Health Zenith

What Type Of Life Insurance Is Best?

2017-06-08T18:51:00.000-07:00

Life Insurance (though it shouldn't be) is to this day a very controversial issue. There seems to be a lot of different types of life insurance out there, but there are really only two kinds. They are Term Insurance and Whole Life (Cash Value) Insurance. Term Insurance is pure insurance. It protects you over a certain period of time. Whole Life Insurance is insurance plus a side account known as cash value. Generally speaking, consumer reports recommend term insurance as the most economical choice and they have for some time. But still, whole life insurance is the most prevalent in today's society. Which one should we buy?

Let's talk about the purpose of life insurance. Once we get the proper purpose of insurance down to a science, then everything else will fall into place. The purpose of life insurance is the same purpose as any other type of insurance. It is to "insure against loss of". Car insurance is to insure your car or someone else's car in case of an accident. So in other words, since you probably couldn't pay for the damage yourself, insurance is in place. Home owners insurance is to insure against loss of your home or items in it. So since you probably couldn't pay for a new house, you buy an insurance policy to cover it.

Life insurance is the same way. It is to insure against loss of your life. If you had a family, it would be impossible to support them after you died, so you buy life insurance so that if something were to happen to you, your family could replace your income. Life insurance is not to make you or your descendants rich or give them a reason to kill you. Life insurance is not to help you retire (or else it would be called retirement insurance)! Life insurance is to replace your income if you die. But the wicked ones have made us believe otherwise, so that they can overcharge us and sell all kinds of other things to us to get paid.

How Does Life Insurance Work?

Rather than make this complicated, I will give a very simple explanation on how and what goes down in an insurance policy. As a matter of fact, it will be over simplified because we would otherwise be here all day. This is an example. Let's say that you are 31 years old. A typical term insurance policy for 20 years for $200,000 would be about $20/month. Now... if you wanted to buy a whole life insurance policy for $200,000 you might pay $100/month for it. So instead of charging you $20 (which is the true cost) you will be overcharged by $80, which will then be put into a savings account.

Now, this $80 will continue to accumulate in a separate account for you. Typically speaking, if you want to get some of YOUR money out of the account, you can then BORROW IT from the account and pay it back with interest. Now... let's say you were to take $80 dollars a month and give it to your bank. If you went to withdraw the money from your bank account and they told you that you had to BORROW your own money from them and pay it back with interest, you would probably go clean upside somebody's head. But somehow, when it comes to insurance, this is okay

This stems from the fact that most people don't realize that they are borrowing their own money. The "agent" (of the insurance Matrix) rarely will explain it that way. You see, one of the ways that companies get rich, is by getting people to pay them, and then turn around and borrow their own money back and pay more interest! Home equity loans are another example of this, but that is a whole different sermon.

Deal or No Deal

Let us stick with the previous illustration. Let us say the one thousand 31 year olds ( all in good health) bought the aforementioned term policy (20 years, $200,000 dollars at $20/month). If these people were paying $20/month, that is $240 per year. If you take that and multiply it over the 20 year term then you will have $4800. So each individual will pay $4800 over the life of the term. Since one thousand individuals bought the policy, they will end up paying 4.8 million in premiums to the company. The insurance company has already calculated that around 20 people with good health (between the ages of 31 and 51) will die. So if 20 people pass away, then the company will have to pay out 20 x $200,000 or $4,000,000. So, if the company pays out $4,000,000 and takes in $4,800,000 it will then make a $800,000 profit.

This is of course OVER simplifying because a lot of people will cancel the policy (which will also bring down the number of death claims paid), and some of those premiums can be used to accumulate interest, but you can get a general idea of how things work.

On the other hand, let's look at whole life insurance. Let us say the one thousand 31 year olds (all in good health) bought the aforementioned whole life policy ($200,000 dollars at $100/month). These people are paying $100/month. That is $1200 per year. If the average person's lifespan (in good health people) goes to 75, then on average, the people will pay 44 years worth of premiums. If you take that and multiply it by $1200 you will get $52,800. So each individual will pay $52,800 over the life of the policy. Since one thousand individuals bought the policy, they will end up paying 52.8 million in premiums to the company. If you buy a whole life policy, the insurance company has already calculated the probability that you will die. What is that probability? 100%, because it is a whole life (till death do us part) insurance policy! This means that if everyone kept their policies, the insurance company would have to pay out 1000 x $200,000 = $2,000,000,000) That's right, two billion dollars!

Ladies and gentleman, how can a company afford to pay out two billion dollars knowing that it will only take in 52.8 million? Now just like in the previous example, this is an oversimplification as policies will lapse. As a matter of fact, MOST whole life policies do lapse because people can't afford them, I hope you see my point. Let's take the individual. A 31 year old male bought a policy in which he is suppose to pay in $52,800 and get $200,000 back? There no such thing as a free lunch. The company somehow has to weasel $147,200 out of him, JUST TO BREAK EVEN on this policy! Not to mention, pay the agents (who get paid much higher commissions on whole life policies), underwriters, insurance fees, advertising fees, 30 story buildings... etc, etc.

This doesn't even take into account these variable life and universal life policies that claim to be so good for your retirement. So you are going to pay $52,800 into a policy and this policy will make you rich, AND pay you the $200,000 death benefit, AND pay the agents, staff and fees? This has to be a rip off.

Well, how could they rip you off? Maybe for the first five years of the policy, no cash value will accumulate (you may want to check your policy). Maybe it's misrepresenting the value of the return (this is easy if the customer is not knowledgeable on exactly how investments work). Also, if you read my article on the Rule of 72 you can clearly see that giving your money to someone else to invest can lose you millions! You see, you may pay in $52,800 but that doesn't take into account how much money you LOSE by not investing it yourself! This is regardless of how well your agent may tell you the company will invest your money! Plain and simple, they have to get over on you somehow or they would go out of business!

How long do you need life insurance?

Let me explain what is called The Theory of Decreasing Responsibility, and maybe we can answer this question. Let's say that you and your spouse just got married and have a child. Like most people, when they are young they are also crazy, so they go out and buy a new car and a new house. Now, here you are with a young child and debt up to the neck! In this particular case, if one of you were to pass away, the loss of income would be devastating to the other spouse and the child. This is the case for life insurance. BUT, this is what happens. You and your spouse begin to pay off that debt. Your child gets older and less dependent on you. You start to build up your assets. Keep in mind that I am talking about REAL assets, not fake or phantom assets like equity in a home (which is just a fixed interest rate credit card)

In the end, the situation is like this. The child is out of the house and no longer dependent on you. You don't have any debt. You have enough money to live off of, and pay for your funeral (which now costs thousands of dollars because the DEATH INDUSTRY has found new ways to make money by having people spend more honor and money on a person after they die then they did while that person was alive). So... at this point, what do you need insurance for? Exactly... absolutely nothing! So why would you buy Whole Life (a.k.a. DEATH) Insurance? The idea of a 179 year old person with grown children who don't depend on him/her still paying insurance premiums is asinine to say the least.

As a matter of fact, the need for life insurance could be greatly decreased and quickly eliminated, if one would learn not to accumulate liabilities, and quickly accumulate wealth first. But I realize that this is almost impossible for most people in this materialistic, Middle Classed matrixed society. But anyway, let's take it a step further.

Confused Insurance Policies

This next statement is very obvious, but very profound. Living and dying are exact opposites of each other. Why do I say this? The purpose of investing is to accumulate enough money in case you live to retire. The purpose of buying insurance is to protect your family and loved ones if you die before you can retire. These are two diametrically opposed actions! So, if an "agent" waltzes into your home selling you a whole life insurance policy and telling you that it can insure your life AND it can help you retire, your Red Pill Question should be this:

"If this plan will help me retire securely, why will I always need insurance? And on the other hand, if I will be broke enough later on in life that I will still need insurance, then how is this a good retirement plan?"

Now if you ask an insurance agent those questions, she/he may become confused. This of course comes from selling confused policies that do two opposites at once.

Norman Dacey said it best in the book "What's Wrong With Your Life Insurance"

"No one could ever quarrel with the idea of providing protection for one's family while at the same time accumulating a fund for some such purpose as education or retirement. But if you try to do both of these jobs through the medium of one insurance policy, it is inevitable that both jobs will be done badly."

So you see, even though there are a lot of new variations of whole life, like variable life and universal life, with various bells and whistles (claiming to be better than the original, typical whole life policies), the Red Pill Question must always be asked! If you are going to buy insurance, then buy insurance! If you are going to invest, then invest. It's that simple. Don't let an insurance agent trick you into buying a whole life policy based on the assumption that you are too incompetent and undisciplined to invest your own money.

If you are afraid to invest your money because you don't know how, then educate yourself! It may take some time, but it is better than giving your money to somebody else so they can invest it for you (and get rich with it). How can a company be profitable when it takes the money from it's customers, invests it, and turns around and gives it's customers all of the profits?

And don't fall for the old "What if the term runs out and you can't get re-insured trick". Listen, there are a lot of term policies out there that are guaranteed renewable until an old age (75-100). Yes, the price is a lot higher, but you must realize that if you buy a whole life policy, you will have been duped out of even more money by the time you get to that point (if that even happens). This is also yet another reason to be smart with your money. Don't buy confused policies.

How much should you buy?

I normally recommend 8-10 times your yearly income as a good face amount for your insurance. Why so high? Here is the reason. Let's say that you make $50,000 per year. If you were to pass away, your family could take $500,000 (10 times $50,000) and put it into a fund that pays 10 percent (which will give them $40,000 per year) and not touch the principle. So what you have done is replaced your income.

This is another reason why Whole Life insurance is bad. It is impossible to afford the amount of insurance you need trying to buy super high priced policies. Term insurance is much cheaper. To add to this, don't let high face values scare you. If you have a lot of liabilities and you are worried about your family, it is much better to be underinsured than to have no insurance at all. Buy what you can manage. Don't get sold what you can't manage.

Advantages and Disadvantages on Group Health Insurance VS Individual Health Insurance

2017-06-08T18:39:00.000-07:00

In this article we will explore the reasons that motivate employers to get group health insurance for employees and we will look at the advantages and disadvantages from both points of view.

Group Health Insurance VS Individual Private Health Insurance

Probably the most significant distinguishing characteristic of group insurance is the substitution of group underwriting for individual underwriting. In group cases, no individual evidence of insurability is usually required, and benefit levels can be substantial, with few, if any, important limitations.

Group underwriting normally is not concerned with the health or other insurability aspects of any particular individual. Instead, it aims to obtain a group of individual lives or, what is even more important, an aggregation of such groups of lives that will yield a predictable rate of mortality or morbidity. If a sufficient number of groups of lives is obtained, and if these groups are reasonably homogeneous in nature, then the mortality or morbidity rate will be predictable. The point is that the group becomes the unit of underwriting, and insurance principles may be applied to it just as in the case of the individual. To assure that the groups obtained will be reasonably homogeneous, the underwriting process in group insurance aims to control adverse selection by individuals within a group.

In underwriting group insurance, then, certain important features should be present that either are inherent in the nature of the group itself or may be applied in a positive way to avoid serious adverse selection such as:

Insurance Incidental to the Group: The insurance should be incidental to the group; that is, the members of the group should have come together for some purpose other than to obtain insurance. For example, the group insurance furnished to the employees of a given employer must not be the feature that motivates the formation and existence of the group.

Flow of Persons through the Group: There should be a steady flow of persons through the group; that is, there must be an influx of new young lives into the group and an out flow from the group of the older and impaired lives. With groups of actively working employees, it may be assumed that they are in average health.

Automatic Determination of Benefits: Group insurance underwriting commonly requires an automatic basis for determining the amount of benefits on individual lives, which is beyond the control of the employer or employees. If the amount of benefits taken were completely optional, it would be possible to select against the insurer because those in poor health would tend to insure heavily and the healthy ones might tend to elect minimum coverage.

As the group mechanism has evolved, however, insurers have responded to demands from the marketplace, particularly large employers, for more flexibility in the selection of benefits. This flexibility typically is expressed in optional amounts of life and health insurance in excess of basic coverage provided by the employer and in more health care financing choices. Also, increasingly popular cafeteria plans allow participating employees to select among an array of benefits using a predetermined allowance of employer funds. Individuals select, subject to certain basic coverage's being required, a combination of benefits that best meet his or her individual needs.

Minimum Participation by the Group: Another underwriting control is the requirement that substantially all eligible persons in a given group be covered by insurance. In plans in which the employee pays a portion of the premium (contributory), generally at least 75 percent of the eligible employees must join the plan if coverage is to be effective. In the case of noncontributory plans, 100 percent participation is required. By covering a large proportion of a given group, the insurance company gains a safeguard against an undue proportion of substandard lives. In cases in which employees refuse the insurance for religious or other reasons that do not involve any elements of selection, this rule is relaxed.

Third Party Sharing of Cost: A portion of the cost of a group plan ideally should be borne by the employer or some third party, such as a labor union or trade association. The noncontributory employer-pay-all plan is simple, and it gives the employer full control over the plan. It provides for insurance of all eligible employees and thus, eliminates any difficulties involved in connection with obtaining the consent of a sufficient number of employees to meet participation requirements. Also, there is no problem of distributing the cost among various employees, as in the contributory plan.

Contributory plans usually are less costly to the employer. Hence, with employee contributions, the employer is likely to arrange for more adequate protection for the employees. It can also be argued that, if the employee contributes toward his or her insurance, he or she will be more impressed with its value and will appreciate it more. On the other hand, the contributory plan has a number of disadvantages. Its operation is more complicated, and this at times, increases administrative cost considerably.

Each employee must consent to contribute toward his or her insurance, and as stated before, a minimum percentage of the eligible group must consent to enter the arrangement. New employees entering the business must be informed of their insurance privilege. If the plan is contributory, employees may not be entitled to the insurance until they have been with the company for a period of time. If they do not agree to be covered by the plan within a period of 31 days, they may be required to provide satisfactory evidence of insurability to become eligible. Some noncontributory plans also have these probationary periods.

Efficient Administrative Organization: A single administrative organization should be able and willing to act on behalf of the insured group. In the usual case, this is the employer. In the case of a contributory plan, there must be a reasonably simple method, such as payroll deduction, by which the master policy owner can collect premiums. An automatic method is desirable for both an administrative and underwriting perspective. A number of miscellaneous controls of underwriting significance are typically used in group insurance plans, but the preceding discussion permits an appreciation of the group underwriting underwriting theory. The discussion applies to groups with a large number of employees.

A majority of the groups, however, are not large. The group size is a significant factor in the underwriting process. In smaller plans, more restrictive underwriting practices relating to adverse section are used. These may include less liberal contract provisions, simple health status questions, and in some cases, detailed individual underwriting of group members.

Group Policy: A second characteristic of group insurance is the use of a group policy (contract) held by the owner as group policyholder and booklet-certificates or other summary evidence of insurance held by plan participants. Certificates provide information on the plan provisions and the steps required to file claims. The use of certificates and a master contract constitutes one of the sources of economy under the group approach. The master contract is a detailed document setting forth the contractual relationship between the group contract owner and the insurance company. The insured persons under the contract, usually employees and their beneficiaries, are not actually parties to the contract, although they may enforce their rights as third party beneficiaries. The four party relationship between the employer, insurer, employee, and dependents in a group insurance plan can create a number of interesting and unusual problems that are common only to group insurance.

Lower Cost: A third feature of group insurance is that it is usually lower-cost protection than that which is available in individual insurance. The nature of the group approach permits the use of mass distribution and mass administration methods that afford economies of operation not available in individual insurance. Also, because group insurance is not usually underwritten on an individual basis, the premiums are based upon an actuarial assessment of the group as a whole, so a given healthy individual can perhaps buy insurance at a lower cost. Employer subsidization of the cost is a critical factor in group insurance plan design. Probably the most significant savings in the cost of marketing group insurance lies in the fact that group commissions absorb a much smaller proportion of total premiums than commission for individual contracts.

The marketing system relieves the agent or broker of many duties, responsibilities, and expenses normally associated with selling or servicing of individual insurance. Because of the large premiums involved in many group insurance cases, the commission rates are considerably lower than for individual contracts and are usually graded downward as the premium increases. Some large group insurance buyer's deal directly with insurance companies and commissions are eliminated. In these cases, however, fees frequently are paid to the consultants involved. The nature of the administrative procedures permits simplified accounting techniques. The mechanics of premium collection are less involved, and experience refund procedures much simplified because there id only one party with whom to deal with such as the group policy owner.

Of course, the issuance of a large number of individual contracts is avoided and, because of the nature of group selection, the cost of medical examinations and inspection reports is minimized. Also, regulatory filings and other requirements are minimized. In the early days of group insurance, administration was simple. That is no longer true. Even with group term life insurance, for which there is no cash value, the push for accelerated death benefits, assignment to viatical companies, and estate or business planning record keeping means that the administration of coverage may be as complex as with an individual policy.

Flexibility: in contrast to individual contracts that must be taken as written, the larger employer usually has options in the design and preparation of the group insurance contract. Although the contracts follow a pattern and include certain standard provisions, there is considerably more flexibility here than in the case of individual contracts. The degree of flexibility permitted is, of course, a function of the size of the group involved. The group insurance program usually is an integral part of an employee benefit program and, in most cases, the contract can be molded to meet the objectives of the contract owner, as long as the request do not entail complicated administrative procedures, open the way to possibly serious adverse selection, or violate legal requirements.

Experience Rating: Another special feature of group insurance is that premiums often are subject to experience rating. The experience of the individual group may have an important bearing on dividends or premium-rate adjustments. The larger and, hence, the more reliable the experience of the particular group, the greater is the weight attached to its own experience in any single year. The knowledge that premiums net of dividends or premium rate adjustments will be based on the employers own experience gives the employer a vested interest in maintaining a favorable loss and expense record. For the largest employers, insurers may agree to complicated procedures to satisfy the employer's objectives because most such cases are experience rated and reflect the increased cost.

Some insurers experience rate based on the class or type of industry, or even based on the type of contract. For small groups, most insurance companies' use pooled rates under which a uniform rate is applied to all such groups, although it is becoming more common to apply separate pooled rates for groups with significantly better or worse experience than that of the total class. The point at which a group is large enough to be eligible for experience rating varies from company to company, based on that insurer's book of business and experience. The size and frequency of medical claims vary considerably across countries and among geographic regions within a country and must be considered in determining a group insurance rate. The composition (age, sex, and income level) of a group will also affect the experience of the group and, similarly, will be an important underwriting consideration.

Advantages and Limitations of the Group Mechanism.

Advantages: The group insurance mechanism has proved to be a remarkably effective solution to the need for employee benefits for a number of reasons. The utilization of mass-distribution techniques has extended protection to large numbers of person s with little or no life or health insurance. The increasing complexity of industrial service economies has brought large numbers of persons together, and the group mechanism has enabled insurance companies to reach vast numbers of individuals within a relatively short period and at low cost. Group insurance also has extended protection to a large number of uninsurable persons. Equally important has been the fact that the employer usually pays a large share of the cost. Moreover, in most countries, including the United States, the deductibility of employer contributions and the favorable tax treatment of the benefits to employees make it a tax effective vehicle with which to provide benefits.

Another significant factor, and one of the more cogent motivations for the rapid development of group insurance, has been the continuing governmental role in the security benefits area. Within the United States, Old-Age. Survivors, Disability, and Health Insurance programs has expanded rapidly, but many observers believe that, had not group insurance provided substantial sums of life insurance, health insurance, and retirement protection, social insurance would have developed even more rapidly. As economies worldwide continue to reduce the size and scope of social insurance programs, we can expect the demand for group based security to grow even more.

Disadvantages: From the viewpoint of the employee, group insurance has one great limitation- the temporary nature of the coverage. Unless an employee converts his or her coverage to an individual policy which is usually ore expensive and provides less liberal coverage, the employee loses his or her insurance protection if the group plan is terminated and often also at retirement because employment is terminated. Group life and health protection is continued after retirement in a significant proportion of cases today in the United States, but often at reduced levels. Recently, with the introduction of a new U.S. accounting standard (FAS 106) requiring that the cost of such benefits be accrued and reflected in financial statements, an increasing number of employers have discontinued post retirement life and health benefits entirely. When such continued protection is not available, the temporary nature of the coverage is a serious limitation.

Retiree group health insurance often is provided as a supplement to Medicare. Another problem of potential significance involves individuals who may be lulled into complacency by having large amounts of group insurance during their working years. Many of these persons fail to recognize the need for, or are unwilling to face the cost of, individual insurance. Perhaps of even greater significance is the fact that the flexibility of the group approach is limited to the design of the master policy and does not extend to the individual covered employees. Furthermore, group plans typically fail to provide the mechanism for any analysis of the financial needs of the individual which is a service that is normally furnished by the agent or other advisor. Many agents, however, discuss group insurance coverage with individuals as a foundation for discussing the need for additional amounts of individual life and health insurance.

Health Insurance Help to Lower Your Premium

2017-05-31T18:37:00.000-07:00

Illness for non-work related injuries can be financially devastating. Insurance keeps you protected against disastrous health care expenses and lost wages. There are enormous health insurance plans available day-to-day, the insurance cost and its benefits vary from one plans to another. Before enrolling for a policy, an individual should consult with the insurance agencies, read the policy to get the complete information about the benefits and costs and also the way the plan works.

Today, there are many more kinds of health insurance to choose from than were available just a few years ago. Traditional differences between and among plans do not longer any more. Also, there is been an increased emphasis on the role of consumers in managing their own health care and health care finances. There is a focus on providing information on the cost of care and health care quality-at the level of the physician, physician group, and hospital-to help consumers and employers choose among the many options available to them. The things have changed a lot, when most people in the United States had health insurance has indemnity insurance (also called as fee-for-service or traditional insurance). This type of insurance coverage assumed that the medical provider i.e. doctor or physicians will be paid a fee for each service provided to the patient.

When we talk about health insurance, we usually mean the kind of insurance that pays medical bills, hospital bills, and typically, prescription drug costs. Nowadays, the insurance also covers Medicare and Mediaid that provides health insurance coverage for certain people, senior citizens, people with disabilities and also an individual and families with low income. Today, the online information helps an individual to compare two best insurance policies and choose best among it. The insurance help an individual for financial planning and accordingly choose the best suitable for the family. The policy helps to avoid the burden of expensive medical bills and ensure the penny paid in health plan is paid for your care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive.

In spite of available health insurance help online, unfortunately many Americans are still uninsured or underinsured. Some may be eligible for private or government but may have difficulty in finding the maze of complex rules and insurance jargons. Many more may not even have chosen the plans due to non-affordability coverage or may not be eligible for any. To help you choose right plan, we give you an overview of programs and strategies for seeking free or reduced-cost health care and managing medical debts.

Why does an individual require health insurance?

As the science and medical care advances, the ways of treatment are also increasing simultaneously. The main purpose of health insurance is to help in paying for care. It protects you and your family members in an unexpected serious illness and injury that may be high in cost. Additionally, you are more likely to get regular and routine checkups, if you have an insurance policy. Every individual requires insurance policy because you cannot predict your illness, injury and your high paying medical bills. One must seriously consider the need for health insurance for own and family. We also know that there is interlinking between having health insurance and getting protective health care. The research states that people having health insurance are more likely to have a regular doctor and get care when it is needed.

How should one get health insurance?

Most of the people get health insurance through their employers or company which they belong to. This is formerly known as group insurance. Some individuals don't have access to group insurance. In this case, one may choose to purchase their own individual health insurance directly from public or privately owned insurance company. Most of the Americans in North America get health insurance through government programs that operate at National, State & Local Levels. Insurance- whether provided by your employer or purchased by you - can be both expensive and complex. To understand better option, you must take health insurance help from the experts and advisors.

Group Insurance:

Group Insurance is basically offered by the employers or else by an organization of which you are a member of union, professional association wherein you may get group coverage. The employee has to choose between several plans been offered by an employer's including both indemnity insurance and managed care. Some employer may only offer one single plan. Some group plans may also include dental care with the health and medical benefits. Hence, it is a very important decision to be taken by and employee before choosing any insurance benefits offered by employer or an organization. It is also essential to compare plans to find the one that offers the benefits as per your need. Once you choose an insurance plan, you usually cannot switch over to another plan until next open season, usually set once a year.

In group health insurance, employer usually pays portion or all of the premiums. This means your costs for health insurance premiums will be lower than they would be if you paid the entire premium alone.

If you are a member of group insurance offered by an organization, you are benefited from being a member of a large group. You will have to pay lesser premium than an individual would be paying. However, the organization often does not pay a share of premium, meaning you are responsible to pay complete premium by yourself.

Individual Insurance:

In an individual Insurance, you get the coverage directly from the Insurance Company. You don't have any access to the group insurance offered by an employer or an organization. When you buy you own insurance, you have to pay entire premium rather than sharing with an employer according to Group Insurance. In individual insurance, you do not share any cost of premium with your employer. You should analyze and choose an individual insurance plan that fits your needs at a price that you are willing to pay; you should also consult a tax advisor to find out whether you are eligible for any tax deduction as per the insurance plan.

