act of one person.” Further, the court of appeal also upheld the commissioner’s interpretation that an insurer’s “willful” violation of the act may be established by showing a purpose or willingness to commit the act, and agreed that penalties for willful violations do not need to require a showing that the insurer intended to violate the law or injure someone. The court held, “As the Commissioner points out, he engaged in an extensive, formal rule-making process in the course of promulgating these regulations. That careful consideration, combined with the Commissioner’s expertise in the area, weighs in favor of according significant deference to the Commissioner’s interpretation of the terms, and we do so.”

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MVCA Holiday Pizza Party Steers Group to a Stronger Future - see page 4

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Fraud Trends in the Central Valley National Insurance Crime Bureau Supervisory Special Agent to share latest at January 18, 2019 MVCA

Friday, January 18, 2019 as we welcome

Special Guest Speaker!!

Supervisory Special Agent, Ken Hutchison National Insurance Crime Bureau @

Dave Wong’s Restaurant

2828 W. March Ln., Stockton

- see page 5

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