Insurance variably differs from one company to another within an insurance industry, from one plan to another and one product to another. Hence, choosing right company, right product, right plan are the important criteria before choosing any plans.

Which type of health insurance is right for you?

Whether you choose group insurance or an individual insurance plan, you must carefully compare coverage and costs. You should compare the following important aspects like coverage and benefits, premiums, exclusions and limitations, access to hospitals, doctors, and other providers etc...

One must consider what kinds of services are covered by the plan? How are benefits being availed of health insurance plan; do you have to submit a claim? When do you need pre-approval to ensure coverage for care? What steps do you need to get the care of you and your family members need? You must ensure how does your insurance plan works. Don't wait until you need emergency care to ask questions.

I am an author having an experience of 28 years in Insurance Industry having done the in-depth study of Insurance. Considering some knowledge, I hereby have shared some information and views about insurance, also some facts, figures and recommendation which enables an individual to choose right insurance policy from right person.

Effect of Liberalisation in Insurance Industry

2017-05-24T18:36:00.000-07:00

Introduction

The journey of insurance liberalization process in India is now over seven years old. The first major milestone in this journey has been the passing of Insurance Regulatory and Development Authority Act, 1999. This along with amendments to the Insurance Act 1983, LIC and GIC Acts paves the way for the entry of private players and possibly the privatization of the hitherto public monopolies LIC and GIC. Opening up of insurance to private sector including foreign participation has resulted into various opportunities and challenges.

Concept of Insurance

In our daily life, whenever there is uncertainly there is an involvement of risk. The instinct of security against such risk is one of the basic motivating forces for determining human attitudes. As a sequel to this quest for security, the concept of insurance must have been born. The urge to provide insurance or protection against the loss of life and property must have promoted people to make some sort of sacrifice willingly in order to achieve security through collective co-operation. In this sense, the story of insurance is probably as old as the story of mankind.

Life insurance in particular provides protection to household against the risk of premature death of its income earning member. Life insurance in modern times also provides protection against other life related risks such as that of longevity (i.e. risk of outliving of source of income) and risk of disabled and sickness (health insurance). The products provide for longevity are pensions and annuities (insurance against old age). Non-life insurance provides protection against accidents, property damage, theft and other liabilities. Non-life insurance contracts are typically shorter in duration as compared to life insurance contracts. The bundling together of risk coverage and saving is peculiar of life insurance. Life insurance provides both protection and investment.

Insurance is a boon to business concerns. Insurance provides short range and long range relief. The short-term relief is aimed at protecting the insured from loss of property and life by distributing the loss amongst large number of persons through the medium of professional risk bearers such as insurers. It enables a businessman to face an unforeseen loss and, therefore, he need not worry about the possible loss. The long-range object being the economic and industrial growth of the country by making an investment of huge funds available with insurers in the organized industry and commerce.

General Insurance

Prior to nationalizations of General insurance industry in 1973 the GIC Act was passed in the Parliament in 1971, but it came into effect in 1973. There was 107 General insurance companies including branches of foreign companies operating in the country upon nationalization, these companies were amalgamated and grouped into the following four subsidiaries of GIC such as National Insurance Co.Ltd., Calcutta; The New India Assurance Co. Ltd., Mumbai; The Oriental Insurance Co. Ltd., New Delhi and United India Insurance Co. Ltd., Chennai and Now delinked.

General insurance business in India is broadly divided into fire, marine and miscellaneous GIC apart from directly handling Aviation and Reinsurance business administers the Comprehensive Crop Insurance Scheme, Personal Accident Insurance, Social Security Scheme etc. The GIC and its subsidiaries in keeping with the objective of nationalization to spread the message of insurance far and wide and to provide insurance protection to weaker section of the society are making efforts to design new covers and also to popularize other non-traditional business.

Liberalization of Insurance

The comprehensive regulation of insurance business in India was brought into effect with the enactment of the Insurance Act, 1983. It tried to create a strong and powerful supervision and regulatory authority in the Controller of Insurance with powers to direct, advise, investigate, register and liquidate insurance companies etc. However, consequent upon the nationalization of insurance business, most of the regulatory functions were taken away from the Controller of Insurance and vested in the insurers themselves. The Government of India in 1993 had set up a high powered committee by R.N.Malhotra, former Governor, Reserve Bank of India, to examine the structure of the insurance industry and recommend changes to make it more efficient and competitive keeping in view the structural changes in other parts of the financial system on the country.

Malhotra Committee's Recommendations

The committee submitted its report in January 1994 recommending that private insurers be allowed to co-exist along with government companies like LIC and GIC companies. This recommendation had been prompted by several factors such as need for greater deeper insurance coverage in the economy, and a much a greater scale of mobilization of funds from the economy, and a much a greater scale of mobilization of funds from the economy for infrastructural development. Liberalization of the insurance sector is at least partly driven by fiscal necessity of tapping the big reserve of savings in the economy. Committee's recommendations were as follows:

o Raising the capital base of LIC and GIC up to Rs. 200 crores, half retained by the government and rest sold to the public at large with suitable reservations for its employees.

o Private sector is granted to enter insurance industry with a minimum paid up capital of Rs. 100 crores.

o Foreign insurance be allowed to enter by floating an Indian company preferably a joint venture with Indian partners.

o Steps are initiated to set up a strong and effective insurance regulatory in the form of a statutory autonomous board on the lines of SEBI.

o Limited number of private companies to be allowed in the sector. But no firm is allowed in the sector. But no firm is allowed to operate in both lines of insurance (life or non-life).

o Tariff Advisory Committee (TAC) is delinked form GIC to function as a separate statuary body under necessary supervision by the insurance regulatory authority.

oAll insurance companies be treated on equal footing and governed by the provisions of insurance Act. No special dispensation is given to government companies.

oSetting up of a strong and effective regulatory body with independent source for financing before allowing private companies into sector.

competition to government sector:

Government companies have now to face competition to private sector insurance companies not only in issuing various range of insurance products but also in various aspects in terms of customer service, channels of distribution, effective techniques of selling the products etc. privatization of the insurance sector has opened the doors to innovations in the way business can be transacted.

New age insurance companies are embarking on new concepts and more cost effective way of transacting business. The idea is clear to cater to the maximum business at the lest cost. And slowly with time, the age-old norm prevalent with government companies to expand by setting up branches seems getting lost. Among the techniques that seem to catching up fast as an alternative to cater to the rural and social sector insurance is hub and spoke arrangement. These along with the participants of NGOs and Self Help Group (SHGs) have done with most of the selling of the rural and social sector policies.

The main challenges is from the commercial banks that have vast network of branches. In this regard, it is important to mention here that LIC has entered into an arrangement with Mangalore based Corporations Bank to leverage their infrastructure for mutual benefit with the insurance monolith acquiring a strategic stake 27 per cent, Corporation Bank has decided to abandon its plans of promoting a life insurance company. The bank will act as a corporate agent for LIC in future and receive commission on policies sold through its branches. LIC with its branch network of close to 2100 offices will allow Corporation Bank to set up extension centers. ATMs or branches with in its premises. Corporation Bank would in turn implement an effective Cash Flow Management System for LIC.

IRDA Act, 1999

Preamble of IRDA Act 1999 reads 'An Act to provide for the establishment of an authority to protect the interests of holders of insurance policies, to regulate, to promote and ensure orderly growth of the insurance industry and for matters connected therewith or incidental thereto.

Section 14 of IRDA Act, lays the duties, powers and functions of the authority. The powers and functions of the authority. The powers and functions of the Authority shall include the following.

o Issue to the applicant a certificate of registration, to renew, modify withdraw, suspend or cancel such registration.

o To protect the interest of policy holders in all matters concerning nomination of policy, surrender value f policy, insurable interest, settlement of insurance claims, other terms and conditions of contract of insurance.

o Specifying requisite qualification and practical training for insurance intermediates and agents.

o Specifying code of conduct for surveyors and loss assessors.

o Promoting efficiency in the conduct of insurance business

o Promoting and regulating professional regulators connected with the insurance and reinsurance business.

o Specifying the form and manner in which books of accounts will be maintained and statement of accounts rendered by insurers and insurance intermediaries.

o Adjudication of disputes between insurers and intermediates.

o Specifying the percentage of life insurance and general and general business to be undertaken by the insurers in rural or social sectors etc.

Section 25 provides that Insurance Advisory Committee will be constituted and shall consist of not more than 25 members.Section 26 provides that Authority may in consultation with Insurance Advisory Committee make regulations consists with this Act and the rules made there under to carry the purpose of this Act.Section 29 seeks amendment in certain provisions of Insurance Act, 1938 in the manner as set out in First Schedule. The amendments to the Insurance Act are consequential in order to empower IRDA to effectively regulate, promote, and ensure orderly growth of the Insurance industry.

Section 30 & 31seek to amend LIC Act 1956 and GIC Act 1972.

Impact of Liberalization

While nationalized insurance companies have done a commendable job in extending volume of the business opening up of insurance sector to private players was a necessity in the context of liberalization of financial sector. If traditional infrastructural and semipublic goods industries such as banking, airlines, telecom, power etc. have significant private sector presence, continuing state monopoly in provision of insurance was indefensible and therefore, the privatization of insurance has been done as discussed earlier. Its impact has to be seen in the form of creating various opportunities and challenges.

Opportunities

1. Privatization if Insurance was eliminated the monopolistic business of Life Insurance Corporation of India. It may help to cover the wide range of risk in general insurance and also in life insurance. It helps to introduce new range of products.

2. It would also result in better customer services and help improve the variety and price of insurance products.

3. The entry of new player would speed up the spread of both life and general insurance. It will increase the insurance penetration and measure of density.

4. Entry of private players will ensure the mobilization of funds that can be utilized for the purpose of infrastructure development.

5. Allowing of commercial banks into insurance business will help to mobilization of funds from the rural areas because of the availability of vast branches of the banks.

6. Most important not the least tremendous employment opportunities will be created in the field of insurance which is a burning problem of the presence day today issues.

Current Scenario

After opening up of insurance in private sector, various leading private companies including joint ventures have entered the fields of insurance both life and non-life business. Tata - AIG, Birla Sun life, HDFC standard life Insurance, Reliance General Insurance, Royal Sundaram Alliance Insurance, Bajaj Auto Alliance, IFFCO Tokio General Insurance, INA Vysya Life Insurance, SBI Life Insurance, Dabur CJU Life Insurance and Max New York Life. SBI Life insurance has launched three products Sanjeevan, Sukhjeevan and Young Sanjeevan so far and it has already sold 320 policies under its plan.

Conclusion

From the above discussion we can conclude that the entry of private players in insurance business needful and justifiable in order to enhance the efficiency of operations, achieving greater density and insurance coverage in the country and for a greater mobilization of long term savings for long gestation infrastructure prefects. New players should not be treat as rivalries to government companies, but they can supplement in achieving the objective of growth of insurance business in india.

Insurance For Beginners

2017-05-18T09:30:00.000-07:00

Welcome to the global business guide. In this context, we will be taking about the insurance industry, the general definition of insurance, adequate and precise explanation of the definition, brief talk about the history, the insurer, the insured, classes of insurance, the role of the underwriter in the industry and how you as an individual can benefit maximally when you get yourself, your car, your house, even that your business insure. We do hope you will enjoy reading this article and the essence of your quest for the topic above will be met.

Insurance is a financial institution classified as a non bank financial institution. They are important financial inter-mi diaries. It is believed to have originated from the ancient practices of inhabitants of the valleys of rivers Tigris and Euphrates in the present day Iraqi in about 4.000BC. History has it that in 1800BC, the Babylonians code of Hammurabi contained provisions which had elements of insurance in the laws that govern their commerce. But today what we have in the industry, both locally and internationally had moved from just an agreement between two persons into a very big industry across the globe.

Going by definition, we learn that insurance means a situation whereby someone protects his or herself against risk and reduce effects of uncertainties as well as distribute loss. Other explanation to this owe it to the situation whereby a certain amount of money when collected from someone by an insurance company agrees to pay a compensation or render services to that person if and whenever that person suffers the kind of loss specified in the insurance agreement; and from the explanation, this is where an insurance company comes into play since they are the people that will go into agreement with the person taking any insurance policy against any of his belongings. This industry has widely been believed as a means whereby people reduce the risk of unforeseen circumstances. As financial intermediaries, they act as middlemen between the surplus units and deficit units of the economy thereby sustaining the general growth of the economy.

One may ask, how do insurance companies generate the money used in compensating their policy holder when affected by any mishap? The answer to this question, will lead us into talking about the various means via which the insurance companies make their money and how their policy holders are compensated. The truth is that, the money they collect from their policy holder (i.e one that has an agreement with the insurance company) is invested in the form of premiums (an extra sum of money paid in addition to the normal cost of something. by BBC. Eng. dict) and that money is invested in Bonds, in stocks, mortgages (i.e house) and government securities (in our subsequent article, we will explain more of this: Bonds, stocks, mortgages and govt. securities). They generate income for themselves and those who are in their service. They invest their policy holder's money in better business that has short term maximum returns on investment and from there meet their numerous needs when needed in claims and losses. These funds themselves are invested, that not only do they earn interest to be added to the funds, but they also benefit the government, public authorities, and industries whose securities the investment are spread, because of the investment policy of the insurer (we will explain later), their reserve funds are not left idle butt are used productively.

Another way via which the insurance companies compensate those who are in their service is that the contribution of many is used to compensate the few among them who were affected by the misfortune insured against. So the loss of few people is share by many.

We hope that to this extend, you must have understood the above explanation about insurance company. Now the next thing we will be considering is the functions of the insurance companies.

Amongst other functions, the main function of the insurance company is risk bearing, the financial losses of individuals are judiciously distributed among many people, for example, in the case of fire, the policy holder in fire insurance pays a premium into a common pool, out of which those who suffer loss are compensated.

FUNCTIONS INCLUDE

1. The insurance industry encourages thrift (i.e money conservation) especially via it's life policies which provide funds for family, welfare and old age provisions. It provides employment opportunity for those that have the interest of working with the industry.

The insurance companies works hand in hand with commerce. It owes it's existence to commerce (i.e business in general both industrial etc) and commerce in return owes it's strong stability to insurance, this is because it helped in various ways to enhance the general trend in business.

Before we proceed further to other functions, let's explain this two terms: the insurer; the insured as it will aid us in our understanding.

The insured: This is the party affecting the insurance in other words, the individual or individuals which is taking the insurance policy. This can be done either directly or indirectly or via an agent or broker.

The insurer: This is the party providing the protection to cover by the policy. The insurer covers every other terms which includes the underwriter who is a senior official of an insurance company whose business lies in undertaking new business for the company.

The insurance company has a contract which promises to pay compensation at a future date for a consideration known as premium (i.e. the money paid by the insured to the insurer for the insurance cover provided in the policy). Like the way we have it in other contracts, i.e having it that contracts is based on the principles of offer and acceptance, consideration and capacity to contract. These contract, especially in insurance involves two parties i.e. the insurer and the insured.

FUNCTIONS 2

Insurer, by reason of their principal function accumulate large funds which they hold as custodians and out of which claims and losses are met. Like in some countries, their insurers operate in many parts of the world and earn vast sums in overseas market in terms of underwriting profit and investment income. This tells us that insurance forms a considerable part of that country's invisible exports.

As we continue in our functions, let's see the role of the insured and the insurer.

ROLES OF THE INSURED:

In insurance, when the proposer becomes insured the party effecting an insurance is known as the proposer throughout the negotiations, and until the contract is in full force. The insurer plays a vital role in making this aforementioned contract to come into force, knowing that in insurance contract, just like we said before is base on the principle of offer and acceptance, consideration and capacity to contract, the contracts are always evidenced in writing which is made up of various forms to be filled and signed. If the insured does not accept the insurance offer and giving meticulous consideration to that, there can hardly be capacity to contract i.e the insurance contract can never be. So, from this, we now learn that this two parties (i.e the insurer and the insured) must be involved before an insurance contract can becomes a policy.

ROLES OF THE INSURER

Here we are considering the roles of the insurer as a subsidiary functions of insurance; this is because in general sense (they have a very wide range of function), the insurer is the one providing the necessary insurance services, benefits to the insured, should any mishap, depending on the insurance policy undertaken. The insurer helps also in loss-prevention in the following ways:

We know that the extend to which loss prevention is seen, is mostly on property. An individual or a population can suffer great loss materially, if it were not for the intervention of loss prevention scheme by insurance companies to their policy holders.

The insurer also assists in boasting business venture: Many large -scale enterprise today can make their business in good faith, having transferred all their risk to the insurance company, in other words. The insurance companies help to maintain and to stabilize the atmosphere of the present day large-scale business and organizations.

Many questions had risen by on onlookers, as on how the policy holder can be compesated, should there be any mishap on the policy covered. It is better for us to note that the insurance company, when a loss is incurred to the policy holder can make for his or her loss, but that can only compensate him and make him return to his normal financial position before the occurrence of the incidence and not to profit him from the misfortune. This is generally because, no amount of financial compensation can pay adequately for the life and health of persons, so life and personal accidents are regarded as benefit policies. So let there be no misconception on this fact when mishap occurs, where the public is looking for the victim to be given everything lost, and having a meager compensation given to him or her. So let's not distrust insurance companies in this area, knowing that it's only the restoration to the exact position before the loss that is provided.

Now, as we have gone so far in understanding the functions of the insurance companies, the roles of the insured and the insurer, we will be proceeding forward to look at the various ways via which one can benefit from being insured in all spheres of life. For those who against all odds, accept insurance policy adequately, benefits, awaits them in areas like

1. pecuniary insurance

2. personal insurance

3. property insurance

4. liability insurance

We will take our time to give you enough explanation in all the sub-sections of these areas that will be of help to you.

1. PECUNIARY INSURANCE: This has to do with money or relating to something of such nature. This insurance policy benefits mostly company owners, directors, managers e.t.c This insurance policy provides cover to the employer against the loss of money unintentionally, or in a situation where an employee defrauds his or her employer on certain amount of money placed under his or her custody or in things relating to other occurrence/loss. Other policies under pecuniary insurance are; fidelity guarantee (known also as surety ship), legal expenses, credit insurance and business interruption insurance. All of these have their various function which in one way or the other relates to pecuniary. Like earlier stated, pecuniary insurance provides cover for C.E.O., M.D'S etc in case of loss of money either by intent or accident placed under the care of their employee or any officer of higher responsibility. These type of insurance cover, which their employee has will help to compensate them (i.e the employer's) and also ease the employee the fear and tension which the mishap might generate for him or her. It is therefore advisable you consider this policy very well as an MD, C.E.O. etc, especially with the assistance of your insurance broker so as to adequately know, and be directed properly on how to go about it.

2. PERSONAL INSURANCE

This involves all classes of life assurance and also accident policies. There are other types of person insurance, and the purpose of each is to meet the different need of individuals in their aim to provide for the future either for themselves or for their dependents. Other sub-divisions of personal insurance are:

i. Life assurance

ii. Personal accident and sickness insurance,

iii. Permanent health insurance,

iv. Social security

These sub-divisions has various similarities which come out at the end to meet the same aim, like in life assurance, personal accident and sickness insurance, this policy ensures that the policy holder when befallen by any misfortune, which resulted into permanent disability or death will still be able to fend for his or herself and also for his or her dependants in the case of death.

3. PROPERTY INSURANCE

Property insurance policy involves insurance cover for property should any risk of damage or loss by fire, accident, burglary or other risks that may occur. Under this, there are other sub-divisions which include:

i. Motor Insurance

ii. Marine Insurance

iii. Fire Insurance

iv. Burglary Insurance

v. Special peril Insurance

vi. All risk Insurance

In all these sub-divisions of property insurance, respective insurance cover is given to them all should there be any damage or loss relating to the type of policy the holder has.

4. LIABILITY INSURANCE

This provides cover for the insured against his legal liability to others. This can arise via negligence of the insured in failing to act in a reasonable manner. Such manners like crossing the road without properly looking on both side of the road which might result in accident. This may also arise via the insured's unlawful disturbance of another person in the enjoyment of his or property (i.e constituting a nuisance to them) or via the insured's trespass which is an unlawful act committed with force or violent on another person's property. Liability insurance is also sub-divided into employer's liability to his employee and public liability by the insured. The two sub-divisions of liability insurance owe their explanation to their respective liabilities, and since liability generally arises from lawsuits, liability policy covers only claims which the insured becomes legally obligated to.

We should also bear in mind that no insurance policy can prevent theft, fire, or other misfortune or the creation of legal liability, but can provide financial assistance in such situations. It does not also protect for example, the material property which is the subject matter of the insurance, but the financial interest of the insurer. This mean that the insurer can only get a financial compensation when any mishap happens to any thing insured against and not having the property restored back in case of fire or collapse (for building).

CONCLUSION

In all, we do hope that all these explanation will give you a better insight towards getting what you want on the good step to take while taking your insurance policy. But, always make sure that you don't do anything without first of all consulting your insurance broker ( who will take more time to tell you one-on-one the policy that will be suitable for you) before going to any insurance company knowing already that the cost of insurance is less than what would be the cost of insurance because the cost of insurance to industrialist for e.g is passed on to consumers along with other product cost and the consumers benefits from the existence of insurance via reduced prices. So make sure you get insured today. Till I see you again. Thank you.

Executive Liability Insurance - Why Private Companies Need It

2017-05-11T18:41:00.000-07:00

Since its inception about fifty years ago, D&O insurance has evolved into a family of products responding differently to the needs of publicly traded companies, privately held businesses and not-for-profit entities and their respective board members, officers and trustees.

Directors' & Officers' Liability, Executive Liability or Management Liability insurance are essentially interchangeable terms. However, insuring agreements, definitions, exclusions and coverage options vary materially depending upon the type of policyholder being insured and the insurer underwriting the risk. Executive Liability insurance, once considered a necessity solely for publicly traded companies, particularly due to their exposure to shareholder litigation, has become recognized as an essential part of a risk transfer program for privately held companies and not-for-profit organizations.

Optimization of protection is a common goal shared by all types of organizations. In our opinion, the best way to achieve that objective is through engagement of highly experienced insurance, legal and financial advisors who work collaboratively with management to continually assess and treat these specialized enterprise risk exposures.

Private Company D&O Exposures

In 2005, Chubb Insurance Group, one of the largest underwriters of D&O insurance, conducted a survey of the D&O insurance purchasing trends of 450 private companies. A significant percentage of respondents gave the following reasons for not purchasing D&O insurance:

• did not see the need for D&O insurance,

• their D&O liability risk was low,

• thought D&O risk is covered under other liability policies

The companies responding as non-purchasers of D&O insurance experienced at least one D&O claim in the five years preceding the survey. Results showed that private companies with 250 or more employees, were the subject of D&O litigation during the preceding five years and 20% of companies with 25 to 49 employees, experienced a D&O claim.

The survey revealed 43% of D&O litigation was brought by customers, 29% from regulatory agencies, and 11% from non-publicly traded equity securities holders. The average loss reported by the private companies was $380,000. Companies with D&O insurance experienced an average loss of $129,000. Companies without D&O insurance experienced an average loss of $480,000.

Some Common Examples of Private Company D&O Claims

• Major shareholder led buy-outs of minority shareholders alleging misrepresentations of the company's fair market value

• purchaser of a company or its assets alleging misrepresentation

• sale of company assets to entities controlled by the majority shareholder

• creditors' committee or bankruptcy trustee claims

• private equity investors and lenders' claims

• vendors alleging misrepresentation in connection with an extension of credit

• consumer protection and privacy claims

Private Company D&O Policy Considerations

Executive Liability insurance policies for privately held companies typically provide a combination or package of coverage that includes, but may not be limited to: Directors' & Officers' Liability, Employment Practices Liability, ERISA Fiduciary Liability and Commercial Crime/ Fidelity insurance.

D&O policies, whether underwritten on a stand-alone basis or in the form of a combination-type policy form, are underwritten on a "claims-made" basis. This means the claim must be made against the Insured and reported to the insurer during the same effective policy period, or under a specified Extended (claims) Reporting Period following the policy's expiration. This is a completely different coverage trigger from other liability policies such as Commercial General Liability that are traditionally underwritten with an "occurrence" trigger, which implicates the insurance policy that was in effect at the time of the accident, even if the claim is not reported until years later.

"Side A" coverage, which protects individual Insureds in the event the Insured entity is unable to indemnify individuals, is a standard agreement contained within many private company policy forms. These policies are generally structured with a shared policy limit among the various insuring agreements resulting in a more affordable insurance product tailored to small and mid-sized enterprises. For an additional premium, separate policy limits may be purchased for one or more of each distinct insuring agreement affording a more customized insurance package.

Also, policies should be evaluated to determine whether they extend coverage for covered "wrongful acts" committed by non-officers or directors, such as employees, independent contractors, leased, and part-time employees.

Imputation of Knowledge & Severability

Coverage can be materially affected if an Insured individual has knowledge of facts or circumstances or was involved in wrongful conduct that gave rise to the claim, prior to the effective date of policy under which the claim was reported. Policies differ as to whether and to what extent, the knowledge or conduct of one "bad actor" may be imputed to "innocent "individual Insureds and / or to the Insured entity.

"Severability", is an important provision in D&O policies that is often overlooked by policyholders until it threatens to void coverage during a serious pending claim. The severability clause can be drafted with varying degrees of flexibility-- from "partial" to "full severability." A "full severability" provision is always most preferable from an Insured's standpoint. Many D&O policies, impute the knowledge of certain policy-specified senior level officer positions to the Insured entity. That imputation of knowledge can operate to void coverage that might have otherwise been available to the Insured entity.

M&A and "Tail Coverage" Considerations

The "claims-made" coverage trigger is critically important in an M&A context where contingent liability risks are inherent. In these contexts, it's important to evaluate the seller's policies' options to purchase a "tail" or "extended reporting period" for each of the target company's policies containing a "claims-made" trigger.

A "tail" coverage option allows for the reporting of claims alleging "wrongful acts" that occurred during the expired policy period, yet were not actually asserted against the Insured until after the policy's expiration, but instead were asserted during the "extended reporting" or "tail" period. An acquiring company's insurance professional should work closely with legal counsel's due diligence team to identify and present alternatives to manage contingent exposures.

What a Director or Officer Doesn't Know Will Hurt Them

Directors' & Officers' Liability insurance policies were originally created solely to protect the personal assets of the individuals serving on public company boards and executive officers. In 1992, one of the most prominent D&O insurers led a major transformational change in D&O underwriting by expanding coverage to include certain claims against the insured entity. Entity coverage for publicly traded companies is typically restricted to securities claims, while privately held companies and not-for-profit organizations benefit from more comprehensive entity coverage because they lack the public securities risk exposure of publicly traded companies.

The "Claims- Made" Coverage Trigger

D&O policies are universally underwritten on a 'claims-made' basis. This translates to an unequivocal contractual requirement that the policyholder report claims made against an Insured to the insurer during the effective policy period. The only exception is in the case where an optional reporting 'tail' is purchased which affords the Insured the ability to report claims during a specified "extended reporting period," as long as the wrongful act occurred during the effective period of the immediately preceding policy.

Defense

D&O policies issued to public companies generally contain no explicit duty to defend and some require the Insured to select from a pre-approved panel of pre-qualified defense counsel. In contrast, many private company D&O policies do contain a provision placing the defense obligation squarely upon the insurer, and still other policies contain options allowing the defense to be tendered by the Insured to the insurer within a specific period of time. Some D&O policies contain defense cost provisions that require an allocation or sharing of the defense costs between the Insured and Insurer, based upon a determination of covered versus non-covered allegations.

Settlement Hammer

D&O policies typically contain a "settlement hammer" provision. This clause operates to limit an insurer's obligation to indemnify in the event the Insured refuses to consent to a settlement that is acceptable to the insurer. Some policies may express the amount the insurer will pay for covered loss under this circumstance as a percentage of the ultimate covered settlement or judgment. Other D&O policies may limit their economic exposure to the amount for which the case could have historically settled, but for the Insured's refusal.

Regulatory Proceedings and Investigations

Most D&O insurance policies afford qualified protection against "regulatory and governmental" investigations, "administrative or regulatory proceedings," and criminal proceedings. Policies often require the proceedings to be directed against a natural person Insured, to be commenced and maintained in a manner specified in the policy, such as a 'formal' order of investigation, and only for policy-defined defense expenses incurred after the issuance of a formal order or an indictment.

D&O policies' definitions and other corresponding provisions and exclusions vary, and should be carefully evaluated to determine whether they encompass informal investigations from the time a subpoena is received, or from the time an Insured person is identified in writing as a person against whom charges may be filed.

Learning the A,B,C's and D's of D&O Coverage

The three main Insuring Agreements found in public company D&O policies, are typically referenced as "Side A, B, and C coverage". They are sometime supplemented with an optional Coverage D.

"Side A "Coverage - Individual Insured Coverage

"Side A Coverage," also known as the "Non-Indemnifiable Loss Insuring Agreement," provides coverage to individual officers and directors against claims for their policy-defined wrongful acts in their official capacities, under fairly rare circumstances in which the Insured entity either cannot or will not provided indemnification.

The policy's "Side A" coverage for non-indemnifiable claims against directors and officers, almost universally provides that no retention is required to be paid by individual Insureds. A separate "Side A" limit may be available in addition to the traditional D&O policy's aggregate limit of liability. "Side A" excess D&O policies have become more commonplace in the past several years, and certain "Side A" excess policies may also offer "difference in conditions" ('DIC') coverage that generally provides a feature of 'dropping down' to respond to claims either not paid by the primary or underlying D&O policy insurer, or in the event indemnification is unavailable from the Insured entity, the underlying limits are eroded by covered claims against the entity, or the underlying D&O insurers deny coverage to the directors. Some Side A policies are underwritten as non-rescindable by the insurer. Purchasers of this coverage should also consider, if available, an option for reinstatement of policy limits for the outside directors, in the event of premature policy limit exhaustion.

"Side B" Coverage - Corporate Reimbursement Coverage

This insuring agreement reimburses the Insured entity for covered loss under claim circumstances where the corporation is indemnifying its directors and officers. This provision does not afford any coverage to the Insured entity for its own potential liability, and is subject to a self-insured retention ("SIR") that must be paid by the Insured entity before an Insurer will make any payments. It's important to note that many Insureds do not realize they are contractually obligated to obtain the insurer's prior consent to incur costs and expenses, and only those costs and expenses approved in advance by the insurer will be deemed to have satisfied the Insured entity's SIR obligation. It's important for policyholders to understand they run a serious risk of losing some or all of their otherwise available coverage, if they incur legal expenses prior to reporting the claim, or if they enter into negotiations or reach a settlement agreement in principle without the insurer's prior knowledge and consent.

"Side C" Coverage - Entity Coverage

This insuring agreement affords coverage to the publicly traded Insured entity only for it own liability and is typically restricted to coverage for securities-related claims. "Securities Claims" is a policy-defined term, encompassing only claims arising from the Insured entity's own securities. Privately held companies and organizations are afforded substantively different coverage under this insuring agreement.

"Side D" Coverage - Outside Entity Insured Person Coverage

This insuring clause is available as an option on most D&O policies. It provides coverage to designated "Insured Persons", for their liability as a result of their membership on an "Outside Entity" board. This coverage applies on a "double excess" basis, meaning it is triggered after the exhaustion of any indemnification provided by the Outside Entity to the Outside Entity director, as well as any insurance coverage available from the Outside Entity. Traditional D&O policies typically extend automatic coverage to insured Individuals who are designated by the policyholder to participate as a board member of a not-for-profit organization.

Some Additional Considerations

In addition to the topics highlighted earlier, D&O insurance purchasers should gain familiarity with how their policies may respond under bankruptcy situations, potential coverage issues arising from a Special Committee's investigative activity, potential issues involving priority of payments among Insureds, hidden D&O insurance program design flaws that can render excess D&O policies unresponsive to catastrophic claims, and the changing requirements of international D&O coverage to remain compliant with local country regulations. These topics will be covered in a future article.

This article provides general information and is neither intended to provide any legal advice nor to provide any advice with regard to the specific interpretation or operation of any insurance policy. Any insurance policy's applicability is highly fact specific. Qualified legal counsel should be consulted regarding laws that may apply with respect to policy coverage interpretation in the state in which the policy will be interpreted.

The author, James J. Ilardi, CPCU, is a Chartered Property and Casualty Underwriter and President of SECURA RISK GROUP, LLC.

SECURA RISK GROUP is a New York based, independent commercial insurance brokerage and advisory firm. The firm specializes in the evaluation, design and procurement of business insurance policies and insurance programs for privately held enterprises, publicly traded companies, non-profit organizations and professional service firms. SECURA RISK GROUP also provides claims advisory and support services.

Everything About Life Insurance!

2017-05-03T18:35:00.000-07:00

I want to start off this 2010 with an article regarding Life Insurance. Many people find this topic morbid but believe me when I say this contract is as important as a Will and should be taken just as seriously as health insurance. Due to the length in details of this article I have provided chapters for easy reading. I hope this will educate you on Life Insurance and the importance of its necessity. (Note: For better understanding "You" is the policy owner and the insured)

Chapters:

1= Introduction

2=When/If you have Life Insurance already

3= Difference between a Insurance Agent and Broker

4= Types of Policies

5= What are Riders and popular types of Riders

6= The medical exam

1) About general Life Insurance:

This is a contract between you and an insurance company to pay a certain amount (the premium) to a company in exchange for a benefit (called the Death Benefit, face amount, or policy amount) to the beneficiary (the person you want to get paid in the time of your death). This can range based on the type of policy (which will be discussed momentarily), your health, your hobbies, the Insurance company, how much you can afford in premiums, AND the amount of the benefit. It sounds overwhelming but it is not if you have the right agent or broker.

Now many people can say that Life Insurance is like gambling. You are betting that you will die in a specific time and the insurance company bets you won't. If the insurer wins, they keep the premiums, if you win...well you die and the death benefit goes to the beneficiary. This is a very morbid way of looking at it and if that is the case you can say the same for health insurance, auto insurance, and rental insurance. The truth is, you need life insurance in order to ease the burden of your death. Example 1: A married couple, both professionals that earn very well for a living have a child and like any other family has monthly expenses and 1 of the couple has a death. The odds of the spouse going back to work the next day is very slim. Odds are in fact that your ability to function in your career will lower which RISK the cause of not being able to pay expenses or having to use one's savings or investments in order to pay for these expenses NOT INCLUDING the death tax and funeral expenses. This can be financially devastating. Example 2: lower middle income family, a death occurs to 1 of the income earners. How will the family be capable of maintaining their current financial lifestyle?

Life insurance is about the ability of lowering the risk of financial burden. This can be in the form of simple cash or taxes via estate planning.

KEY Definitions:

The Insured: The person that is covered by the insurance company (He/She does NOT have to the policy owner)

The (policy) Owner: The one that pays the premium, controls the beneficiary, and basically owns the contract (Does NOT have to the insured...hope you understand it can be either/or).

Face Amount: Also known as the death benefit. The amount to be paid to the beneficiary.

The Beneficiary: Is the person/persons/organization who will receive the face amount (death benefit)

2) When/If you have Life Insurance:

First, you should review your beneficiaries once a year and your policy approximately once every 2-3 years. This is free! You need to make sure the beneficiaries are the people/person you want to get paid! Divorce, death, a disagreement, or anything of the sort can make you change your mind about a particular person to receive the benefit so make sure you have the right people, estate/trust, AND/OR organization (non-profit preferably) to receive the benefit. Furthermore, you need to review every 2-3 years because many companies can offer a lower premium OR raise the benefit if you renew your policy or if you find a competitor that sees you have been paying the premiums may compete for your business. Either way, this is something you should consider to either save money or raise the policy amount! This is a win-win for you so there should be no reason not to do this.

3) Life Insurance Agent or Broker, what is the difference?:

The major difference is an Agent is usually an independent sales man that usually works with different insurance companies in order to give the client the best possible policy while the Broker works for a particular company. My personal advice: always choose an Agent. Not because I am one myself BUT because an agent can look out for your benefit by providing different quotes, types, riders that are available (explained later), AND pros/cons regarding each insurance company. If you don't like a particular insurance company, tell the agent and he should move on to the next carrier (if he persist for some odd reason, fire him). Buyers BEWARE: The Agent should get paid by the carrier that is chosen, not by you specifically. If an Agent asks for money upfront for anything, RUN! There are also Insurance consultants that you pay but to keep things simple, see an Agent. Consultants and Agents are also great in reviewing current policies in order to lower premiums or increase benefits.

4) Types of Policies:

There are 2 main categories: Term and Permanent Insurance. Within each of the 2 categories have sub-categories. I will explain them at a glance in order for you to make the best possible choice for you and your loved ones. Remember, you can have estate/trust or a organization as the beneficiary. (Note: There are even more sub-sub-categories within these sub-categories but the difference are so small and self explanatory that I have not included it in this article. Once you speak to an agent you will have enough knowledge by this article that you will know what questions to ask and know if you agent is right for you).

Term Insurance: A temporary policy in which the beneficiary is paid only upon death of the insured (you) within a specific time period (hence the word "Term"). Term Insurance is usually less expensive with a smaller death benefit. Some do not require medical exams BUT expect to pay a higher premium since the risk of the insurance company is unknown. Also, term insurance normally does not accumulate cash value (explained in permanent insurance) but can be purchased on top of your permanent policy (for those that may have coverage already):

Convertible Term: Ability to convert policy to permanent. There are some REALLY GOOD policies that require no medical exam, driver history, or hazardous avocations at a certain point in order to convert to permanent coverage guaranteed with all the benefits that permanent insurance policies has to offer.

Renewable Term: Able to renew a term policy without evidence of insurability.

Level Term: Fixed premiums over a certain time period than increases (great for those that are young adults and expect within 10 years to have a increase in pay).

Increasing/Decreasing Term: Coverage increases or decreases throughout the term while the premium remains the same.

Group Term: Usually used for employers or associations. This covers several people in order to reduce premiums. (Great for small business owners)

Permanent Insurance: Just as the name states, this provides coverage throughout the lifetime of the insured. This also builds cash value which is fantastic for tax purposes because if you loan out money to yourself using this cash value there are no tax implications. Few policies may have in general withdrawal tax-free. However in most cases, If you withdraw the cash value you pay the only the taxes on the premiums (the amount that grew) which is fantastic. Just make sure your agent knows not to have the cash value grow larger than the death benefit otherwise it is subject to 10% taxes! Surrender charges may also apply when you withdrawal so PLEASE consult with an agent who can assist you with these details. You should consider Permanent Insurance if you have a family and don't mind an increase in premiums (amount you pay) by a few dollars compared to term.

Traditional Whole Life: Pay a fixed amount of premium in order to be covered for the insured's entire life which includes accumulating cash value.

Single-Premium Whole Life Insurance: Whole life insurance for 1 lump sum premium (usually that 1 lump sum is very large in order to get a great death benefit).

Participating Whole Life Insurance: Just like Traditional Whole life except it pays you dividends which can be used as cash OR pay your dividends for you! There is no guarantee that you will be paid the dividends, this is based on performance within the insurance company.

Limited Payment Whole Life Insurance: Limited payments for whole life but requires a higher premium since you are in fact paying for a shorter amount of time. This can be based on payment amounts (10, 20, 30, etc payments) or a particular age (whole life is paid up at age 65, 75, 85, etc).

Universal Life Insurance: Flexible premiums with flexible face amounts (the death benefit) with a unbundled pricing factors. Ex: If you pay X amount, you are covered for X amount.

Indexed Universal Life: Flexible premium/benefit with the cash value is tied to the performance of a particular financial index. Most insurance companies crediting rate (% of growth) will not go below zero.

Variable Life Insurance: Death Benefit and cash value fluctuates according to the investment performance from a separate account of investment options. Usually insurance policies guarantee the benefit will not fall below a specified minimum.

Variable Universal Life Insurance (also called Flexible Premium Variable Life Insurance & Universal Life II/2): A combination of Variable and Universal which has premium/death benefit flexibility as well as investment flexibility.

Last Survivor Universal Life Insurance (also called Survivorship or "Second to die" Insurance): Covers 2 people and the death benefit is only paid when both insurers have died. This is FANTASTIC and somewhat a necessity for families that pay estate taxes (usually High-Net-worth individuals).

5) Life Insurance Riders, what is it and why is it very important:

Rider is the name of a benefit that is added to your policy. This provides special additions to the policy which can be blended and put together. There are SO MANY types of riders that I would have to write a different article regarding Riders (and insurance companies add new types of riders often) but I want to at least name the most popular (and in my opinion, the most important) that you should highly consider when choosing a policy. Riders add to the cost of the premium but don't take riders lightly; it can be a life saver!

Accidental Death Benefit Rider (AD&D): Additional death benefit will be paid to the beneficiary if you die from a result of an accident (ie: Car accidents, a fall down the stairs). This is especially important if the insurer travels often, relatively young, and has a family. Please note: You can buy AD&D Insurance separately.

Accidental Death & Dismemberment Rider: Same as above BUT if you lose 2 limbs or sight will pay the death benefit. Some policies may offer smaller amounts if losing 1 eye or 1 limb. This is great for those that work with their hands.

Disability Income Rider: You will receive a monthly income if you are totally and permanently disabled. You are guaranteed a specific level of income. Pay attention to this detail, depending on the policy it will either pay you depending on how long the disability lasts OR time frame of the rider.

Guaranteed Insurability Rider: Ability to purchase additional coverage in intervals based on age or policy years without having to check insurance eligibility.

Level Term Rider: Gives you a fixed amount of term insurance added to your permanent policy. This rider can add 3-5 times the death benefit or your policy. Not a bad deal!

Waiver of Premium Rider: If you become disabled which results to the inability to work/earn income, the waiver will exempt you from paying the premiums while your policy is still in force! There is a huge gap between policies and insurance companies so the devils in the details with this rider.

Family Income Benefit Rider: In case of death of the insurer, this rider will provide income for a specific time period for your family.

Accelerated Death Benefit Rider: An insurer that is diagnosed with a terminal illness will receive 25-40% of the death benefit of the base policy (The decision is made between the insurer and the insurance company). This will lower the death benefit however depending on your finances or living lifestyle, this rider should not be taken lightly and should seriously be considered.

Long-Term Care Rider: If the insurer's health compels to stay in a nursing home or receive care at home, this rider will provide monthly payments. Please Note: Long Term Care insurance can be bought separately for more benefit.

6) The Medical Exam:

This section is not to scary you away but to mentally (and possibly physically) prepare you for the medical exam so this way you know what to expect and can get the lowest possible premiums while receiving the highest possible death benefit. This really shouldn't be a concern if you work out regularly and maintain a healthy eating habit (notice I said habit and not diet. Diets don't work for long term).

The exam is mandatory for most insurance policies. Many term insurance do not require one but expect a low death benefit and/or higher premium. The idea of the exam is not just to see if you're insurable but to also see how much they will charge the insurer/policy owner. The exam is done by a "paramedical" professional that are independent contractors hired by the insurance company who either come to your home or has an office where you/the insurer visit. They are licensed health professionals so they know what to look for! In very few cases the insurance company may ask for an "Attending Physician Statement (APS)" from your doctor. This must be provided by your doctor and NOT copies by you. TIP: The "paramedical" job is to give the insurance company a reason to increase your premiums so don't give any details that are not asked.

First part (either called Part 1 or Part A) is complete by the Agent or by you. Part 2/B is the paramedical or physician portion. The best bet is to have your agent contact a paramedical that specializes in mobile exams for an easier exam for you. Paramedical will contact you to schedule an appointment. The exam is not optional so it's not a matter of yes or no but when and where. This entire exam will cost you nothing except time so make the time, life insurance is important!

The paramedical/physician will take your medical history (questions), physical measurements of height and weight, blood pressure, pulse, blood, and urine. Additional tests will vary based on age and policy amount (yes, the higher the death benefit = the more tests that must be provided). Now if the policy is substantial, the insurance company may not send a paramedical but require an actual Medical Doctor to exam you. Of course, this is chosen by the insurance company so remember my tip earlier! This exam may even include a treadmill test and additional crazy exams in order to see if you qualify for that substantial amount and low premium. On the flip side, if you choose a low insurance policy, you will just have a paramedical doing simple tests that mentioned earlier with no additional exams.

What they are looking for: Paramedical/Physicians are looking for health conditions that may shorten your life. Remember, insurance companies are here to make a business and if you're a liability then it might be a risk they do not want to take or raise the premium to make the risk tolerable. Blood and urine is taken to see the following:

- your antibodies or antigens to HIV

- Cholesterol and related lipids

- Antibodies to hepatitis

- Liver/kidney disorders

- Diabetes

- Immunity disorders

- Prostate specific antigen (PSA)

- Drug tests such as cocaine

The Results: They are sent directly to the insurance company's home office underwriters for review. Many times you can request (must be written request) to receive a copy of the results however many insurance companies will automatically do this. Many times they will find abnormalities but it's usually not a concern and just speak to your medical professional for a follow up (remember: the insurance company will look at these exams with a "fine tooth cone" in order to see what the risk are). The underwriters will look at the exam results and the application (remember part 1/a? well, now they want to see if your also lying) and determine the premium amount. Smokers pay more; any nicotine in your system will consider you a smoker, even if it is just socially.

The premium is determined by a category that you fit in. This really depends on the insurance company on how they factor but the general rule is if you are a higher risk, you pay higher premium. If you are standard risk, you will pay a standard premium, and if you are a preferred risk, you will pay a low premium.

You can decline the policy after you receive the final quote after the exam but do remember this: All results will become part of the MIB group's database (Medical information Bureau). This is a clearinghouse of medical information that insurance companies use to store information after you apply for Life/Health/Disability Income/Long Term care/Critical Illness insurance. So for seven years it will be on database. You can receive a free report annually (like a credit check) at their website which I included at the bottom of this article.

Now that you know practically everything there is to know about life insurance. I hope you realize how important it is. It may seem like a lot but the hardest part is simply choosing what type of policy is right for you. This can be done with the help of your Agent. In the end, everyone is different and everyone should analyze their own situation and need for the beneficiaries. If you have even the slightest concern for a loved one regarding what will happen if you was no longer with us then you should consider life insurance. There truly is a feeling a relief once you know you and your loved ones are covered regardless of how much you or that person makes. For many that feel that their loved ones don't need the death benefit due to whatever the case may be ("they earn enough money to survive" is the biggest reason I hear against life insurance), this can be a simple last gesture of "I love you" or appreciation for them being part of your life.

Free Insurance Quotes - Cheap and Simple Way to Manage Our Savings

2017-04-25T18:34:00.000-07:00

Have you checked your insurance for better insurance rate quotes lately? Many people ignore this just because they don't want to go through all the troubles looking for insurance rate information or comparing rates, and decide to stick with the old companies which they think have already given them the best rates and coverage even if the rates are raised by the companies. If that is what happen, they might have missed the chance of getting better rates and coverage offered by other insurance companies on the market.

In every insurance company, insurance rate is dynamically changed through time. There are so many aspects that can influence the rate changing whether it is an external or internal factor.

Government rules and policies, political and economic situation, business atmosphere such as number of competitors, or even a natural disaster could be considered as external factors that give effect to an insurance rate as well as the coverage. For example when the political situation is getting hot which might trigger some riots or civil commotions insurance companies will raise their rates since the risk factors are increasing, and they might lessen the extend coverage for RSCCTS (riot, strike, civil commotion, terrorism, and sabotage) or give an extra charge for the items. But if an insurance company finds a lot of competitors on the market selling the same insurance product, this could make the company lower their rate and sometimes offers a better coverage and service.

While the internal factors usually have something to do with the loss and profit of an insurance company. Let's say insurance company A provides auto insurance and homeowner insurance. Due to a catastrophic in one area, they have to pay out a large amount of homeowner insurance claims. To cover the loss over the homeowner insurance claims, the company may raise premiums for their auto insurance customers. But if the company is in a profitable year they might lower their rates to attract more customers. Beside that, certain record of costumers might also affect the insurance rate like credit history or driving record in the case of auto insurance.

Since there are so many factors that could affect the raise or decrease of insurance rates, we can be sure that there is no guarantee we will continue to receive the best rates from the time we signed with an insurance company. Like I said before, insurance rate is dynamically changes through time, so even if we still pay the same rate like the first time we signed with an insurance company or even lower than that, we still have a chance of getting a better insurance deal on the market.

To ensure we are getting the best rate, best is to make a regular review of our policy and then make a comparison against the offerings from other competing insurance companies. Not like in the past, when to obtain insurance quotes could take a lot of time and waste so much energy since we have to spend hours on the phone and having lots of meetings with different insurance agents, today we can easily get free insurance quotes from the internet. This could be done in a very short time, only by filling out the online questionnaire and without lifting the phone or leaving home, we already can obtain free insurance quotes from many different insurance companies.

We can get free insurance quotes from insurance company websites, insurance broker websites, or from any other insurance websites that have free insurance quotes tool. If we'd like to have a more detail information on coverage and services of an insurance product beside the rate, we can get a free insurance quote from insurance company websites. But this way, we're going to have to travel from website to website to get quotes from other insurance companies and also we have to fill the questionnaire form again and again. So if we'd like to save a little time and energy, we can get free insurance quotes from insurance consulting websites that offer free insurance quotes. We can easily find these websites by simply type "free insurance quotes" on the search engine, and we'll find hundreds of websites offering to give free insurance quotes. The best thing is we don't have to visit another websites to get insurance quotes from different insurance companies and usually we only have to fill the questionnaire form once. These kind of websites usually also give tips on how to get the best rate, coverage, and other insurance services.

To obtain sufficient information from free insurance quotes to be able to help us in making comparisons and determine which insurance company will we choose, here are some things should be noted:

o We must determine from which site we will ask for an insurance quote based on our needs. If we want more detailed information about coverage and services provided by an insurance company is better to directly ask for quotes from the insurance company's website. We should also do this if we want an insurance quote for specific types of insurance such as the antique car insurance which has many different aspects from the general car insurance. But if we wish to make a quick comparison and intend to more detailed information later on, we can go to any insurance site which provides a free insurance quote for many different insurance companies, and be sure we pick the site which has a large amount of insurance company database so we can have a lot of choices to compare.

o Determine what kind of coverage we really need and how much money we prepared, and what amounts of coverage needed to protect us. Because the insurance market is sometimes like a shopping mall that often tempt us with products that are irresistible, so we often fall and spend money on something that we don't really need.

o Fill the questionnaire form with accurate data, if we do not feel confident about what we have to fill in one column, it's better to ask or look for documents that can help us fill, in case of auto insurance maybe we can prepare the vehicle documents, driver license, and any related documents. If the insurance object is under insured, the policy's declarations page can help you a lot in filling the form. Answer all the questions in the form truly and don't hide anything, this is the only way for us to obtain an accurate quote.

o Ask free insurance quotes from at least three different companies to be able to get more alternatives. If we ask for quotes from different sites, make sure to enter exactly the same information so that we can get a balanced comparison.

o Do some experiments by changing information or value in various fields that can affect insurance rates and consider the results of the calculation to see which one best suits our needs and budget, then do the same thing with quotes from other insurance companies in order to make comparisons. For example, generally if we increase the deductible value and decrease the amount coverage then we shall have a lower rate. Or in case of auto insurance, number of drivers and average mileage can also affect the rate. But please notice that there are some fields which also affect the rate that we cannot change like driving record in case of auto insurance or health record in case of health insurance otherwise we won't get an accurate quote.

After getting a rate quote that suits our needs and budget, we can continue to do a further check to the insurance company and the insurance plan. Remember, that the cheapest quote doesn't necessarily mean you will get the best value on your coverage and good coverage doesn't always come from a big company. Here are what we have to do after getting rate quotes:

o Look beyond the amount of money to what the coverage actually covers. Pay attention to the several other factors that could affect the claim process and payment as well as the length of the claim process, also find out what is not covered in the policy exclusions. We can get the information on the website if it's available there or best is to contact the insurance agent to get more sufficient comprehensive information.

o Check the history and reputation of the company, since having insurance covers from an experienced and reputable company can give us peace of mind. Find out whether they provide high quality costumer care or if there were complains about the company performance. we can find testimonials or experts review on an insurance company concerning these issues.

o There's nothing wrong to follow our instinct as long as we also use common sense in deciding which insurance company we should choose. We can go with the company that makes us feel most comfortable as long as it gives a nice rate and coverage based on the insurance quote. Pay attention if the agent or company representative able to answer all our coverage and policy questions or whether the agent treat you with courteous and respect. After all, we always want to have insurance protection with the best rate and service.

After we have made our mind and choose one insurance company to insured us, we shouldn't stop trying to get more discounts or lower rate. Besides raising up the deductible amount which can give us up to 15-30% lower rate, there are still many other things that can lower the insurance rate such as:

o If the insurance company handles a wide range of insurance products consider having all our insurance provided by this company, this will give us a great discount on our premiums.

o In the case of auto or homeowners' insurance, ask the company about multi-family price reductions for coverage. If there is a price reduction, consider to purchase multi-family over a single type of insurance from the company. We can also get discount by having well-security system for the vehicle / house.

o We can also choose to make annual premium payment to save money. That's because most insurance companies do charge a service fee if we make quarterly or monthly payments since this increases the risk that we won't pay the next month. Some insurance companies don't charge these fees but do give us a discount if we pay our entire premium in one lump sum. While that might seem too expensive of a bill to pay at once, we could always put back the amount of the monthly premiums into a savings account each month then we'd have the full amount to pay the yearly premium

After we have got the best coverage with the best rate, all we have to do is to keep it that way by avoiding things that can cause us to lose some protection and rate increases. For example, in case of auto insurance, we should be a safe driver, avoid accidents, and try to avoid making too much claims. As for homeowners' insurance, we can try to minimize our liability risks by placing fence around the pool or having adult supervision when anyone is at home. We might also consider small repairs yourself without making a claim.

This way we can maintain the coverage and the low rate we already have although it's not 100% guarantee it will stay that way for a very long time. That's why we still have to make a regular review of our policy especially at the end of an insurance period to get the best deal on the market by taking advantage of free insurance quotes available, since the rate might easily changed every time.

Life Insurance For Mortgages

2017-04-22T09:30:00.000-07:00

Bank Coverage vs. Private Coverage. What you need to know!

So let's get on to a mortgage insurance discussion. Did I say mortgage insurance? Ah yes! Yes, it's a unique name given to normal, ordinary life insurance, couched under a very nice sounding name - which makes a whole lot of difference to people wary of "life insurance." So, they're not buying life insurance-no, no, they're buying mortgage insurance. I wish there were many more such unique names for good old Life Insurance which would persuade people to buy life insurance and protect their loved ones and their estates.

Apparently, people do not want to talk about death; so life insurance is the last topic for discussion unless you get a close call from the Creator, by way of a heart attack or stroke. Mortgage insurance is not mandatory at your bank, or anywhere for that matter. All you have to do is sign a waiver and you're off to the races. The waiver releases the lending institution of its obligations to offer you a plan that would take care of your family in the event you had a premature death.

Let's get back to the statistics. Out of 1,000 people aged 30, 125 will die prior to the conclusion of a 25 year mortgage. And surprisingly, despite having this fantastic name to this very important plan there are thousands of families lacking protection and leaving their dependent families open to the risk of losing their homes. I am certainly glad that due to the plans aggressively marketed by the banks, many families are protected. Or else, there would be thousands of unprotected families who would end up homeless.

If a mortgage is not paid immediately, in the event of your death, it will become a huge liability to the family.

Choices: Let's visit the choices your family would have to make in such a situation.

1. Will the surviving spouse/partner carry on the entire burden of the mortgage and will the bank accept the risk? If two incomes together found it difficult to make both ends meets, how can one income possibly be adequate?

2. The family could sell the house, relocate or rent somewhere else. Will there be a buyer for the house? What about the cost involved in selling the house? Will there be enough money after selling or will the family owe the bank?

3. Sell the house and move in with the relatives. Not the best alternative and how many people have philanthropic, generous relatives willing to take in another family? Not many, I can bet.

4. It's an accepted fact that for most people their house is their most valuable asset and they protect it by way of mortgage insurance.

By the way, I'm sure you have heard this statement from a friend saying that someone they knew had died and that the surviving family does not have any money. You can immediately conclude that those folks did not have insurance and must have probably snubbed many insurance advisors like me. If one truly loves his or her family, a mere $15.00 a month can prevent such an eventuality.

o Why take advice from a bank official, whose experience is not insurance?

Before we discuss the nitty-gritty of the plans marketed by the banks and other lending institutions, let's get one thing straight. Would you go to your dentist if you are ill? Or, would you go to your family doctor? True, both are doctors, but their lines of specialty are totally different. Why, then, would a person take advice from a bank official (whose expertise is banking and NOT insurance) to purchase protection of his/her most valuable asset?

Don't get me wrong-bank officers may be extremely knowledgeable in the financial aspects of banking related issues, but insurance issues are far beyond their scope. They are only doing their duty by offering the mortgage plans available.

Therefore, getting advice and signing an extremely important document which can affect your entire family's financial future is something you have to take really seriously. An Insurance Advisor, on the other hand, is qualified to give you better advice on insurance related issues.

o Plans offered by an Insurance Advisor provide coverage that remains level for the term you select.

Mortgage insurance plans offered by banks relate to your mortgage balance, and obviously as your mortgage drops so does your insurance coverage. In this case, if you are happy about reducing your mortgage, remember that the insurance company is equally happy because this reduces their liability.

Individually acquired plans are tailor made for you personally and so, if you are healthy, you get a better rate. Unfortunately, the plans that banks recommend are group plans. It does not matter how healthy you may be compared to others in the group.

o Plans we offer have premiums guaranteed and cannot be changed by the insurer.

As you might be aware, group plan premiums are generally not guaranteed. Mortgage insurance plans are group plans.

o Individual plans do not reduce their benefits and so the premium remains the same.

Mortgage insurance plans offered by banks relate to your mortgage balance, and as your mortgage drops so does your insurance coverage, as mentioned previously. However, the premiums that the bank charges you remain the same. Does this seem fair?

Most bank plans leave the insurance carrier with loopholes to decline your claim.

o Individual plans will require complete medical check-ups done by qualified medical professionals, at the time of application, which will save your beneficiaries from problems later. It also protects your interests and the interests of your beneficiaries at a later date. Qualified Insurance Advisors will coach you on most medical questions so that your answers are accurate and appropriate.

Most bank plans can be set up with a few condensed medical questions-which leaves your bank's insurance carrier with loopholes to decline your claim.

o Our plans do not require you to pay additional PST. The premium offered is the final figure, no PST surprise.

Premiums quoted by group insurance plans do not include Provincial Sales Tax. Therefore, just like the rest of your regular purchases PST sneaks in silently to add to your total. So, when you shop for a price, please take this into consideration. A PST of 8% could buy you a lot of additional insurance coverage OR reduce your cost significantly.

With our plans, the premium offered is the final figure-no PST surprise.

o The plans offered by an Insurance Advisor insure both spouses separately, and so, insurance is paid on both deaths, for instance in a disaster where both the insured die, two separate death claims in the same amount will be paid, thus doubling the benefit.

Bank mortgage plans are "first to die" plans-i.e. the plans pay and cease when one person of the two insured dies. Obviously you would agree that that's the purpose of this insurance. Sure. However, wouldn't you prefer a better option?

For example: a 45 year old male and a 42 year old female insured for a mortgage of $250,000 "first to die" would pay $49.50 per month. By insuring them separately for two amounts, the cost would be about $52.00 per month. Wouldn't you agree that it's worth an additional $2.00 month to double the coverage, so that the beneficiaries receive $500,000? That's the advice you will receive from a qualified insurance professional.

o The plans an Insurance Advisor offers can generally be converted to a permanent plan, without the necessity for further medical evidence. So if you develop a medical condition which would disqualify you for insurance, this feature would be of great importance in the continuation of your insurance policy, thus protecting your family.

Bank mortgage plans are strictly rental (term) plans and that's about it. You do not have a choice.

o Our plans are traditional life insurance policies, the proceeds of which go to a named beneficiary tax free. The insurance policies are creditor proof, thus totally negating undue expenses such as probate fees.

When insurance proceeds from a bank plan are paid towards a property, those proceeds may be open to probate or creditors.

o With traditional life insurance plans, the choice of coverage amount is always yours and does not require mortgage documentations.

Again, as the coverage of bank plans relates to your mortgage balance, you do not have a choice. For instance, if you wanted an extra amount of coverage to protect your family, you would need to purchase it from elsewhere and unnecessarily end up paying an additional amount of money by way of policy fees.

o With the plans an Insurance Advisor offers, the choice of using the benefit amount anyway you choose is yours, and you can make any changes as and when you need. For instance, when you die, your spouse has the option of whether he/she wishes to pay off the mortgage in its entirety or not, as per the spouse's needs at the time.

With a bank policy the bank is the beneficiary; your family has no choice.

o Our plans are portable. They are not tied to any property. They are based on your life-not your house or any other asset.

When you purchase a mortgage insurance plan from a bank, you are confining the coverage to a particular property; hence, the moving to another property requires another contract.

o Refinancing does not affect the insurance plans that an Insurance Advisor will offer.

Refinancing alters your mortgage balance and so the contract of a bank plan stands void. There will be a rate increase in line with your current age, with additional underwriting. You in fact may not be able to get insurance again as your health conditions may have changed.

o We offer you choices of coverage ranging from 5 to 21 critical illnesses with the flexibility of purchasing the amount of coverage that you can afford. Also, you can claim two benefits separately-i.e. if the insured gets a critical illness and claims, then dies after the claim is paid, the death benefit also gets paid.

Some institutions generally add the critical illness benefit to your life insurance coverage, giving you no choice with regard to the amount you may wish to purchase according to what you can afford. It also does not allow you to claim two benefits-i.e. if you collect a claim on a heart attack which is a critical illness benefit and you survive, then the contract ends. Also, the number of critical illnesses covered is limited.

o A qualified Insurance Advisor can draw out a plan which allows you the option to stop paying premiums and still continue your policy.

Bank mortgage insurance plans are term products which have no cash values, and so, if you stop payments, the policy will immediately lapse.

o Most insurance agents will service you effectively and most of all take care of a claim, personally assisting your family when in dire need. Most Insurance Advisors' actions will definitely speak better than bank TV commercials. They will assist you in the creation of an estate and certainly will meet you one-on-one and at your choice of venue or at your home. Basically you have hired the services of a professional in this line for the rest of the term of the plan you have purchased.

Can you recall any bank making personal contact with you such as sending you a birthday card, a calendar, newsletters, or even making a courtesy call, etc.? The only time you would hear from them is possibly at the time of renewal, which would mean an additional sale for them.

It's worth noting that traditional life insurance policies from an Insurance Advisor offer a discount of approximately 9 per cent if the premium is paid annually, thus reducing the cost significantly. This discount factor does not arise with a bank's mortgage insurance plans, which are generally paid on a monthly or biweekly basis.

The Basics - What Insurance Is, Why Do You Need Insurance?

2017-04-12T18:31:00.000-07:00

According to Wikipedia, insurance is:

"Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed small loss to prevent a large, possibly devastating loss"

Insurance can be Personal or Business one, but the main goal of insurance is to insure you or your business against a possible loss. Term insurance can be described as:

- A small loss that prevents a large, possibly devastating loss.

Insurance protects you against financial loss in a future if you have an accident. Insurance is a contract between you - a policyholder (person or entity buying the insurance), and the insurance company. Policyholder's payments are called premium.

At Free Insurance Quotes Site we have some great offers that you don't want to miss! Feel free to fill out the form and do the insurance quote. Most important - it's free of charge and you can save up to $550 for year or more!

There are a lot of types of insurance, but let's stick with the main ones:

Auto Insurance

Auto insurance also known as

- vehicle insurance

- car insurance

- motor insurance

It is purchased for cars, trucks, motorcycles and other vehicles. The primary use of auto insurance is to provide protection against losses incurred as a result traffic accidents.

There were more than 180 million automobiles in USA in 2006. About 175 million were covered by auto insurance companies. It's the largest auto insurance market in the world. There are more than 35 million automobiles in Russia. About 34 million are insured as well. China - 10 million insured automobiles.

Auto insurance provides:

a) Property coverage - it pays for thief or damage of your car

b) Medical coverage - it pays for your responsibility to others for bodily injury or property damage

c) Liability coverage - it pays for the cost of treating injuries, lost wages or even funeral costs.

Insurance premium varies for males and females, teenagers and adults. According to the statistics males drive more miles than females and consequently have a proportionally higher accident involvement at all ages. Teenagers who have no driving record will have higher car insurance premiums as well.

Owners of sport cars, motorcycles would have higher insurance premiums as opposed to compact cars, midsized cars and electric cars.

Your auto insurance policy is a contract, most polices are issued from six months to one year period. In USA, Russia, Brazil, Japan auto insurance company should notify you by mail, phone or any other method to renew your policy.

Home Insurance

As auto insurance, home insurance provides compensation or insure you against damage of a home from disasters. Sometimes it's called hazard insurance or homeowners insurance as well. In the real estate industry it is abbreviated as HOI.

This is the type of insurance that covers private homes. It can include:

- losses occurring to one's home

- loss of home use

- home contents

- loss of other personal possessions of the homeowner

In some geographical areas, it is necessary to buy additional insurance plan for certain types of disasters, for example:

- flood insurance

- earthquakes

- war

They excluded from original policy plan and require additional coverage. Home insurance policy is a lengthy contract. It names what will and what will not be paid in the case of various events. It can be seasonal or long term.

Home insurance company should notify you by mail, phone or any other method to renew your policy.

Health Insurance

Health insurance is the type of insurance that pays for medical expenses. It also known as:

health coverage

health care coverage

health benefits

Policy can be purchased by individual or company on group basis to cover its employees. Health insurance policy is a lengthy contract. Policyholders should pay premiums to help protect themselves from unexpected healthcare expenses. Insurance contract can be renewable annually or monthly.

In 2008 approximately 84% of USA citizens have health insurance:

About 9% purchase health insurance directly

About 60% obtain it through an employer

About 20% of Americans obtain health insurance from various government agencies.

In 2006, there were 16% of Americans (47 million people) who were without health insurance. Average spending is higher in the individual market. Many medical expense plans include coverage for dental expenses. Stand-alone dental insurance is also available.

Health care system is mainly in private hands in USA. Hospitals and doctors generally funded by payments from patients and insurance.

Hospitals provide some outpatient care in their emergency rooms and specialty clinics, but primarily exist to provide inpatient care.

In 2008 a report by the Commonwealth Fund ranked the USA last in the quality of health care among the 19 compared countries. According to the Institute of Medicine of the National Academy of Sciences, the United States is the "only wealthy, industrialized nation that does not ensure that all citizens have coverage".

Life Insurance

Life insurance is also known as life assurance. Insurer (or Life Insurance Company) agrees to pay sum of money upon the occurrence of the policyholder's death, illness, critical illness, terminal illness or other event. Policyholder pays a fee at regular intervals or in lump sums. This fee is called a premium.

Life insurance can be:

Temporary.

It's life insurance coverage for a specified term of time for a specified fee (premium). Usually premium buys protection in the event of death and nothing else.

Permanent

Type of insurance that remains in force until the policy matures (in other words pays out), unless the policyholder fails to pay the specified fee when due.

As with most insurance policies, life insurance is a contract between the insurer and the policyholder whereby a benefit is paid to the designated beneficiaries if an insured event occurs which is covered by the policy.

Insured events that may be covered include:

Protection policies

Investment policies

Illness

Each contract may include limitations of the insured events. Usually they a written to limit the liability of the policyholder: for example claims relating to war, suicide or fraud. Any misrepresentations by the insured on the application will cause the nullification of the contract.

Upon the insured's death or illness the insurance company requires acceptable proof before it pays the claim. For example list of necessary documents that required upon the policyholder's death:

Death certificate

Completed, signed and notarized claim form

If insured's death looks suspicious, it can be investigated by insurance company before deciding whether it has an obligation to pay the claim. Proceeds from the policy may be paid as a lump sum or as an annuity.

Life Insurance - Learn From an Old Agent

2017-04-04T18:28:00.000-07:00

Life Insurance is an insurance product that pays at the death of the insured. It really should be called "Death Insurance," but people don't like that name. But it insures the death of an individual. Actually, what is insured is the economic loss that would occur at the death of the person insured.

Those economic losses take a lot of different forms, such as:

the income stream of either "breadwinner" in a family
the loss of services to the family of a stay-at-home-mom
the final expenses at the death of a child
final expenses of an individual after an illness and medical treatment
"Keyman" coverage, which insures the owner or valuable employee of a business against the economic loss the business would suffer at their death
estate planning insurance, where a person is insured to pay estate taxes at death
"Buy and Sell Agreements," in which life insurance is purchased to fund a business transaction at the untimely death of parties in the transaction
Accidental death insurance, in which a person buys a policy that pays in case they die due to an accident
Mortgage life insurance, in which the borrower buys a policy that pays off the mortgage at death - and many more.

Life insurance has been around for hundreds of years, and in some cases, has become a much better product. The insurance companies have been able to develop mortality tables, which are studies of statistical patterns of human death over time...usually over a lifetime of 100 years. These mortality tables are surprisingly accurate, and allow the insurance companies to closely predict how many people of any given age will die each year. From these tables and other information, the insurance companies derive the cost of the insurance policy.

The cost is customarily expressed in an annual cost per thousand of coverage. For example, if you wanted to buy $10,000 of coverage, and the cost per thousand was $10.00, your annual premium would be $100.00.

Modern medicine and better nutrition has increased the life expectancy of most people. Increased life expectancy has facilitated a sharp decrease in life insurance premiums. In many cases, the cost of insurance is only pennies per thousand.

There is really only one type of life insurance, and that is Term Insurance. That means that a person is insured for a certain period of time, or a term. All of the other life insurance products have term insurance as their main ingredient. There is no other ingredient they can use. However, the insurance companies have invented many, many other life products that tend to obscure the reasons for life insurance. They also vastly enrich the insurance companies.

Term Insurance

The most basic life insurance is an annual renewable term policy. Each year, the premium is a little higher as a person ages. The insurance companies designed a level premium policy, which stopped the annual premium increases for policyholders. The insurers basically added up all the premiums from age 0 to age 100 and then divided by 100. That means that in the early years of the policy, the policyholder pays in more money that it takes to fund the pure insurance cost, and then in later years the premium is less than the pure insurance cost.

The same level term product can be designed for terms of any length, like 5, 10, 20, 25 or 30 year terms. The method of premium averaging is much the same in each case.

But this new product caused some problems. Insurers know that the vast majority of policyholders do not keep a policy for life. Consequently the level term policyholders were paying future premiums and then cancelling their policies. The insurance companies were delighted because they got to keep the money. But over time, they developed the concept of Cash Value.

Cash Value Insurance

With Cash Value insurance, a portion of the unused premium you spend is credited to an account tied to your policy. The money is not yours...it belongs entirely to the insurance company. If you cancel your policy and request a refund, they will refund that money to you. Otherwise, you have other choices:

1. Use the cash value to buy more insurance

2. Use the cash value to pay existing premiums

3. You may borrow the money at interest

4. If you die, the insurance company keeps the cash value and only pays the face amount of the insurance policy.

So, does this cash value product make sense? My response is "NO!"

Cash Value Life Insurance comes in lots of other names, such as:

Whole Life
Universal Life
Variable Life
Interest Sensitive Life
Non-Participating Life (no dividends)
Participating Life (pays dividends)

Many life insurance agents and companies tout their products as an investment product. But cash value insurance is not an investment. Investment dollars and insurance premiums should never be combined into one product. And investment dollars should NEVER be invested with an insurance company. They are middle men. They will take your investment and invest it themselves, and keep the difference.

Think about the methods that agents use to sell life insurance, and compare them to any other type of insurance. What you'll see is that life insurance sales tactics and techniques are ridiculous when compared to other insurance products.

Would you ever consider buying a car insurance policy, or homeowners policy, or business insurance policy in which you paid extra premium that the insurance company kept, or made you borrow from them? But, curiously, life insurance agents have been wildly successful convincing otherwise intelligent people that cash value life insurance is a good product to buy.

Care to guess why insurance agents have aggressively sold cash value insurance and eschewed term insurance?

Commissions.

The insurance companies have become vastly wealthy on cash value insurance. So, to encourage sales, they pay huge commissions. Term insurance commissions can range from 10% to 50%, sometimes even 100%. But cash value insurance commissions can be up to 100% of the first year's premium, and handsome renewal commissions for years after.

But it's not just the commission rate that matters. It's also the premium rates that come into play. Term insurance is FAR CHEAPER than cash value insurance.

Here's an example of a 30 year old male, non-smoker, buying $100,000 of coverage:

Term insurance costs $0.50 per thousand for a premium of $50.00. At 100% commission, the commission would be $50.00.

Cash Value insurance costs $12.50 per thousand for a premium of $1,250.00. At 100% commission, the commission would be $1,250.00.

So you see that it would be easy for an agent to place his own financial well-being ahead of the well-being of his client. He would have to sell 25 term policies to make the same commission as only one cash value policy.

But, in my opinion, that agent would have violated his fiduciary duty to the client, which is the duty to place the client's needs above his own. The agent would also have to set aside his conscience.

My opinion is that life insurance agents operate from one of three positions:

1. Ignorance - they simply don't know how cash value insurance works.

2. Greed - they know exactly how cash value insurance works and sell it anyway.

3. Knowledge and Duty - they sell term insurance.

Which agent do you want to do business with?

How do I know this stuff? Because I sold cash value life insurance early in my career.

When I started as an insurance agent in 1973 I knew absolutely nothing about how life insurance worked. The insurance company taught me to sell whole life insurance, and to discourage clients from term insurance. But, after some time of reading and research, I learned that cash value insurance is a bad deal. I began to sell only term insurance. I refused to set aside my conscience. I also went back to some early clients and switched their policies from cash value to term.

The insurance company fired me for that decision.

I found a new insurance company that only sold term insurance and also paid high commissions. I made a good living selling term insurance, so I know it can be done.

So, as you shop for life insurance, please accept the advice of an old agent. Never, never, ever buy cash value life insurance. Buy term insurance.

Now, I'd like to offer you two special reports at no cost. One is "5 Things To Do When Shopping For Car Insurance," and the other is "5 Things To Avoid When Shopping For Car Insurance." Each one is a $9.95 value, but free to you when you sign up for my newsletter at the website address below.

Insurance Appraisal Process - A Policyholder's Best Chance to Resolve an Insurance Claim Dispute!

2017-03-28T18:26:00.000-07:00

Many homeowners and business owners find themselves disagreeing with their insurance company's analysis of their insurance claim. However, most are unaware that they can dispute the insurance company's findings via the insurance appraisal process! Even though the policyholder (you) submits a contractor's estimate, receipts for repairs or materials, or even photos showing damages that the insurance company did not include for repairs... they still won't budge.

Most policyholders are unaware of how to dispute and resolve their claim with the insurance company. Policyholders have a choice and a voice within their policy for this very purpose. It's called The Appraisal Clause - also know as The Appraisal Provision. Now, don't let this scare you. It may seem like a fancy clause that would take a law degree to understand. However, a simple way to understand it is that it's the insurance industry's version of arbitration. Although similar, the Appraisal Process is NOT an arbitration or mediation and the umpire is not an arbitrator, mediator, or judge. Insurance Appraisal, Mediation, and Arbitration are separate things.

In short; Arbitration requires attorneys and a legal process, where Insurance Appraisal does not require attorneys or a legal process. Arbitration is a dispute between two parties for any reason, where as, the Insurance Appraisal Process is a dispute between the "value or cost," to repair or replace property only - bee it an automobile, plane, train, couch, house, commercial building, etc.

Most Policies Have the Appraisal Clause

If you feel you're at a dead end with your insurance company and want to resolve your claim you'll need to check your policy for the Appraisal Clause. Most policies will have the provision listed under the "What to do after a loss," section or the "Conditions" section of the policy. Below, you will find a sample of a typical Insurance Appraisal Clause included in most policies. Keep in mind that policies can be different in each state. Therefore, you should read your own policy to see if this clause exists. It will say something similar to the following ;

"APPRAISAL - If you and we fail to agree on the amount of loss, either one can demand that the amount of the loss be set by appraisal. If either makes a written demand for appraisal, each shall select a competent, independent appraiser. Each shall notify the other of the appraiser's identity within 20 days of receipt of the written demand. The two appraisers shall then select a competent, impartial umpire. If the two appraisers are unable to agree upon an umpire within 15 days, you or we can ask a judge of a court of record in the state where the residence premises is located to select an umpire. The appraisers shall then set the amount of the loss. If the appraisers fail to agree within a reasonable time, they shall submit their differences to the umpire. Written agreement signed by any two of these three shall set the amount of the loss."

OK, But How Does the Insurance Appraisal Process Work?

The Appraisal Process allows the policyholder (you) to hire an independent appraiser to determine the value of their damages. In turn, the insurance company will also hire their own independent appraiser. The two appraisers will then get together and select an umpire. The umpire is basically the arbitrator, or what you might call the judge. If a disagreement between the two appraisers arises, they can present their differences to the umpire who will make a ruling.

OK; so far so good, the basics of the insurance appraisal process are beginning to come together. We have an independent appraiser for the policyholder. We have an independent appraiser for the insurance company. Finally, there is an Umpire. These three individuals are known as The Appraisal Panel. The object of the Appraisal Panel is to set or determine The Amount of Loss. The Amount of Loss is the total dollar amount needed to return the damaged property back to its original condition, either by repair or replacement.

Once the Appraisal Panel is set, the policyholder's chosen appraiser and the insurance company's chosen appraiser will review the documents, estimates, and differences between them. The two independent appraisers will try to discuss and resolve the differences in damage and in cost. For example; the insurance company may determine that brick on a home does not need to be replaced. Where as, the contractor or appraiser for the policyholder says that it does have to be replaced. The two appraisers will discuss their reasons for their position and try to come to an agreement, first if it should be repaired or replaced, and secondly the cost to return the brick back to it's original condition prior to the loss.

One benefit of the Insurance Appraisal Process is that the two independent appraisers have not been subject to the bickering and anger between the policyholder and the insurance company. Basically, it's the hope that cooler heads will prevail. All the appraisers really have is the amount of the damage and the difference between the two estimate numbers. They do not have the previous baggage or anger that led up to the Appraisal. The process was designed so that these two individuals, who have no interest in the outcome, could discuss a settlement based on the facts presented to them.

Sometimes issues arrive where the two independent appraisers can't agree on certain items. In this event, the two appraisers will submit their differences to the chosen umpire. The three will discuss the issues and try to reach an agreed settlement of the differences. As stated above; the settlement or final number is called The Amount of Loss. The final amount is known as the Appraisal Award. The Award is signed by the individuals who agree on The Amount of Loss. However, only TWO of the three individuals need to agree. (An agreement between the two independent appraisers, or the umpire and either appraiser) Once any TWO of the three individuals on the Appraisal Panel sign the award... the dispute is over! The amount on the Award binding and is paid by the insurance company, to the policyholder.

Can I Use An Insurance Attorney To Dispute My Claim?

The Appraisal Clause was initiated to lower the number of lawsuits filed against insurance companies. The courts found that many lawsuits were entering the legal system where the cost to repair or replaced damaged property was being disputed. In many cases the suites were being resolved when professional engineers and contractors could address the issues. The Appraisal Process was created to get such individuals together and keep these disputes out of the courtroom. Assuming you acquired an estimate of repair to your property for $100,000, from a contractor or insurance claims expert. Your insurance company has created an estimate for $30,000. This would be a clear dispute between the amounts of damage. This type of dispute is exactly what the Appraisal Clause was developed to resolve.

The clause allows parties on both sides of the insurance policy to dispute their differences using this less costly provision. Let's face it; the courts are filled with lawsuits. The Insurance Appraisal Process allows for the dispute to be settled out of court. Using Insurance Attorneys and lawsuits can have insurance claims tied up in court for years. The Appraisal Provision was designed to keep these disputes out of court for a less costly and timelier resolution.

Insurance Claim Attorneys will usually represent policyholders for bad faith practices. Bad Faith is a whole other issue and sometimes happens after the Appraisal Process has been completed. Bad Faith claims are for much larger suites against insurance companies when it is alleged that they did not act with good faith of the policy they sold to the policyholder. In summary; disputes between the amount of damages and repairs will follow the Appraisal Process before entering into the legal system. Many Insurance Attorneys will also advise the policyholder to engage in the Appraisal Process before any lawsuits will begin.

How Do I know if the Insurance Appraisal Process is a Good Option for My Claim?

If the Appraisal Clause is in your policy then it is always an option. However, it's wise to point out that Appraisal is usually an option when there is a substantial difference in the amount between the two estimate totals. For example; let's say a fire completely destroys a house and the homeowner's personal property within it (Know as the Contents). The differences between what the insurance company wants to pay and what you wish to receive is $5,000. In this situation, the Appraisal Process is not the best idea. After paying the fees involved for the appraisal, you may not end up with much of the $5,000 being disputed.

Now, if we take the same fire that destroys the property and the dispute between the policyholder and the insurance company is $40,000, appraisal should be considered. The policyholder now has a chance to recover substantially more money than originally offered.

Also, the Appraisal Clause is only applicable if a dispute arises from a covered loss. If the insurance company denied the claim as something not covered then this is not a dispute on the amount to repair, but rather a dispute on coverage. For example; homeowners and business policies due not cover floods. Flood policies are purchased separately. So, if there is no coverage for the flood damages then the Appraisal Process is not an option.

Simply put, the Insurance Appraisal Process is to determine the "amount of loss," to property only. The Appraisal Panel is not to determine coverage, policy provisions, deductibles, how much was previously paid on the claim, etc. Let's say there was an appraisal for a grand piano that fell off a delivery truck on the highway. The Appraisal Panel's job is not to determine who's at fault, the policy coverage limit, if the truck had a registration, or anything other than "How Much is the Piano Worth."

As with our example earlier, if the insurance company offers a settlement of $10,000 to repair a roof and the policyholder has contractor bids for $15,000, then the Appraisal Process may not be the best option. The Appraisal Process may cost more than the $5,000 that's being disputed. Unfortunately, the differences in repair/replacement costs are usually much greater. When an insurance company generates an estimate for a claim of $75,000 and the policyholder has acquired professional bids several contractors of $200,000 or more, its time to invoke the appraisal clause.

Beginning The Appraisal Process

Either party associated with the policy can invoke the Appraisal Process. However, such a request must be made in writing. Each policy will have a time limit of when this can take place. Even if a claim has been closed for many years, either party can still dispute the claim and reopen for review. It's recommended that the request to invoke appraisal be sent via certified mail. Once the request to invoke the Appraisal Clause has been initiated, as explained earlier, each party, the insurance company and policyholder, appoints an Independent Appraiser. (If you wish to invoke the appraisal clause in your policy you need to submit a letter to your insurance company. Find more information at http://www.insurance-appraisal-services.com/invoke-appraisal.html )

Choosing An Independent Appraiser

It's important to select an Independent Appraiser that has experience with the damages being disputed in the claim. A person with expert knowledge of insurance claims handling and firsthand knowledge of the damaged property and its replacement cost. For example; a person with expert knowledge of insurance claims handling and with expert knowledge of the Appraisal Process, with little experience on the costs to replace an antique grand piano may not be the best choice. In the case of a home or building fire; a good Appraiser is someone who can generate their own line-item detailed estimate to repair or replace the damaged property, can secure multiple bids from reputable contractors to back up their findings, knows building codes, and can articulate unforeseen costs of repairs. If a building has historic features with materials like, solid Adler doors, large detailed moldings, and custom cabinets, a great amount of research with a salvager may be needed. The Appraiser should have experience with building procedures, materials and the cost of such terms to create an accurate "amount of loss," to return the property to the same condition it was prior to the loss. See, the policy provides coverage to replace the damaged property with those of like kind and quality. An Independent Appraiser that is not familiar with, or that does not have experienced contractors, engineers, and other experts to consult with about mold, demolition, cost associated with contents, and in some cases, additional living expenses, does not sound like a good candidate. You should choose your Independent Appraiser wisely. Look and interview someone with experience of the type of damage you have and with the type of property damaged, as well as a specialist when it comes to the Insurance Appraisal Process and also Insurance Claims Handling.

Many people confuse the words Independent Appraiser with that of a real estate appraiser. As you can see, a real estate appraiser is far from what is needed for an Insurance Appraisal. An Independent "Insurance," Appraiser is an insurance claims expert on costs and processes to repair or replace damaged property. The next question is, "Who will have such knowledge?" People requesting assistance in the past have asked if the following experts with the following backgrounds are good choices ;

Structural Engineers: This person may be a structural expert and could probably provide a good estimate to replace a building, but what about the contents (furniture, food, etc.) damage? Do they know anything about the insurance policy, the claims process, the software used by insurance companies, the Appraisal Process?

Construction Attorney: A Construction Attorney most likely has knowledge of construction contracts and issues that building contractors have. Do they know anything about the insurance policy, the claims process, the software used by insurance companies, the Appraisal Process, the contents damaged? (NOTE: If you retain an attorney as Appraiser, remember, there is NO attorney/client privilege because the attorney is being hired as an Appraiser, not as an attorney.)

Construction Superintendent or General Contractor: Again, excellent choice for generating a structural estimate, but is most likely not familiar with insurance claims... and even more importantly, the Insurance Appraisal Process.

Insurance Claim Attorney / Lawyer: Keep in mind that the process was designed to keep these types of disputes out of court. You can surely use an attorney as your appraiser; however, the fees can exhaust your reward. Attorney's fees range between 30% and 40% of the amount collected. This will dig deep into the net amount you receive. An Insurance Attorney will also have expert knowledge of the policy. However, the Appraisal Provision clearly notes that no policy provisions will apply. Has the attorney represented their clients in many appraisals or mostly in court cases? How familiar are they with the Appraisal Process, building costs, construction practices, the contents damaged? Does the attorney know anything about the software used by insurance companies? (NOTE: If you retain an attorney as Appraiser, remember, there is NO attorney/client privilege because the attorney is being hired as an Appraiser, not as an attorney.)

Independent Insurance Appraiser: Doesn't it make sense to hire an individual who is an expert of the process in which you are about to engage? You've heard the expression, "Would you go to your auto mechanic if you needed brain surgery?" It is highly recommended to use a qualified, professional, Insurance Appraiser. This professional will already know the Insurance Appraisal Process. They will also have qualified professionals (engineers, contractors, inspectors, etc.) at there disposal to back up their analysis.

Regardless of background, an Independent Appraiser will also require good communication skills and agree with the position they are defending. They should know about the insurance policy, the claims process, the software used by insurance companies, the Appraisal Process, contents damage, structural damages, building costs and processes, as well as materials and building codes. Makes sense, right?

Advantages to the Insurance Appraisal Process

There are several advantages to the Insurance Appraisal Process. The most obvious is costs. Insurance Attorney's will usually charge 30% to 45% of the total award. On a $200,000 claim, the attorney's fee would be in the range of Sixty to Ninety-thousand dollars ($60,000 to $90,000). That can hurt a policyholder trying to rebuild their life. Remember, the Insurance Appraisal Process was designed to keep these disputes out of the courtroom.

The advantage of invoking appraisal allows for a less formal or non-legal proceeding. An Independent Appraiser usually charges in the range of $125 to $200 per hour. Using the same example above with an award of $200,000; if the dispute took 25 to 50 hours, the cost would be in the range of Five Thousand to Ten Thousand dollars ($5,000 to $10,000). This can be a significant difference.

Another advantage is time. The courtroom can delay an insurance claim dispute for years, where the Appraisal Process usually only takes a few months. Sometimes it can last longer depending on the complexity of the claim. However, the courtroom will most certainly be longer. The result of less time and less cost becomes a less of a burden for both sides of the dispute.

Once an award is signed the insurance company has 30 to 60-days (depending on state) to settle the award.

Should I Invoke the Appraisal Clause For My Claim?

When the dispute is real and the damages are real, the policyholder usually see's a greater return at the end of the appraisal. If the policyholder's claim is supported by an Insurance Claims Expert, building or repair contractors, or an engineer - and the amount of money between the two estimates is large, the Appraisal Process is a no-brainer. However, if a contractor or Public Adjuster is trying to beef-up the damages for their own benefit, then it's the policyholder that pays dearly for it. If you're considering invoking appraisal on your claim you should consult an insurance claim expert to see if it's worth your time and effort.

Being that the Appraisal Award is binding the policyholder should be sure before they cost themselves unwanted anguish. If the outcome of your Appraisal Award is not what was to be expected, both parties must live with the result. As stated, the Appraisal Award is binding on "both parties."

At the end of the day nothing is risk free. There are no promises or guarantees with the outcome of any Appraisal. However, if you have a dispute over $20,000 you're more than likely to have a result you can live with. Do your homework and remember to choose an Independent Appraiser that is educated and experienced with the type of damages you have, what caused the damage, and the type of property damaged. Keep in mind that this is "YOUR," property and "YOUR," insurance policy. Your policy protects you with the Insurance Appraisal Process, so that...

The Playing Field Remains Level, and The Process Works Fairly

For Both Parties... Not Just The Insurance Companies!

Copyright of Insurance Claims Group, Inc. & Joseph P. Brennan: Joe Brennan is President and owner/operator of Insurance Claims Group, Inc., a national independent adjusting, appraisal, and umpiring firm. Joe has been in the property loss business for more than 24-years. His loss experience began as a contractor / builder, which included water and fire damage restoration repair services. After 20-years of insurance restoration estimating and repair experience, Mr. Brennan became a licensed independent insurance claims adjuster. Joe has maintained his IICRC Certification in both Fire and Water Restoration and also maintains active adjuster licenses in 10-states. Throughout his career, he has handled many multi-million dollar losses, both commercial and residential. The amount of combined experience and knowledge of new construction, damage repairs, and insurance claims handling has advanced his ability to act as a Dispute Appraiser and Appraisal Umpire. Mr. Brennan is highly educated with the appraisal process and has acted as an appraiser and umpire on dozens of claims.

How Some Life Insurance Policies Fail and Leave Grieving Families to Struggle Financially

2017-03-15T10:00:00.000-07:00

Many people own life insurance, but let's face it. It's probably not a purchase that most people brag about to their friends like they might if they had just purchased a new Corvette, but they made the purchase anyway because they love their families and want their family to carry on living their current lifestyle in the event of the primary breadwinner's untimely death. While this article doesn't apply to people who own term insurance, those who bought permanent life insurance, which is life insurance with an additional savings component, will find this information very important.

To understand the problem, I will first give you a brief primer on life insurance, and then explain how something that seems like a sure bet can go so wrong. Life insurance can be separated in to two basic types, term and permanent life insurance. With term insurance a person pays a certain amount of money, called a premium, for a period of time, from one year up to 30 years. During the specified period of time, as long as the insured person is paying the premium, the insurance company is obligated to pay a certain amount of money, called a death benefit, to the insured person's beneficiary in the event the insured person dies during that time period. If the person does not die in that time period the insurance company keeps the money as well as the earnings on that money. While there are different types of term insurance nowadays, including "return of premium" term which returns the insureds premium dollars at the end of the term(but not the earnings on the money), the general jist of term insurance is that a person is covered during a certain period of time. If they want coverage beyond that time period they have to buy another policy. Term insurance is really not the focus of this article so if that's what you have you can stop reading now if you wish, and rest assured that as long as you pay the premium, and the insurance company remains financially solvent, your family will be paid in the event of your untimely death.

The other type insurance is called permanent insurance. Permanent insurance is insurance that has a death benefit to it, similar to term, but also contains a savings "sidecar", this gives the policy a value called cash value. The premiums are paid on the policy, a portion is pulled to pay for the insurance and the remainder goes into the savings sidecar. There are three primary types of permanent insurance that vary depending on what is done with the savings component. The first type of permanent insurance is Whole Life Insurance. The savings component of Whole Life Insurance is invested in the general fund of the insurance company where it earns interest. The amount of interest apportioned to a particular individual is depended on how much of the money in the general fund belongs to that individual. Some policies if they are are "participating" policies also earn dividends. Generally speaking whole life policies are not a lapse danger as the amounts that it earns are guaranteed by the insurance company. As long as the insurance company remains solvent it will pay out a death benefit. The only problems a person who owns a Whole Life policy typically runs into is overpaying for insurance, and the death benefit not keeping pace with inflation.

The second type of permanent insurance is called Universal Life Insurance. With Universal Life Insurance the savings sidecar is a separate account, as opposed to Whole Life where the savings sidecar is invested into the general fund of the insurance company. Universal Life Insurance's main advantage is it's flexibility. For example, if you are a landscaper in the northeastern part of the country and basically have your winter months off, you could buy a Universal Life policy, fund it heavily during the spring, summer, and fall when you're raking in the big bucks, and then not pay anything during the winter months. As long as there is a certain amount of money in the savings sidecar (based on insurance company formulas), nothing needs to be done. Also, if you need additional insurance because you just had a child, you don't need to buy another policy. As long as you are insurable you can increase the death benefit on your current Universal Life Insurance policy and pay the extra premium. The money in the savings sidecar of a Universal Life Insurance policy is typically invested in ten year bonds. The Universal Life policy has a guaranteed interest rate to it, as well as a current rate. The money in the sidecar typically earns the slightly higher current rate, but the policy owner is only guranateed the guaranteed amount. Keep this last thought in your mind because after I describe Variable Insurance in the next paragraph, I'm going to tie these two together in the following paragraph and that final concept is the thing that's going wrong

The final type of permanent life insurance is Variable Life Insurance. It can be either straight Variable Life Insurance, or Variable Universal Life Insurance, which combines the versatility of Universal with Variable Life Insurance. Variable Insurance came about due to the awesome bull market in stocks that ran basically uninterrupted from 1982 through 2000. People wanted to invest as much as possible in the stock market and the thought of investing money in an insurance policy that invested in lower yielding bonds was quite distasteful to many. So the Variable Insurance Policy was built. With Variable Life the savings sidecar can be invested in insurance "sub-accounts" which are basically mutual funds within a Variable Life, or Variable Annuity. In fact, many sub-accounts exactly mirror a particular mutual fund, some mutual fund managers manage both their respective fund as well as its sub-account "sister." So with the Variable Life policy buying insurance no longer meant leaving the high flying stock market, you could have the best of both worlds by protecting your family AND investing in the stock market. As long as the savings in the sidecar was at an adequate level things were fine. Again, remember this last line because I'm about to show you how the whole thing goes to pot.

In the heyday of Universal Life Insurance and Variable Life Insurance interest rates were high and so was the stock market, and the insurance industry had two products that were custom designed to take advantage of the times. The problem came about when the agents designing these policies for the public assumed that the high interest rates and high flying stock market would never end. You see, whenever these products are sold, several assumptions have to be made outside of the guaranteed aspect of the policies which is typically about 3-5%, depending on the insurance company. The current values are paid out based on the prevailing rates or returns of the time, and that's exactly how the policies were designed. I can still remember when I began in the insurance industry back in 1994, when the experienced agents in my office were were writing Universal Life with a hypothetical 10-15% interest rate. Variable Universal would be written anywhere between 10-20%. Happy days were here to stay. Or were they? Unfortunately, those interest rates started heading south about the mid-1990s, and as we all know, except for a couple of years, the stock market didn't do so swell after the 2000 tech bubble, maybe two or three "up" years out of eight and possibly nine. This is a real problem because many families' futures were riding on the assumptions that were made in these policies. Many policyowners were told to pay during their working years and then to quit when they retired and the policy would be fine, the returns earned on the savings sidecar would keep the policy in force. There are countless Universal and Variable Life policies in bank and corporate trust accounts, as well as in dresser drawers and fire proof safes that were bought and assumed that as long as the premiums were paid, things were good to go. Many of these policies are sick or dying as we speak. Some people, or trustees will get a notice letting them know that they need to add more money or the policy will lapse, of course by this time "red line" has already been reached. The people who get this notice may even ignore it because hey, the agent said that all would be well, "pay for 20 years and the family will be taken care of when I meet my maker." So the policy will lapse and nobody will know it till it comes time for the family to collect their money, only to find out that they will meet the same fate as Old Mother Hubbard's Dog. If anybody reading this can picture the litigation attorneys licking their chops, waiting to let insurance agents and trustees have it with both barrels for negligence, don't worry that onslaught has already begun. But if you have one of these policies, don't count on the 50/50 prospect of winning a court case, do something about it!

One of the first things I do when I get a new client that has an existing permanent life insurance policy is do an "audit" of that policy. Just like the IRS does an audit to find out where the money went, I do an audit to find out where the premiums went. The way this is done is by ordering what is called an "In Force Ledger" on the policy from the insurance company. The In Force Ledger will show the status of the policy now under current conditions, as well as several other scenarios paying more or less money. It will also show if the policy is lapsed or will lapse in the future. By doing this audit the policyholder may get something that they didn't have before, OPTIONS!

For example, take a 50 year old policyowner, who is also the insured on the policy, and the In Force Ledger showed that the policy, under current condtions is going to lapse when the policyowner is 63 assuming premium payments were going to be kept the same, and stock market conditions were going to stay the same (this was in early 2007 and this policy was a Variable Universal Life, it probably would not have lasted till 63, given what has happened in the stock market.) Since the policyowner is the family breadwinner, they have a 16 year old daughter, and their savings could not sustain the wife and daughter in the event of an early death of the breadwinner, whether or not to keep the life insurance is not even a question, life insurance is absolutely needed in this case. Now the next question is, does he keep on paying on a policy that is going to lapse or write a new one? For that I go to some business associates at an insurance brokerage I work with, and find out how we can get a new policy without a huge increase in premium, in some cases the it is possible to get an increase in death benefit and a decrease in premium. How can this be done since the policyholder is older than when the policy is written? Easy. With the advances in medicine between 1980 and 2000 (the years the mortality tables used were written), people are living longer, conditions that used to cause death such as cancer, people are surviving and even live normal lives after the cancer is eliminated. It used to be you either smoked or you didn't. Now allowances are made for heavy smokers, social smokers, snuff users, cigar smokers etc. One company will even allow mild cannabis use. So in some cases your policy may not be lapsing, but a person may be overpaying even though they are older. Maybe they smoked socially then, but quit 5 years ago, but their policy still has them listed as a smoker paying the same premium as someone that smoked like a chimney. What happens if the solution that makes the most sense is a new policy? We do what is called a 1035 Exchange into a new policy, that allows the cash value of the current policy to be transferred to the new one without being taxed. What if the insured doesn't want another life insurance policy but wants to get out of the one they are currently in and not pay taxes? Then we do a 1035 Exchange to an annuity, either variable or fixed. I'm currently using a no-load annuity that works great and the expenses are low. Is a 1035 Exchange right in every situation? Absolutely NOT! Many things must be explored before making the exchange, especially on a policy written before 1988 when the tax law on insurance policies changed for the worse, in the above example it proved to be the correct move, but in the end it's up to the policyowner and family as to what direction to go.

In conclusion, if you have a permanent life insurance policy that is 5 years old or older, make sure you have it audited. The cost (nothing), versus the benefit (a family that doesn't have financial worries in their time of grief) makes this decision a no-brainer.

Mexican Tourist Auto Insurance - Tips on How to Purchase Insurance For Mexico

2017-03-11T10:00:00.000-08:00

Congratulations - you are embarking on an exciting road trip adventure to Mexico. You have your vehicle tuned and all of your gear packed, and now it is time to purchase your Mexican tourist auto insurance. Your Mexican auto insurance coverage decision could be the most important decision you make, but unfortunately it is often one of the most rushed and least researched decisions that many Mexico travelers make. Do not make the mistake of assuming that all Mexican insurance is the same, because the differences in insurance coverages and benefits can vary tremendously between Mexico insurance companies. Even though researching insurance coverage is not very exciting for most people, this article will show you how 5 to 10 minutes of research on the internet could save you thousands of dollars and many frustrating hours if you were to actually need to use your Mexico insurance to pay for a loss.

Use the internet to quote and purchase Mexican tourist auto insurance

The vast majority of Mexican auto insurance is now purchased directly from the internet. There are a number of websites that sell Mexico insurance, and buying your insurance from the internet makes a lot of sense for the customer. Would you rather wait till the last minute to buy your insurance at the border, or would you prefer to buy your insurance from the convenience of your own computer before you leave on your trip to Mexico? Most customers prefer to get their insurance taken care of ahead of time.

The best websites to buy your Mexico insurance from are ones that offer multiple Mexico insurance companies. This allows you to do comparison shopping through one website instead of filling out multiple quotation forms on multiple websites. One good Mexican insurance website with a comparison insurance rater will save you a lot of time and confusion.

Which websites can be trusted?

Before getting your insurance quote, make sure to look for a valid insurance license and contact information. Also, you may want to look for a 'Surplus Lines Broker' license number. A surplus lines broker is an insurance broker who has a direct contract with the Mexican insurance companies and is licensed to sell foreign insurance coverage within the United States. A surplus lines broker license is a good sign that the website is run by a company who specializes in Mexico insurance. If the insurance license is not a surplus lines broker license, this means the website is most likely run by an insurance agent who is selling through a surplus lines broker. This does not mean the products on the website are not valid, but you may not receive the same level of customer service as you would from a surplus lines broker who specializes entirely in Mexican insurance. You may also want to look for a Better Business Bureau listing and some sort of internet security approval such as Hacker Safe or McAfee Secure to ensure that your information will be secure during your internet transaction.

Mexico insurance coverage to look for

Once you have selected a website that sells Mexico tourist auto insurance, you will fill out the quick insurance quote form. Within a minute, you should be able to get a firm quote and begin researching the benefits of the insurance products offered. Remember, this will be a much quicker and streamlined process if you use a website that offers multiple competing insurance companies all under one quoting system (a comparative quote rater).

Look for a chart below or above the insurance prices that clearly explains exactly what the Mexico insurance limits are and what is actually covered. In this chart, you will want to look at the following categories:

Deductibles: The best Mexican insurance policies will offer fixed deductibles, meaning the deductibles will be locked at a set amount regardless of what the value of your vehicle is. Some of the less expensive policies will base deductibles on a percentage of the vehicle value. If the vehicle's value is less than $20,000, percentage based deductibles may be fine, but when vehicle values get up in the $30,000 range or higher, the percentage based deductibles can get very high. If the website does not specifically list the deductibles, you should not use that website!

US Hourly Labor Rates for Repairs Made in the US or Canada: In the old days, most Mexican auto insurance companies tried to make customers repair their vehicles in Mexico. Repairs made in Mexico instead of the US were often much less expensive for the Mexican insurance companies, and many customers were unwilling to leave their car in Mexico, so the company got out of paying these claims. Today, many of the better Mexico insurance programs allow you to fix your vehicle in the US or Canada if you wish. The catch is that some of the less expensive Mexican insurance programs will only pay a limited hourly labor rate for repairs made in the US (some as low a $20 per hour). This means the customer would have to pay the difference in hourly labor rates out of their pocket. The best Mexican insurance programs will pay very high US labor rates such as $70 per hour or state that they will pay whatever the current US hourly labor rate is. These policies could significantly minimize your out of pocket expenses in the event of a claim. If the Mexico insurance website does not specify if repairs in the US are allowed or what the hourly labor rate is, do not use that website to purchase your Mexican insurance!

Vandalism and Partial Theft Coverage: Vandalism and partial theft (meaning only part of the car is stolen such as the tires, door panels, etc) is typically not covered by standard Mexican auto insurance. In the past few years the higher quality Mexican insurance programs have started to offer this coverage in their enhanced coverage programs. If you want to protect yourself against as many types of losses as possible, you should look for this coverage.

Liability Limits: This is the portion of the Mexican insurance policy that pays for damages you cause to third parties. This coverage is essential when traveling in Mexico. Most people in the industry feel that $50,000 worth of liability insurance is probably the minimum you should consider. Some of the best Mexican insurance programs will go up to $300,000 combined single limit (a lump sum for property damage or bodily injury damages), but it will also increase the insurance premium. Some customers wish to carry these higher limits to work in tandem with their US umbrella liability policies. You may want to ask your US insurance provider if your umbrella insurance will recognize your Mexico auto insurance as a primary coverage.

Medical Payments: This is the portion of the Mexico insurance policy that pays for medical costs for you and your passengers (people inside your vehicle). $2,000 per person with a total of $10,000 per accident is the lowest limit you should consider, but many policies will offer much higher limits. Some of the better policies will also increase this amount if you are hit by an uninsured motorist who is at fault. You may want to check with your US or Canadian health insurance provider to make sure they will cover you for medical costs incurred while traveling in Mexico. If not, you may also want to research an international health insurance plan - but that is a different subject.

Legal Service: Make sure your Mexico insurance includes legal service or legal assistance. This coverage will pay for any court costs, attorney fees, or bail payments that are a result of a traffic accident in Mexico. The service will also dispatch a legal representative to hold your hand through any legal procedures. This coverage is absolutely essential, so do not purchase any Mexico auto insurance that does not include this coverage!

Road Assistance: Most of the better Mexico insurance companies will include some level of road assistance that will cover towing expenses, flat tires, locksmith, and other services. This is a great coverage to have, so make sure this is included with your Mexico insurance policy.

Medical Evacuation: As the market for Mexican insurance becomes more competitive, many Mexico carriers are now bundling in extra special coverages to make their products stand out. When medical evacuation is automatically included with your Mexico auto insurance, it is an incredible value and convenience. This coverage will coordinate and pay for air or land ambulance services in the event of 'grave illness or injury'. This means life threatening or very serious illnesses or injuries. Purchasing a medical evacuation program on your own will often cost hundreds of dollars per year, and can often have many limitations. The quality Mexico auto insurance programs that bundle in the medical evacuation coverage will usually cover multiple people in your travel group automatically up to four or more people. Make sure to look for how many people are covered by the medical evacuation. If the amount of people covered is not listed in the insurance quote details, you can assume that the medical evacuation may only cover the driver. Other websites do exist that specifically cover 4 or more people in your travel group, so it is highly recommended that you look for websites that offer this broader medical evacuation coverage.

Plane Tickets Home: Another great benefit that many of the better Mexico insurance websites are offering is plane tickets home in the event that your car is stolen or not drivable. This can save you thousands of dollars, and alleviate the nightmare of needing to coordinate your transportation back to your home from Mexico. If this benefit is offered, make sure to see for how many people the policy will provide plane tickets home. If plane tickets home is not listed, or the website does not specify how many people are covered, you should check a different website. A few websites do offer coverage for four people or more in your travel group.

When in doubt, call the website customer service phone line for help

The reputable Mexico insurance websites will encourage you to call their customer service departments if you have questions about the Mexico insurance. If nobody answers the phone, or does not call you back within a few minutes (during normal business hours), you may not want to purchase your insurance from that website! Most Mexico insurance websites are like ATM machines. The website is there for your convenience if you want to write the policy yourself, but you are also welcome to call the website customer service insurance agents and have the agents write the policy for you over the phone.

If you check for each of these insurance coverages and website features while shopping for Mexican auto insurance on the internet, you are guaranteed to purchase the best insurance for your situation. Five to ten minutes of research could save you thousands of dollars and hours, if not weeks, of headaches in the event that you need to file a Mexican insurance claim. Be safe, and have fun in Mexico!

Insurance In Tort Laws

2017-03-03T18:22:00.000-08:00

INTRODUCTION

This project has been an eye opener for me. It is extremely relevant to the modern times and as the future of India we should understand that it is the common mass that runs the country. Consumer protection rights are an important issue in modern days. The law can be effectively used to stop any abuse of the common people especially illiterate masses who do not understand the rules and regulations which is to be followed while buying particular item. It is law, the controller of the entire society which can stop this abuse from taking place. It can place effective standards guiding a product's genuinity and the proper verification of its price. No extra taxes should be issued according to the seller's wish. I have proceeded by referring to the books written by Avtar Singh, Venkat Rao and others. It has been a wonderful and educational delight in going about this topic and making a project which is of greatest importance in the present day scenario.

DEFINITION OF CONSUMER

The words "consumer", "consumed", "consumption" is all cognate, and when one is defined, the contents of the definition go into all of them wherever they occur in the same act.

Section 2 of the act wherein 'consumer' is defined. According to him, the definition of the consumer will not take a client who engaged the advocate for professional services.

Consumer means any person who-

- Buys any goods for a consideration which has been paid or promised or partly paid and partly promised or under any system or deferred payment and includes any user of such goods other than the person who buys such goods for consideration paid or promised or partly promised or under any system of deferred payment when such use is made with the approval of the person, but does not include a person who obtains such goods for resale or for any commercial purpose

- Hires or avails of any services for a consideration which has been paid or promised or partly paid or partly promised or under any system of deferred payment and includes any beneficiary of such services other than the person who hires or avails of the services for the consideration paid or promised or partly paid or partly promised or under any system of deferred payment when such services are availed of with the approval of the first mentioned person but does not include a person who avails of such services for any commercial support

In Black's Law Dictionary it is to mean:

One who consumes. Individuals who purchase, use, maintain or dispose of products and services. A member of that broad class of people who are influenced by pricing policies, financing practices, quality of goods and services, credit reporting debt collection and other trade practices for which the state and federal consumer laws are enacted.

OBJECTVES OF THE ACT

The act is dedicated, as its preamble shows, to provide for better protection of rights of consumers and for that purpose to make provisions for the establishment of consumer councils and other authorities for settlement of consumer disputes and for other connected matters. In the statement of objects, reasons it is said that and the act seeks to provide speedy and simple redressal to consumer disputes. Quasi judicial body machinery has been set up at the district, state and central levels. These quasi judicial bodies have to observe the principle of natural justice and have been empowered to give relief to a specific nature and to award, wherever appropriate, compensation to consumers. Penalties for non compliance of orders given by quasi judicial bodies have also been provided.

The object and purpose of rendering the act is to render simple, inexpensive and speedy remedy to consumers with complaints against defective goods and deficient services and for that quasi judicial machinery has been sought to be set up at the district, state and national levels. These quasi judicial bodies are required to apply the principle of natural justice and have been empowered to give relief of specific nature and appoint wherever necessary, compensation to consumers.

INSURANCE

An operational definition of insurance is that it is

- the benefit provided by a particular kind of indemnity contract, called an insurance policy;

- that is issued by one of several kinds of legal entities (stock company, mutual company, reciprocal, or Lloyd's syndicate, for example), any of which may be called an insurer;

- in which the insurer promises to pay on behalf of or to indemnify another party, called a policyholder or insured;

- That protects the insured against loss caused by those perils subject to the indemnity in exchange for consideration known as an insurance premium.

The influence of insurance on the law of torts has been significant, both on theoretical level and on practice. Insurance has undermined one of the two main functions of awarding of damages, and it has in cast doubt on the value judgements made by the courts in determining which particular test of liability is appropriate in the given circumstances.

Regardless of whether in the particular circumstances the appropriate principle of liability is intention is malice, fault or strict liability, the purpose of common law damages remains the same. The primary purpose of an award of damages is to compensate the victim for his loss, with view to restoring him as near as possible to the position he would have been in but for the tort of the wrongdoer. But damages have another: by making the wrongdoer responsible for meeting an award of damages, the courts are trying to deter others from committing similar tortuous wrongs.

Insurance vitiates the secondary purpose of damages, at the same time incidentally ensuring that the primary purpose is more often achieved.

It can scarcely be realistically asserted that insured defendants are deterred by the prospect of losing no-claims bonus or by increasing of premium on renewal of their policies. Once it is conceded that insurance renders compensation for the sole purpose of damages but then the tort action itself becomes vulnerable to attack, for there are many ways-some perhaps fairer and administratively cheaper than tort- of compensating a victim for a loss he has suffered.

Prima facie, where a person suffers loss of recognized kind as the result of another's act, then the latter should have to make good that loss. But for valid reasons, the courts have held that, in certain circumstances, the actor will have to compensate his victim only if he is at fault. The victim's right to compensation is, therefore curtailed in an attempt to be fair to both the parties. The courts have made a policy decision that, in the circumstances, it is right to reward a defendant who has been careful by protecting him from liability for the consequences of his actions and that, as a corollary the plaintiff must forego his compensation. The policy decision is made on the supposition that the wrongdoer would himself have to pay for the damages but for this protection; it by no means follows that the same decision would be made if there were no risk of the wrongdoer having to provide the compensation.

It is difficult to judge the victim's right to compensation should be curtailed when that curtailment is not justified by a corresponding benefit to the wrongdoer. The requirement of fault ceases to play its role as the leveler between the victim's legitimate expectations and the wrongdoer's legitimate expectations, and becomes simply a hurdle to the victim's progress to compensation. If it is accepted that no one can insure against liability for harm caused by intentionally to another , then similar arguments can be made by the inappropriateness of the victim's having, in certain circumstances to prove an intention to do him wrong or harm, when it is irrelevant to the wrongdoer whether he had such an intention or not.

Again the victim's right to compensation is being curtailed without any corresponding benefit to the wrongdoer.

However, insurance has influenced the law of tort on a much more practical level as well. While the fact of insurance is not of itself a reason for imposing liability , there can be no doubt that it does add "a little extra tensile strength" to the chain which a wrongdoer to his responsibilities.

As well it has given new horizon to damages ; it is true that traditionally it was considered to inform the court that a defendant was insured , but "those days are long past" and now it is frequently openly recognized that the defendant would be insured.

The policy of insurance constitutes a contract of insurance between Life Insurance Corporation or a subsidiary of General Insurance Company of India, as the case may be, such services such has been undertaken to render under the contract of insurance. However as a rule, occasion to render services arise only when insured surrenders his policy, or the policy matures for payment or the insured dies or any other contingency which gives rise to render service occurs.

Breach of contract of insurance may give rise to a cause of action to file a civil suit, but such breach of contract may itself constitute deficiency in service, so as to give a cause of action to file a complaint under the consumer protection act for one such more relieves awardable hereunder.

Section 13(4) of the act vests in a redressal agency powers of the Civil Court, while trying a suit in respect of such matters as examination of witnesses on oath and production of documents. Declining to exercise jurisdiction in a case before it only because it involves examination and cross examination of facts, witnesses and production and consideration of documents would amount to abdication of its jurisdiction.

Such discretion can be exercised only when the gives rise to several issues and necessities taking of voluminous oral and documentary evidence, or otherwise involve complex questions of fact and law which cannot be decided in time bound proceedings under the consumer protection act.

MOTOR VEHICLE INSURANCE

Where the sale of a vehicle is complete, the title therein passes to the purchaser notwithstanding that his name has not been recorded in the R.C.Book. Such owner is entitled to get his vehicle insured and also to maintain a claim on the basis of such insurance. The earlier owner, who has lost insurable insurance on the sold vehicle, cannot advance a claim on the basis of policy of the said vehicle, earlier taken by him, on the ground that he is still the recorded owner of the said vehicle.

Section 157 of the motor vehicles act is only in respect of third party risks and provides that the certificate of insurance described therein shall be deemed to have been transferred in favour of the person to whom the motor vehicle is being transferred. It does not apply to other risks, if any, covered by the policy. If the transferee wants to avail the benefits of other risks covered by it, he has to enter into an agreement thereof with the investor.

FRAUD BY INSURER

If it is established that the discharge voucher was obtained by fraud, misrepresentation, undue influence or coercive bargaining or compelled by circumstances, the authority of the consumer forum may be justified in granting relief. Mere execution of the discharge voucher would not deprive the consumer of his claim in deficiency of service.

DELAY IN SETTLEMENT OF CLAIM

In Sarveshwar Rao v. National Insurance Company Ltd. , it was held that the delay of two or more years in settling the insurance claim would result in inadequacy in the quality, nature and manner of the service which the insurance company has undertaken to render, and amounts to deficiency in service.

In Delkon India Pvt. Ltd. V. The Oriental Insurance Company Ltd. . The National Commission has held that it was a deficiency of service to have delayed the claim by two years on the ground that the final police report was not coming.

INTERPRETATION OF TERMS

In Skandia Insurance Company v. Kokilaben Chandravadan , the honorable Supreme Court ruled that the exclusion terms of the insurance must be read with so as to serve the main purpose of the policy, which is to indemnify the damages caused to the vehicle.

CONDUCT OF THE INSURER

In Oriental Insurance Co. Ltd. V. Mayur Restaurant and bar , the conduct of the insurer was under question. The commission held that deficiency of the service was established on the part of the opposite party on two counts i)delay in settlement of claims and ii) unreasonable and un maintainable reasons for repudiating the claim of the complainant, and the compensation with the interest and cost was awarded.

SUICIDE BY THE ASSURED

In Life Insurance Corporation v Dharma Vir Anand, the national commission refused to hold the insurance commission liable as the insured committed suicide before the expiry of three years from the date of the policy.

BREACH OF TERMS

In B.V.Nagarjuna v Oriental Insurance Company Ltd., the terms of insurance contract permitted the insured vehicle to carry six passengers at a time but the driver allowed two more persons to get in. It was held that merely adding two more persons without the knowledge of the driver did not amount to indemnification by the insurance company.

NOMINEE'S RIGHTS

In Jagdish Prakash Dagar v. Life Insurance Corporation , it was held that a nominee under a policy of life insurance will be a consumer within the meaning of section 2(1) (d) of the Consumer Protection Act. The commission held that the nominee could legislatively maintain an action against deficiency raised in service by the arbitrary decision of the insurer.

REPUDIATION

Repudiation is defined as the renunciation of a contract (which holds a repudiator liable to be sued for breach of contract, and entitles the repudiatee on accepting the repudiation to treat the contract as at an end

This concept of repudiation is needed in the concept of insurance. The concept of repudiation will be dealt hereto a number of times and to provide beneficiary evidence, the definition has been given.

Unilateral repudiation of its liability, under the contact of by the life insurance corporation or an insurance company does not, by itself oust the jurisdiction of a redressal agency, to go into the sustainability of such repudiation, on facts and in law and to decide and to adjudicate if, in the facts of the case, it amounts to deficiency in service or unfair trade practice, and if so, to award to the aggrieved person, such relief or reliefs under Section 14(1) of the said Act as he or she is entitled to. The fact that before such repudiation it obtained a report from a surveyor or surveyors also does not oust the jurisdiction of a redressal agents to into the merits of such repudiation, for otherwise in each case the corporation or such company, and deprived the aggrieved person of the cheap and expeditious remedy under the consumer protection act.

Where, however the corporation or the company conducts thorough investigations into the facts which have given rise to claim and other associated facts, and repudiates the claims in good faith after exercise with due care and proper application of mind, the redressal agency should decline to go into the merits of such repudiation and leave the aggrieved person to resort to the regular remedy of a suit in a civil court.

The law does not require the life insurance corporation or an insurance company to accept every claim good or bad, true or false, but it does require the corporation or the company to make a thorough investigation into such claim and to take decisions on it, in good faith, after exercise of due care and proper application of mind and where it does so it renders the service required by it and cannot be charged with deficiencies in service, even if, in the ultimate analysis, such decisions is wrong on the facts and in law and the redressal agency would be disinclined to substitute its own judgement in the place of the judgement of the corporation or insurance company.

The question as to whether repudiation of its liability does or does not amount to deficiency in service would depend upon the facts of each case.

Where a cheque sent towards a premium is dishonoured by the drawee bank and consequently the policy is cancelled or it lapses or the injured dies before the proposal is accepted and contract of insurance results, no claim can be founded in such a policy, which was cancelled or has since lapsed, or a contract of insurance, which did not materialize at all. Repudiation of such claim can never amount to deficiency in service.

Insurance agent is not entitled to collect premium on behalf of the corporation. Where an insured issues a bearer cheque towards premium and hands it over the insurance agent who encashes it, but does not deposit the premium with the corporation event till the expiry of the grace period and consequently the policy lapses and meanwhile the insured also dies, his nominee has to blame himself or herself for the indiscretion of the insured and cannot blame or fault the corporation.

BASIC PRINCIPLES OF INSURANCE

There are some basic principles concerning the topic of Consumer Protection Law and Insurance.

- Settlement of insurance claim is service, default or negligence therein is deficiency of that service

In the case of Shri Umedilal Agarwal v. United India Assurance Co. Ltd, the National Commission observed as under:

"We find no merit in the contention put forward by the insurance company that a complaint relating to the failure on the part of the insurer to the settle the claim of the insured within a reasonable time and the prayer for the grant of compensation in respect of such delay will not within the jurisdiction of the redressal forums constituted under the consumer protection act.

The provision of facilities in connection with insurance has been specifically included within the scope of the expression "service" by the definition of the said word contained in section 2(i) (o) of the act. Our attention was invited by Mr. Malhotra, learned counsel for the insurance company to the decision of the Queen's Bench in national transit co. ltd. V. customs and central excise commissioners . The observations contained in the said judgement relating to the scope of the expression insurance occurring in the schedule of the enactment referred to therein are of no assistance to all of us in this case because the context in which that expression is used in the English enactment considered in that case is completely different. Having regard to the philosophy of the consumer protection act and its avowed object of providing cheap and speedy redressal to customers affected by the failure on the part of persons providing service for a consideration, we do not find it possible to hold that the settlement of insurance claims will not be covered by the expression insurance occurring in section 2(1)(d).Whenever there is a fault of negligence that will constitute a deficiency in the service on the part of the insurance company and it will perfectly open to the concerned aggrieved customer to approach the Redressal Forums under the act seeking appropriate relief."

- L.I.C. Agent has no authority in collecting the premium

The supreme court held that under regulation 8(4) of life insurance corporation of India (agents) regulation, 1972 which had acquired the status of life insurance corporation agents rules with effect from January 31, 1981, which were also published in the gazette, LIC agents were specifically prohibited from collecting premium on behalf of LIC and that in view thereof an inference of implied authority cannot also be raised.

- Rejection of claim as false after full investigation

The national commission held as follows:

" from the facts disclosed by the record and particularly averments contained in the consumer affidavit filed by the first respondent it is seen that the insurance company had fully investigated into the claims put forward by the complainant that his claim was rejected. Thus it is not a case where the insurance company did not take a prompt and immediate option for deciding the claims against the insurance company. Having regards to the facts and circumstances of this case and the nature of the controversy between the parties we consider that this is a matter that should be adjudicated before a civil court where the complainant as well as the respondent will have ample opportunities to examine witnesses at length, take out the commission for local inspections etc. and have an elaborate trial of the case."

- Unilateral reduction in the insurance amount.

The national commission held that the insurance company is not entitled to make a unilateral reduction of Rs. 4, 29,771 from Rs. 30, 12,549 at which its own surveyor assessed the loss.

- Mere repudiation does not render the complaint not maintainable.

The national commission overruled the objection of the insurance company that merely because the insurer had totally repudiated its liability in respect of the claim, no proceedings could validly be initiated by the insured under the consumer protection act.

- Mere unilateral repudiation does not oust the jurisdiction.

The national commission held that merely because the insurer has repudiated the insurance claim under the policy unilaterally, it is difficult to hold that the various redressal forums constituted under the consumer protection act, 1986 will have no jurisdiction to deal with the matter that if such a contention of the insurance company can get a report from the surveyors, repudiate the claim and oust the jurisdiction of the redressal forums, that the redressal forums are, therefore, bound to see whether or not the repudiation was made in good faith on valid and justifiable grounds that if the surveyor or surveyors choose to submit the wrong report and the insurance company repudiates the claims without applying its mind then the repudiation cannot be said to be justified that the report of the surveyor will show that the investigations have been proper, fair and thorough and that it has to be remembered that the surveyors bread comes from the employer.

- Mere unilateral repudiation no ground to oust jurisdiction.

The national commission repelled the objection and observed as under:

"Ordinarily a remedy is available to a consumer in Civil Court but mere repudiation of claim arising out of policy of insurance under section 45 of the insurance act, 1938, cannot take away the jurisdiction of the redressal forum constituted under the act. The avowed object of the act is to provide cheap, speedy and efficacious remedy to the consumers and it is with this object that section 3 of the act lies down as follows:

3. Act not in derogation of the provisions of any other law: - the provisions of this act shall be in addition to and not in derogation of the provisions of any other law for the time being in force."

The national commission overruled the objection in the view of repudiation of contract of insurance by the corporation; the redressal agencies under the act cannot entertain the claim of the insured and reiterated the law laid down by it in the Divisional Manager, Life insurance Corporation of India, Andhra Pradesh v. Shri Bhavnam Srinivas Reddy.

- Removal of insured goods on attachment no theft.

It was ruled in the stated case that attachment of certain items of insured Machinery and goods by the bailiff of a civil court, though later found to be illegal and consequent removal did not amount to theft and or house breaking by force so as to entitle the insured to prefer a claim under the policy.

- When repudiation amounts to deficiency and when it does not?

The national has held:

In M/s Rajdeep Leasing and Finance and others v. New India Assurance Company Limited and others -

That rejection of the claim by the insurance company after examining and considering the two separate survey reports from qualified surveyors and three legal opinions from different oriental counsels could not be said to constitute a deficiency in service so as to give a rise in the cause of action for a complaint under the consumer protection act.

In Oriental Insurance Co. Ltd. V Modern Industries Ltd. , the national commission has held that where the cover note inter alia mentions that the risk is subject to the usual terms and conditions of the standard policy, it is equally the responsibility of the complainant to call for these terms and conditions even if they are not sent by the insurance company, as alleged, to understand the extent of risk covered under the policy and associated aspects.

In Life Insurance Corporation of India v. Dr. Sampooran Singh

The complainant had taken out an insurance policy of 40,000 rupees in 1982, for the purpose of payment of estate duty on his only residential house in chandigarh in the event of his death and paid 5 premia, but with the abolition of estate duty on one residential house owner in 1985, the policy became inoperative due to the act of the state and not due to any deficiency on the part of the corporation any dispute between the parties as to the amount payable there under cannot be construed as deficiency in service on part of the corporation.

In LIC of India v M/s Kanchan Murlidhar Akkalwar

The complainant applied to the opposite party for housing loan, and on the advice of the latter, she took two LIC policies, one for Rs. 90000 and the other for Rs. 20000 entered into an agreement for the purchase of the house with the house with the owner on the advice of the opposite party obtained a fire policy for Rs. 2 lakhs. The opposite party advised the complainant to obtain a release deed from the zilla parishad co operative society in respect of the she proposed to purchase with a certificate that the said plot is not mortgaged therein. The complainant got a certificate from the Maharashtra government that the vendor had re paid the housing loan and interest thereon due to Zilla Parishad Krishi Karmachari Sehakari Gribe Narman Sanstha and that there was nothing outstanding from him towards loan amount or interest. Still the opposite party did not release the loan. On these facts the national commission by its majority judgement observed that:

"We have carefully gone through the records and heard the counsel. Clause 1 (c) of the loan offer letter clearly states that the advance of the loan is subject to the property being free from encumbrances to the satisfaction of the insurance company and a good and marketable title. At the same time it appears that the respondent-complainant had to go through a number of steps, although necessary, having financial implications and causing mental and physical stress to her and at the end of all of which she was told that no dues certificate given by the maharashtra government in respect of the prospective seller of the property in question, was not "release of mortgage" certificate that was obtained. The respondent complainant perhaps also had in her mind the case of Mr. Vaishempayam who got the loan under similar circumstances. Thus the evasion petition is disposed of as above."

CONCLUSION

This project topic is increasingly beneficial in the modern times with the consumer protection rights being redressed with due care. It is being advertised in the mass media in our country. The slogan which our consumer is using is: "JAGO GRAHAK JAGO". The time has come to realize the ideal market situation in which the buyers are not persuaded or coerced falsely into buying items which are of no use to them at all. Besides the relationship between buyer and seller should not be damaged at any cost. The relationship between the buyer and seller is said to be a fiduciary relationship and the trust between them should remain intact. A time has come in which the customer should get his proper position in the market conditions. He has to have proper knowledge about what is going on in the market and the concerned prices and the supply and the different other practices referred to.

Insurance is a very sensitive issue in the modern times. People are being hoodwinked into signing up in companies which are turning out to be frauds in the true sense of the term. This project has been an eye opener to me and I have come to realize the importance of the consumer protection act and insurance.

Small Business Health Insurance - The Best Policy Is A Great Agent

2017-02-23T18:18:00.000-08:00

I have been a health insurance broker for over a decade and every day I read more and more "horror" stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few "loopholes" in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn't until they receive a "denial" letter from the insurance company that they take their policy out to really read through it.

The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan's coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible.

For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don't realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that "benefits were denied."

Sure, we all complain about insurance companies, but we do know that they serve a "necessary evil." And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price.

Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they "want" and the benefits they really "need." Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great "curb appeal," I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not! In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month?

Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn't the 80/20 plan still offer you adequate coverage? Don't you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn't it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?

Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) qualified H.D.H.P.'s (High Deductible Health Plans) so they have more control over how their health care dollars are spent. Consumers who purchase an HSA Qualified H.D.H.P. can put extra money aside each year in an interest bearing account so they can use that money to pay for out-of-pocket medical expenses. Even procedures that are not normally covered by insurance companies, like Lasik eye surgery, orthodontics, and alternative medicines become 100% tax deductible. If there are no claims that year the money that was deposited into the tax deferred H.S.A can be rolled over to the next year earning an even higher rate of interest. If there are no significant claims for several years (as is often the case) the insured ends up building a sizeable account that enjoys similar tax benefits as a traditional I.R.A. Most H.S.A. administrators now offer thousands of no load mutual funds to transfer your H.S.A. funds into so you can potentially earn an even higher rate of interest.

In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or "ripped-off" by their insurance company and/or insurance agent. In fact, I hear almost identical comments from almost every business owner that I speak to. Comments, such as, "I have to run my business, I don't have time to be sick! "I think I have gone to the doctor 2 times in the last 5 years" and "My insurance company keeps raising my rates and I don't even use my insurance!" As a business owner myself, I can understand their frustration. So, is there a simple formula that everyone can follow to make health insurance buying easier? Yes! Become an INFORMED consumer.

Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in their filing cabinet or dresser drawer. You know the policy that they bought to protect them from having to file bankruptcy due to medical debt. That policy they purchased to cover that $500,000 life-saving organ transplant or those 40 chemotherapy treatments that they may have to undergo if they are diagnosed with cancer.

So what do you think happens almost 100% of the time when I ask these individuals "BASIC" questions about their health insurance policy? They do not know the answers! The following is a list of 10 questions that I frequently ask a prospective health insurance client. Let's see how many YOU can answer without looking at your policy.

What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. Blue Cross Blue Shield-"Basic Blue")
What is your calendar year deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? (e.g. The majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needed extensive medical care.)
What is your coinsurance percentage and what dollar amount (stop loss) it is based on? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000 or there are some policies on the market that have NO stop loss dollar amount.)
What is your maximum out of pocket expense per year? (e.g. All deductibles plus all coinsurance percentages plus all applicable access fees or other fees)
What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any "per illness" maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but may have a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)
Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, N.A.S.E. is known for endorsing schedule plans) 7. Does your plan have doctor co-pays and are you limited to a certain number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you go to the doctor per year for a co-pay and, quite often the limit is 2-4 visits.)
Does your plan offer prescription drug coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications).
Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you will often have to pay for all anti-rejection medications out of pocket).
Do you have to pay a separate deductible or "access fee" for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health's "CoreMed" plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Also, many plans have benefit "caps" or "access fees" for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit "caps" could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 "access fee" per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible).

Now that you've read through the list of questions that I ask a prospective health insurance client, ask yourself how many questions you were able to answer. If you couldn't answer all ten questions don't be discouraged. That doesn't mean that you are not a smart consumer. It may just mean that you dealt with a "bad" insurance agent. So how could you tell if you dealt with a "bad" insurance agent? Because a "great" insurance agent would have taken the time to help you really understand your insurance benefits. A "great" agent spends time asking YOU questions so s/he can understand your insurance needs. A "great" agent recommends health plans based on all four variables; wants, needs, risk and price. A "great" agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And lastly, a "great" agent looks out for YOUR best interest and NOT the best interest of the insurance company.

So how do you know if you have a "great" agent? Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a "great" agent. If you were able to answer the majority of questions, you may have a "good" agent. However, if you were only able to answer a few questions, chances are you have a "bad" agent. Insurance agents are no different than any other professional. There are some insurance agents that really care about the clients they work with, and there are other agents that avoid answering questions and duck client phone calls when a message is left about unpaid claims or skyrocketing health insurance rates.

Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don't be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. If you don't feel comfortable with the type of coverage that your agent suggests or if you think the price is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you purchase. And, most importantly, read all of the "fine print" in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.

If you can't understand something, or aren't quite sure what the asterisk (*) next to the benefit description really means in terms of your coverage, call your agent or contact the insurance company to ask for further clarification.

Furthermore, take the time to perform your own due diligence. For example, if you research MEGA Life and Health or the Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find that there have been 14 class action lawsuits brought against these companies since 1995. So ask yourself, "Is this a company that I would trust to pay my health insurance claims?

Additionally, find out if your agent is a "captive" agent or an insurance "broker." "Captive" agents can only offer ONE insurance company's products." Independent" agents or insurance "brokers" can offer you a variety of different insurance plans from many different insurance companies. A "captive" agent may recommend a health plan that doesn't exactly meet your needs because that is the only plan s/he can sell. An "independent" agent or insurance "broker" can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.

Over the years, I have developed strong, trusting relationships with my clients because of my insurance expertise and the level of personal service that I provide. This is one of the primary reasons that I do not recommend buying health insurance on the Internet. In my opinion, there are too many variables that Internet insurance buyers do not often take into consideration. I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an agent or broker, my advice would be to use eBay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make....your health insurance policy.

Lastly, if you have any concerns about an insurance company, contact your state's Department of Insurance BEFORE you buy your policy. Your state's Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn't being honest with you, your state's Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.

In closing, I hope I have given you enough information so you can become an INFORMED insurance consumer. However, I remain convinced that the following words of wisdom still go along way: "If it sounds too good to be true, it probably is!" and "If you only buy on price, you get what you pay for!"

Auto Insurance Principles Should Apply to Health Insurance

2017-02-08T18:13:00.000-08:00

Many Americans rely on their automobiles to get to work. No automobile means no job, no rent or mortgage money, no food. A single parent, struggling to make ends meet in the suburbs with 100,000 miles on the odometer, would presumably welcome the guaranteed opportunity for low-priced insurance that would take care of every possible repair on her auto until the day that it reaches 200,000 miles or falls apart, whichever comes first. Especially if the insurance is valid regardless of whether she even changes the oil in the interim.

So why aren't the auto insurance companies writing such coverage, either directly or through used auto dealers? And given the importance of reliable transportation, why isn't the public demanding such coverage? The answer is that both auto insurers and the public know that such insurance can't be written for a premium the insured can afford, while still allowing the insurers to stay solvent and make a profit. As a society, we intuitively understand that the costs associated with taking care of every mechanical need of an old automobile, particularly in the absence of regular maintenance, aren't insurable. Yet we don't seem to have these same intuitions with respect to health insurance.

If we pull the emotions out of health insurance, which is admittedly hard to do even for this author, and look at health insurance from the economic perspective, there are several insights from auto insurance that can illuminate the design, risk selection, and rating of health insurance.

Auto insurance comes in two forms: the traditional insurance you buy from your agent or direct from an insurance company, and warranties that are purchased from auto manufacturers and dealers. Both are risk transfer and sharing devices and I'll generically refer to both as insurance. Because auto third-party liability insurance has no equivalent in health insurance, for traditional auto insurance, I'll examine only collision and comprehensive insurance -- insurance covering the vehicle -- and not third-party liability insurance.

Bumper to Bumper

The following are some commonly accepted principles from auto insurance:

Bad maintenance voids certain insurance. If an automobile owner never changes the oil, the auto's power train warranty is void. In fact, not only does the oil need to be changed, the change needs to be performed by a certified mechanic and documented. Collision insurance doesn't cover cars purposefully driven over a cliff.
The best insurance is offered for new models. Bumper-to-bumper warranties are offered only on new cars. As they roll off the assembly line, automobiles have a low and relatively consistent risk profile, satisfying the actuarial test for insurance pricing. Furthermore, auto manufacturers usually wrap at least some coverage into the price of the new auto in order to encourage an ongoing relationship with the owner.
Limited insurance is offered for old model autos. Increasingly limited insurance is offered for old model autos. The bumper-to-bumper warranty expires, the power train warranty eventually expires, and the amount of collision and comprehensive insurance steadily decreases based on the market value of the auto.
Certain older autos qualify for additional insurance. Certain older autos can qualify for additional coverage, either in terms of warranties for used autos or increased collision and comprehensive insurance for vintage autos. But such insurance is offered only after a careful inspection of the automobile itself.
No insurance is offered for normal wear and tear. Wiper blades need replacement, brake pads wear out, and bumpers get dings. These aren't insurable events. To the extent that a new car dealer will sometimes cover some of these costs, we intuitively understand that we're "paying for it" in the cost of the automobile and that it's "not really" insurance.
Accidents are the only insurable event for the oldest automobiles. Accidents are generally insurable events even for the oldest autos; with few exceptions service work isn't.
Insurance doesn't restore all vehicles to pre-accident condition. Auto insurance is limited. If the damage to the auto at any age exceeds the value of the auto, the insurer then pays only the value of the auto. With the exception of vintage autos, the value assigned to the auto goes down over time. So whereas accidents are insurable at any vehicle age, the amount of the accident insurance is increasingly limited.
Insurance is priced to the risk. Insurance is priced based on the risk profile of both the automobile and the driver. The auto insurer carefully examines both when setting rates.
We pay for our own insurance. And with few exceptions, automobile insurance isn't tax deductible. As a result, the fear of increasing insurance rates due to traffic violations and/or accidents changes our driving behavior and we sometimes select our automobiles based on their insurability.

Each of the above principles is supported by solid actuarial theory. Although most Americans can't describe the underlying actuarial theories, most everyone understands the above principles of auto insurance at the intuitive level. For sure, as indispensable automobiles are to our lifestyles, there is no loud national movement, accompanied by moral outrage, to change these principles.

Unsustainable Market

In contrast, similar principles are routinely violated in health insurance. To demonstrate this, let's return to the same suburban mother from the opening paragraph. She's busy working, driving to and from work, and driving her kids to school and activities. She ends each day exhausted, sitting on the couch with fast food. She's obese, has a sedentary life, a bad diet, and hasn't taken the time to go to the doctor in years. After a simple injury doesn't heal for weeks, she turns up at the emergency room and learns she has type II diabetes. Although type II diabetes is controllable, changing diet and exercise habits and properly tracking her condition takes time and effort and she's never quite successful in implementing the necessary lifestyle changes.

So the initial emergency room visit is only the first of a long list of health care related to non-controlled diabetes and other problems associated with obesity. Whether she has individual or group insurance, her insurance pays for each episode of care, without singling her out for a premium increase, and without charging her any more cost sharing than is charged to the healthiest and most medically diligent insureds. Her coverage continues until she voluntarily changes insurance companies and/or employers or becomes eligible for Medicare. If she's covered under group insurance she may not even pay any premium. Her insurance continues unabated, even though the disease was caused by neglecting her body and she maintains her poor lifestyle even after the disease becomes known.

This just wouldn't happen in auto insurance. This scenario is the auto insurance equivalent of guaranteed access to low-priced auto insurance that takes care of every possible repair, including damage already done, until the day the car falls apart so completely it's unsalvageable (death) or reaches 200,000 miles (Medicare), regardless of whether she even changes the oil (takes care of herself) in the interim.

As a society, we don't expect this in private-market auto insurance, but we expect it in private-market health insurance. Furthermore, there's a chorus of national and state interests, which continuously pushes us further away from the auto insurance principles.

The current private health insurance market isn't sustainable. Prices have been consistently increasing faster than inflation for decades. Each year, insureds use more health care than ever before and more people have no insurance at all. Most actuaries and other people in the private health insurance market don't want national health insurance with its bureaucracy and one-size-fits-all benefits. Yet, we're trying to sustain a private insurance system, which violates the very principles we know are necessary for private insurance markets.

Yes, health insurance involves the sacredness of human life and is therefore different from auto insurance. But if we're to sustain a private-market solution to health insurance, actuaries need to explain to the larger society, in terms that society understands, the rationale for the following principles:

As sacred as health care is, it's still an economic transaction that has to be balanced by individuals and societies, against other economic choices. It can't be unlimited. Sometimes it will be secondary to other choices. On a given day, for example, the mother in our scenario may value her car more than her health.
Insurance premiums should be paid by the individual and tied to controllable risk factors. This will provide the best incentive for the control of risk factors.
Although it's hard to draw the line between abuse, neglect and ignorance, self-abuse shouldn't be insured and we need to draw that line somewhere.
The private market can't provide unlimited, self-directed health insurance.
Routine care and ongoing treatments of chronic conditions can be pre-funded, can even be subsidized, but they don't constitute "insurable events."
Insurance can't be expected to keep every human body in pristine condition. No amount of health care will prevent everyone's ultimate death.
Comprehensive, unlimited, non-subsidized private-market coverage isn't possible for people with severely impaired health.
The private health market can provide limited non-subsidized health insurance, such as protection from accidents, to even health-impaired individuals.
Individuals who can afford to do so and who take good care of themselves should be able to "buy up" to better coverage. People have the option of buying up for everything else in life.

Discussion of these principles is lacking from most of the current health insurance debate. If society can intuitively understand how similar principles apply to health insurance, then they should be able understand the principles in the health insurance context. We need to initiate the debate.

Insurance for Your Business

2017-02-03T18:10:00.000-08:00

The importance of insurance cannot be over-emphasized and neither can the danger of paying for insurance you don't need. It is strongly recommended you solicit the advice of an in-dependent business insurance agent. Don't forget to SHOP! Talk to three or four independent agents and compare notes and prices. An insurance agent will lay out a vast array of insurance coverage much of which you simply may not need. Your situation will be unique and you must consider each insurance element carefully to ensure comprehensive coverage.

Whatever your final insurance program looks like, you should review it at least every six months. Your business can change rapidly, especially in the first few years and insurance needs change with it. Keep your program up to date by calling in your agent and reviewing your coverage. Make changes where necessary.

LIABILITY INSURANCE

This is probably the most important element of your insurance program. Liability insurance provides protection from potential

losses resulting from injury or damage to others or their property. Just recall some of the big cash awards you have read about that have resulted from lawsuits concerning liability of one kind or another and you will understand the importance of this insurance. Your insurance agent can describe the various types of liability insurance coverage that are available. If you will end up with a comprehensive general policy, make certain that the general policy does not include items you don't need. Pay for only the insurance you need. For example, your business may not need product liability insurance.

Do not confuse business liability coverage with your personal liability coverage, both of which you need. Your personal coverage will not cover a business-generated liability. Check to be certain.

Compare the costs of different levels of coverage. In some cases a $2 million policy costs only slightly more than a $1 million policy. This economy of scale is true with most forms of insurance coverage. That is, after a certain value, additional insurance becomes very economical.

KEY PERSON INSURANCE

This type of insurance is particularly important for the sole proprietorship or partnership where the loss of one person through illness, accident, or death may render the business inoperative or severely limit its operations. This insurance, although not inexpensive, can provide protection for this situation. Key person insurance might also be necessary for others involved in your business.

SGC was a small firm run by three partners, a software programmer, marketer, and a general manager. Their product was a complex computer program used by aerospace firms. Al, the programmer, was involved in a severe automobile accident, became totally disabled, and SGC lost their programming capability. The problem was that the computer program written by Al was essentially the company's sole product. Modifications to accommodate the customer became impossible and the time to bring another programmer up to speed was excessive. SGC lost considerable business as a result of this situation. These losses could have been offset by key person insurance.

DISABILITY INSURANCE

You, as a business owner, should be covered by disability insurance whether or not you decide on key person insurance. This insurance, along with business-interruption insurance, described below, will help ensure your business will continue to operate in the unfortunate situation where you are unable to work. Your disability insurance policy needs to provide satisfactory coverage. Particular attention should be paid to the definition of "disability," delay time until payments start, when coverage terminates, and adjustments for inflation.

FIRE INSURANCE

Fire insurance, like all insurance is complicated and you should understand what IS and IS NOT covered. For example, a typical fire insurance policy covers the loss of contents but does not cover your losses from the fact that you may be out of business for 2-months while your facility is rebuilt. Fire insurance is mandatory whether you're working out of a home office or you have a separate facility. You should discuss a comprehensive policy with your agent. Take the time to understand the details. For example, will the contents be insured for their replacement value or for actual value at the time of loss?

Consider a co-insurance clause that will reduce the policy cost considerably. This means that the insurance carrier will require you to carry insurance equal to some percentage of the value of your property. (Usually around 85%.) With this type of clause it is very important that you review coverage frequently so you always meet the minimum percentage required. If this minimum is not met, a loss will not be paid no matter what its value.

If you are working out of your home, your existing homeowner's policy may not cover business property. If this is the case, have your insurance agent to add a home-office rider to your policy.

AUTOMOBILE INSURANCE

You probably already have automobile insurance but it might not include business use of your vehicle. Make sure that it does.

WORKER'S COMPENSATION INSURANCE

If you make the decision to hire employees, you will be required, in most states, to cover them under worker's compensation. The cost of this insurance varies widely and depends on the kind of work being performed and your accident history. It is important that you properly classify your employees to secure the lowest insurance rates. Work closely with your insurance agent.

BUSINESS INTERRUPTION INSURANCE

This protects against loss of revenue as the result of property damage. This insurance would be used, for instance, if you could not operate your business during the time repairs were being made as a result of a fire or in the event of the loss of a key supplier. The coverage can pay for salaries, taxes, and lost profits.

CREDIT INSURANCE

This will pay for unusual losses as the result of nonpayment of accounts receivables above a certain threshold. As with all policies, you must thoroughly understand the details so discuss it with your insurance agent. One of the largest providers of this coverage is American Credit Indemnity, Baltimore, MD. (800) 879 1224.

BURGLARY/ROBBERY/THEFT INSURANCE

Comprehensive policies are available that protect against loss from these perils, including by your own employees. Make certain you understand what is excluded from coverage.

RENT INSURANCE

This policy covers the cost of rent for other facilities in the event your property becomes damaged to the extent that operations cannot continue in your normal location.

DISABILITY INSURANCE

This insurance will pay you an amount each month slightly less than your current salary in the event you become disabled and are unable to work. Cost for this coverage varies considerably depending on your profession, salary level, how quickly benefits start, and when they end. Benefits paid are tax-free only if you, not your company, pay the premiums.

This list could be continued since it is possible to purchase insurance for just about any peril you can imagine ... if you can pay the premium! When considering your insurance coverage, use the following checklist:

INSURANCE COVERAGE CHECKLIST:

Can you afford the loss?
What coverage is required by Federal, state, or local law?
What SPECIFIC items are covered by the policy?
Are items to be insured for their replacement cost or original value?
What SPECIFIC items are EXCLUDED by the policy?
If there is a co-insurance clause, do you have adequate coverage?
Have you chosen deductibles wisely in order to minimize costs?
Do any of the policies you are considering duplicate or overlap one another?
Do you need any insurance based on location, e.g., flood, earthquake?

Use the following checklist to review your insurance plans:

INSURANCE PLAN CHECKLIST:

o Employ an independent insurance agent rather than going to individual insurance companies. Ensure the agent shops for your insurance.

Talk to and get quotations from at least THREE agents and pick the best one for you.
Use money saving comprehensive policies, if possible.
Perform periodic (every 6-months) reviews of your insurance program.
Have business assets professionally appraised to determine coverage needs.
Ensure existing personal insurance coverage includes business-related activities and add riders as necessary or obtain additional coverage.

http://www.TotalBusiness.com is a Website that provides business owners with the information they need in order to successfully start, manage, grow, and sell their businesses.

The site features over 3,000 articles and 60 guides on business topics such as starting a business, financing a business, sales and marketing, building a website, setting up an office, hiring employees, and selling a business. The site also contains articles on legal and accounting issues affecting businesses and allows business owners and entrepreneurs to get free expert advice from local lawyers or accountants. The site contains over 1,000 business forms and agreements that are helpful to business owners and provides a business directory with over 1,700 merchants who provide services specifically for small businesses.

Are You New to Buying a RIB or Buying RIB Insurance?

2017-01-27T18:06:00.000-08:00

Thinking of buying a Rigid Inflatable Boat (RIB)? Well assuming it's for private and pleasure (P&P) use (commercial use will be dealt with in a separate article) here's a guide to some of the insurance issues you may encounter as well as some of the benefits you might get as part of your cover.

Use an Insurance Broker!

I'm going to say specialist insurance broker rather than a quotation sourced direct from an insurer. I will declare an interest here in that I actually am a specialist broker. There are advantages:

A specialist broker can do your shopping for you because they will have access to multiple markets and therefore make a recommendation as to which one best fits your needs.

A specialist broker should also be able to help you if a claim happens. Understanding and liaising with your insurers regarding liability and/or settlement value. They may also have access to a wide range of approved boat builders, dealers and repairers that will help you get your RIB back in use with minimum disruption to your pleasure in using your RIB.

This is in contrast to going direct to an insurance company which means you will just receive information based on their product. It also means you will have to make time consuming multiple telephone calls find out what is available so to decide what is best for you. That's OK if you have time, but time is money!

What Value is the RIB insured for - Purchase Price or Agreed Value?

You need to understand the basis on which your RIB is covered. It is common for insurers to cover the RIB and its equipment for the purchase price. However, cover can also be on "agreed value". If you are unsure which yours is check your insurer's policy wording. Some may state that they will pay the value stated in in the Schedule of Cover (this will be "agreed value") and others will state they will only pay up to that value (i.e. the purchase price less any depreciation). If your RIB is a total loss the difference in the policy wording could have a significant effect on the amount of your claim is settled for.

As you will expect, the more you pay for your RIB, the more your insurance cover is likely to cost. Insurers rate your policy on the value of your hull, machinery, trailer and any special equipment you might have. The rate applied will usually decrease as the insured value slides up, so the cost to cover a RIB at £50,000 would usually be proportionately cheaper to cover than one valued at under £10,000.

Here are some of the other factors that will affect your overall annual premium for your RIB insurance:

Where are you keeping your RIB?

Location can matter. Certain parts of the UK that are considered prone to extreme weather and it will cost more to insure there. Additionally, your choice of mooring can have an effect too - chances are you could be relatively free from a moorings loading if you are on a pontoon in a marina but a swing mooring will often result in your cover costing you more. Also it is worth mentioning that, if your RIB is permanently moored in Continental Europe it will be rated differently than if UK based.

How Fast Can Your RIB Go?

There's no doubt that the last few years have seen an increase in performance of RIBs being used for P&P and the maximum speed of your craft will be a factor on your premium and the availability of cover.

Generally, up to 35 Knots is within the appetite of insurers. Above 35 Knots things start to change, with premium increased but most RIB insurers are comfortable offering cover up to 55 Knots. Above 55 Knots many insurers are uncomfortable meaning that they won't provide cover or there is a sharp rise in premium rates for these RIB's.

What is your experience on RIB's?

Some insurers will allow a small premium discount if you are an experienced skipper. By experienced this is usually taken to mean more than 5 years with RIB's. If you have less than 5 years' experience then be prepared to have your premium loaded - over 2 years' experience but under 5 would typically attract a load of 5% to the basic premium. Under 2 years and it could start to get painful; under 1 and you start to find insurers who will not even offer a quotation and others who will - but with a significant premium increase.

You're Qualifications?

The Royal Yachting Association (RYA) has recognised training centres worldwide. If you invest in getting appropriate RYA qualifications - such as Powerboat Levels 1&2 - there may be a premium discount.

No Claims have occurred?

Typically, insurers will allow a 5% discount per year up to a maximum of 5 if you have held boat insurance and made no claims but it is possible to find insurers offering larger discounts in certain circumstances.

Covering Personal Possessions & Accessories

Trailers, inflatables and other accessories used with your RIB can be added to your schedule of cover - there will usually be an additional premium charged. Check your policy documentation for terms and conditions relating to use, security and storage of these items.

In return for a further additional premium your insurers may allow you to add cover for personal possessions against loss of damage whilst on board your RIB. Before opting for this extension, however, it is worth checking exactly what is and isn't covered as some policy wordings will detail a lengthy list of excluded property, including (but not limited to) passports, money, credit cards, travel tickets, jewellery, watches keys, mobile phones and laptops. You might also be able to obtain a better premium rate and scope of cover for this type of property as an "All Risks" extension to your home contents insurance policy.

European Vacation?

Many providers will include up to 30-days European use (including road transit) as a free extension so you can hook up your trailer and have fun - don't forget to check your certificate and/or schedule to make sure this cover is in place before you go.

Here's a tip: If you are going overseas ask your insurer to provide you with a certificate in the language of the country where you will be using your RIB - it may save you a lot of hassle with the local authorities if you can present a certificate of cover that the local authorities don't have to get translated.

Transiting Your RIB

Cover for road transit of your RIB can be included on your policy - sometimes this is a freebie but some insurers will levy an additional premium for transit cover - don't forget to ask your broker if your transit cover is free or if they are charging for the extension.

Marine Third Party Liability

Your RIB's Marine Third Party Liability Insurance covers your legal liabilities arising from the use of your RIB as agreed by your insurers. It will cover injury to passengers and other third parties as well as damage to third party property.

This cover often comes as a free extension to your RIB's Hull & Machinery Insurance but some providers will levy a separate premium for your Liability Insurance. At time of publication the indemnity limit commonly provided by insurers is £3,000,000, though some will provide a higher limit if required (eg. a particular marina insists on a higher limit) in return for an additional premium.

Depending on where your RIB is berthed, it may be a requirement for you to have Marine Third Party Liability Insurance. For example, the Environment Agency (EA) requires all vessels on their waterways to be registered and part of the registration process is to provide details of your insurance. Although you are not required to submit your documentation the EA carries out spot checks and will fine boat owners who do not have the correct level of insurance.

Will You Be Water-skiing or Towing Toys?

Obviously you'll want to have fun with your RIB and if that includes water skiing or towing toys such as bananas, ringos and other inflatables you will need to have your liability insurance extended to include this activity.

Policies are commonly endorsed with the permitted number of toys or skiers that can be towed at any one time and may have additional conditions applied such as having somebody on board to act as a look-out or observer in addition to the helmsman.

Some Small Print to Look For:

High Speed Clauses

If the maximum speed of your RIB is in excess of 17 Knots then your insurers are likely to apply some additional terms and conditions to your cover.

Commonly defined as a "High Speed Clause" you are likely to find an endorsement on your schedule or certificate of cover that excludes cover that your policy usually provides to vessels with a design speed up to 17 Knots.

Each insurer will have a slightly different wording so it is worth studying this exclusion if it is likely to apply to you. If in doubt, speak to a specialist broker who is familiar with the nuances of different policies and is able to make a suitable recommendation to meet your specific requirements.

Outboard Locks

Theft of outboard engines is prevalent. Professional gangs seem to be able to operate without fear of being caught and some cases, such as where they have succeeded in removing even the largest engines from vessels in marinas, their success in escaping with tens of thousands of pounds worth of outboard has been extraordinary.

Insurers will almost certainly require your outboard engines to be secured to your RIB with an anti-theft device in addition to its normal method of attachment.

Wheel Clamps

Theft of your vessel while left unattended at any time on a trailer will more than likely be excluded unless it is secured by a wheel clamp. Some insurers will relax this if the trailer is in a locked building or compound. Check your documentation to be absolutely sure what your insurer's requirements are.

Excesses

Excesses often vary - usually the higher the value of your RIB and outboard, the higher the excess is likely to be. In addition to the standard excess, insurers may apply higher excesses for particular types of claim. For example, claims resulting from damage to semi-submerged objects (SSOs) can be subject to higher excesses than the policy's standard.

Kill Cords

At time of writing it is not a legal requirement in the UK for P&P craft to have kill cords in use whilst the craft is underway. However, some insurers are now making the attaching of kill cords a requirement of their cover for fast craft. Again, check your wording or speak to your provider if you are not sure what your insurance obliges you to do.

Nb. These examples represent only a small part of your policy's terms and conditions. You should carefully read the whole of your policy document to ensure you are aware and fully understand all policy requirements and the scope of cover provided. If in doubt, speak to your insurance provider and obtain clarification from them.

Additional Cover & Free Benefits

Legal Expenses

This cover is usually an "add on" which attracts a charge. A Legal Expenses policy will cover your uninsured losses in the event of a non-fault claim such as your standard policy excess. It might also cover you with regard to contractual disputes and legal defence.

Data Tag

One insurer I work with offers a free data tag to all policy holders. This is particularly useful for RIB owners as, if your outboard should disappear overnight, it is possible for it to be located by the police and the perpetrators apprehended.

Marina Benefits

We have already discussed (in Part 1) the premium benefits you are likely to enjoy if your vessel is kept in a marina. This is due to greater security against theft as well as the marina generally being a safer haven from adverse weather conditions than other types of mooring.

In addition to premium savings you can often benefit from not having your excess applied in the event of a claim arising whilst your RIB is marina berthed. Some insurers will also provide the benefit of not penalising your no-claims bonus in the event of theft or damage occurring whilst your vessel is moored in a marina.

Personal Accident Insurance

This is a useful feature and, in most cases, it usually does come as a genuine free benefit. The sums insured are relatively low (typically £5,000 or £10,000) and do not compare favourably with stand-alone personal accident policies but, nevertheless, would provide some support if an insured event were to occur.

There Are Two Kinds of People in the US - Those Who View Health As Static and Those Who Don't

2017-01-08T18:01:00.000-08:00

Introduction: We're Not #1

I believe Americans need a new way of thinking about health. Look where our current perspectives on the subject have gotten us - we are last among the world's 17 most industrialized nations in all the key indicators of health. It's hard to believe but true: we're last in life expectancy; we have the highest rates of obesity, infant mortality, low birth weights, heart disease, diabetes, chronic lung disease, homicide rates, teen pregnancy and sexually transmitted diseases.

The lead author of the Institute of Medicine, NIH sponsored study that revealed this situation remarked that "Americans get sicker, die sooner and sustain more injuries than people in all other high-income countries." (That's a quote from the report.) Then he added this coup de grace: "We were stunned by the propensity of findings all on the negative side - the scope of the disadvantage covers all ages, from babies to seniors, both sexes, all classes of society. If we fail to act, life spans will continue to shorten and children will face greater rates of illness than those in other nations."

Two Ways to Think of Health

I believe Americans are overly passive about their health. Good health can only be attained and maintained by conscious deeds. These deeds require planning and disciple. Examples include exercising regularly and vigorously, dining in ways that nourish the body without causing problems and otherwise behaving in positive, active ways.

The level of health you will enjoy is clearly affected by your lifestyle choices. Your health status depends to a great extent on whether you invest in your well being or not. If you make little or no such investments, your health will depend on chance, genetics, the aging process and the timeliness of the quality of medical care you receive.

If, on the other hand, you do invest, if you seek, protect and defend an advanced state of well being, the nature of the health status you will have will be dramatically different - and better.

Therefore, we need to distinguish these two kinds of health situations - one passive, one active.

The Institute of Health report that places America last reflects that segment of America that is passive. If the quite small segment of the American population that practices active health were separated, if their health data were compiled and compared, I'm sure we would be #1.

For these and related reasons, I propose we view health in two different ways - by making a distinction between static health - which is how most view and approach their health, and earned health. The latter is what you get when you invest wisely in your own well being.

It's a way of life I call REAL wellness.

Health As Currently Perceived

The WHO definition of health is unrealistic (nobody, not even the most devout wellite, enjoys "complete physical, mental and social well-being," at least not every day). Most think of health in far less exalted ways. Most think they are well if they are not sick. This is pathetic. It equates with not needing immediate medical attention. For the vast majority, this is a "good enough" view of health. Thinking that way is a self-fulfilling prophesy. It means that not healthy is the best you can hope for. This is the static definition of health and it must be reformed and at least accompanied by another, comparison perspective for those Americans willing to do their part. That would be earned health.

I think we need ideas about health that remind people of a key fact, namely, that a passive situation is not as effective, desirable, protective or rewarding as a dynamic earned state of health. We should all be aware that static health, the default setting you get for just existing and doing nothing special to enhance health, can and must be reinforced and boosted.

Employing a term like earned health might remind people that health can be much more than non-illness. The term earned health can signal the availability of a richer level of well being. It can remind everyone that health at its best is more than a static condition. Health is a dynamic state; it gets better with effort, worse if ignored.

Earned health represents a higher health standard. Earned health is more ambitious and more consistent with a REAL wellness mindset and lifestyle than the current norm of health as non-sickness.

The Static/Earned Health Continuum

This continuum is another way of expressing Dr. John Travis' original, simple line drawing model of health along a continuum, with "premature death" on the far left side of his continuum) and an ever-changing dynamic of "high level wellness" at the other, right side extreme. The "0" in the middle represents a neutral point, which could be simple non-sickness.

The Static/Earned Health Continuum

-10 ______________ 0 ______________ +10

Earned health is what happens from the neutral point to the +10 indicator. Everyone moves along an imaginary continuum of this kind every day, because health is dynamic, under constant change. By living wisely with the right behaviors, we fuel a state of health that is better than if we allow health status to be determined by the passage of time (i.e., the aging process, chance, medical interventions, circumstances and events.

This continuum is a simple way of depicting the basic fact that earned health evolves largely due to our own efforts to improve and protect our well being; static health, on the other side is affected by what happens to you.

By the way, Dr. Travis made regular expansions to his original model. You can view the latest edition and read more the continuum here. A related construct that will interest wellness enthusiasts is Dr. Travis Wellness Energy System.

Earned health is not determined or advanced by medical interventions. Static health, that is, health along the continuum from the center to the left of the of the continuum, is so influenced.

The Path to REAL Wellness

To become healthier in an earned sense, it's up to us to act so as to move along the right side of the continuum.

The failure to appreciate the different nature of health, earned from static, partly accounts for why America can have so much medical care and yet not enjoy the best quality of health status. After all, modern medicine is a wonderful thing but there are two problems: people expect too much of it and too little of themselves.

Understanding the difference between static and earned health might encourage people to be less passive - to realize the need for and value of REAL wellness lifestyles.

A Fable

Here is a fable to express the limits of medicine to boost health status versus the power of our own behaviors.

Imagine a country where everyone owns high powered luxury cars - they cost next to nothing and are easily replaced. In this mythical country, everyone gets unlimited free medical care of the highest quality, plus all the medications they need plus there are highly skilled trauma teams set up at every intersection. The thing is, the people in this mythical country can do whatever they like - there are no laws governing auto safety. Everyone drives way over the speed limits, nobody wears seat belts, there are no air bags and no stop signs, traffic signals or rules of the road. One more thing - brakes haven't been invented yet.

Interpretation of the Fable

The greatest advances in the mythical society would not follow from introducing more doctors, hospitals, drugs or trauma teams. Changes in customs and driver behaviors would, on the other hand, go a long way to promote a healthier society.

Changes in lifestyles are also the key to better health outcomes in the real world, our country in particular. We have a great health care system - now we need sensible people making wise lifestyle choices that make life not just healthier but more rewarding, more fulfilling and more attractive. We need to help people understand that health is not only a static phenomenon: Earned health offers so much more.

The philosopher Epicurus (c. 341-270 BCE) offered this bit of wisdom long ago: "It is impossible to live pleasurably without living prudently, honorably, and justly; or to live prudently, honorably, and justly, without living pleasurably."

We all want to live pleasurably. Let's recognize and act on the other qualities that enable us to earn active positive health. Let's embrace REAL wellness lifestyles.

All About Affordable Health Insurance Plans

2016-12-22T18:03:00.000-08:00

While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of money.

With the implementation of the affordable care act, the reach of affordable health plans is set to increase. Or at least, this is what is believed to be the objective of healthcare reforms. However, lots of consumers are still in confusion about how things would work. In this article, we will discuss some detailed options that consumers can try while looking to buy affordable health plans.

To get a hand on affordable health insurance plans, consumers need to take of certain things. First among them is about knowing the options in the particular state of the residence. There are lots of state and federal government-run programs that could be suitable for consumers. Knowing the options is pretty important. Next would be to understand the terms and conditions of all the programs and check the eligibility criteria for each one of them. Further, consumers should know their rights after the implementation of healthcare reforms, and something within a few days, they may qualify for a particular program or could be allowed to avail a particular health insurance plan. If consumers take care of these steps, there is no reason why consumers can't land on an affordable health plan that could cater to the medical care needs.

Let's discuss some options related to affordable health insurance plans state-wise:

State-run affordable health insurance programs in California

While considering California, there are three affordable health insurance plans that are run by the state government. Consumers can surely get benefitted by these if they are eligible for the benefits.

• Major Risk Medical Insurance Program (MRMIP)

This program is a very handy one offering limited health benefits to California residents. If consumers are unable to purchase health plans due to a preexisting medical condition, they can see if they qualify for this program and get benefits.

• Healthy Families Program

Healthy Families Program offers Californians with low cost health, dental, and vision coverage. This is mainly geared to children whose parents earn too much to qualify for public assistance. This program is administered by MRMIP.

• Access for Infants and Mothers Program (AIM)

Access for Infants and Mothers Program provides prenatal and preventive care for pregnant women having low income in California. It is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees.

Some facts about affordable health insurance in Florida

While talking about affordable health insurance options in Florida, consumers can think about below mentioned options:

• Floridians who lost employer's group health insurance may qualify for COBRA continuation coverage in Florida. At the same time, Floridians, who lost group health insurance due to involuntary termination of employment occurring between September 1, 2008 and December 31, 2009 may qualify for a federal tax credit. This credit helps in paying COBRA or state continuation coverage premiums for up to nine months.

• Floridians who had been uninsured for 6 months may be eligible to buy a limited health benefit plan through Cover Florida.

• Florida Medicaid program can be tried by Floridians having low or modest household income. Through this program, pregnant women, families with children, medically needy, elderly, and disabled individuals may get help.

• Florida KidCare program can help the Floridian children under the age of 19 years and not eligible for Medicaid and currently uninsured or underinsured.

• A federal tax credit to help pay for new health coverage to Floridians who lost their health coverage but are receiving benefits from the Trade Adjustment Assistance (TAA) Program. This credit is called the Health Coverage Tax Credit (HCTC). At the same time, Floridians who are retirees and are aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), may qualify for the HCTC.

Some facts about affordable health insurance in Virginia

While talking about affordable health insurance options in Virginia, consumers need to consider their rights:

• Virginians who lost their employer's group health insurance may apply for COBRA or state continuation coverage in Virginia.

• Virginians must note that they have the right to buy individual health plans from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield.

• Virginia Medicaid program helps Virginians having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, and elderly and disabled individuals are helped.

• Family Access to Medical Insurance Security (FAMIS) helps Virginian children under the age of 18 years having no health insurance.

• In Virginia, the Every Woman's Life Program offers free breast and cervical cancer screening. Through this program, if women are diagnosed with cancer, they may be eligible for treatment through the Virginia Medicaid Program.

Some facts about affordable health insurance in Texas

While talking about affordable health insurance options in Texas, consumers need to consider their rights:

• Texans who have group insurance in Texas cannot be denied or limited in terms of coverage, nor can be required to pay more, because of the health status. Further, Texans having group health insurance can't have exclusion of pre-existing conditions.

• In Texas, insurers cannot drop Texans off coverage when they get sick. At the same time, Texans who lost their group health insurance but are HIPAA eligible may apply for COBRA or state continuation coverage in Texas.

• Texas Medicaid program helps Texans having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, elderly and disabled individuals are helped. At the same time, if a woman is diagnosed with breast or cervical cancer, she may be eligible for medical care through Medicaid.

• The Texas Children's Health Insurance Program (CHIP) offers subsidized health coverage for certain uninsured children. Further children in Texas can stay in their parent's health insurance policy as dependents till the age of 26 years. This clause has been implemented by the healthcare reforms.

• The Texas Breast and Cervical Cancer Control program offers free cancer screening for qualified residents. If a woman is diagnosed with breast or cervical cancer through this program, she may qualify for medical care through Medicaid.

Like this, consumers need to consider state-wise options when they search for affordable health coverage. It goes without saying that shopping around and getting oneself well-equipped with necessary information is pretty much important to make sure consumers have the right kind of health plans.

Patient Abandonment - Home Health Care

2016-12-03T18:00:00.000-08:00

Elements of the Cause of Action for Abandonment

Each of the following five elements must be present for a patient to have a proper civil cause of action for the tort of abandonment:

1. Health care treatment was unreasonably discontinued.

2. The termination of health care was contrary to the patient's will or without the patient's knowledge.

3. The health care provider failed to arrange for care by another appropriate skilled health care provider.

4. The health care provider should have reasonably foreseen that harm to the patient would arise from the termination of the care (proximate cause).

5. The patient actually suffered harm or loss as a result of the discontinuance of care.

Physicians, nurses, and other health care professionals have an ethical, as well as a legal, duty to avoid abandonment of patients. The health care professional has a duty to give his or her patient all necessary attention as long as the case required it and should not leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for the attendance of another. [2]

Abandonment by the Physician

When a physician undertakes treatment of a patient, treatment must continue until the patient's circumstances no longer warrant the treatment, the physician and the patient mutually consent to end the treatment by that physician, or the patient discharges the physician. Moreover, the physician may unilaterally terminate the relationship and withdraw from treating that patient only if he or she provides the patient proper notice of his or her intent to withdraw and an opportunity to obtain proper substitute care.

In the home health setting, the physician-patient relationship does not terminate merely because a patient's care shifts in its location from the hospital to the home. If the patient continues to need medical services, supervised health care, therapy, or other home health services, the attending physician should ensure that he or she was properly discharged his or her-duties to the patient. Virtually every situation 'in which home care is approved by Medicare, Medicaid, or an insurer will be one in which the patient's 'needs for care have continued. The physician-patient relationship that existed in the hospital will continue unless it has been formally terminated by notice to the patient and a reasonable attempt to refer the patient to another appropriate physician. Otherwise, the physician will retain his or her duty toward the patient when the patient is discharged from the hospital to the home. Failure to follow through on the part of the physician will constitute the tort of abandonment if the patient is injured as a result. This abandonment may expose the physician, the hospital, and the home health agency to liability for the tort of abandonment.

The attending physician in the hospital should ensure that a proper referral is made to a physician who will be responsible for the home health patient's care while it is being delivered by the home health provider, unless the physician intends to continue to supervise that home care personally. Even more important, if the hospital-based physician arranges to have the patient's care assumed by another physician, the patient must fully understand this change, and it should be carefully documented.

As supported by case law, the types of actions that will lead to liability for abandonment of a patient will include:

• premature discharge of the patient by the physician

• failure of the physician to provide proper instructions before discharging the patient

• the statement by the physician to the patient that the physician will no longer treat the patient

• refusal of the physician to respond to calls or to further attend the patient

• the physician's leaving the patient after surgery or failing to follow up on postsurgical care. [3]

Generally, abandonment does not occur if the physician responsible for the patient arranges for a substitute physician to take his or her place. This change may occur because of vacations, relocation of the physician, illness, distance from the patient's home, or retirement of the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable of the patient's special conditions, if any, has been arranged, the courts will usually not find that abandonment has occurred. [4] Even where a patient refuses to pay for the care or is unable to pay for the care, the physician is not at liberty to terminate the relationship unilaterally. The physician must still take steps to have the patient's care assumed by another [5] or to give a sufficiently reasonable period of time to locate another prior to ceasing to provide care.

Although most of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles apply to all health care providers. Furthermore, because the care rendered by the home health agency is provided pursuant to a physician's plan of care, even if the patient sued the physician for abandonment because of the actions (or inactions of the home health agency's staff), the physician may seek indemnification from the home health provider. [6]

ABANDONMENT BY THE NURSE OR HOME HEALTH AGENCY

Similar principles to those that apply to physicians apply to the home health professional and the home health provider. A home health agency, as the direct provider of care to the homebound patient, may be held to the same legal obligation and duty to deliver care that addresses the patient's needs as is the physician. Furthermore, there may be both a legal and an ethical obligation to continue delivering care, if the patient has no alternatives. An ethical obligation may still exist to the patient even though the home health provider has fulfilled all legal obligations. [7]

When a home health provider furnishes treatment to a patient, the duty to continue providing care to the patient is a duty owed by the agency itself and not by the individual professional who may be the employee or the contractor of the agency. The home health provider does not have a duty to continue providing the same nurse, therapist, or aide to the patient throughout the course of treatment, so long as the provider continues to use appropriate, competent personnel to administer the course of treatment consistently with the plan of care. From the perspective of patient satisfaction and continuity of care, it may be in the best interests of the home health provider to attempt to provide the same individual practitioner to the patient. The development of a personal relationship with the provider's personnel may improve communications and a greater degree of trust and compliance on the part of the patient. It should help to alleviate many of the problems that arise in the health care' setting.

If the patient requests replacement of a particular nurse, therapist, technician, or home health aide, the home health provider still has a duty to provide care to the patient, unless the patient also specifically states he or she no longer desires the provider's service. Home health agency supervisors should always follow up on such patient requests to determine the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has taken place that might give rise to liability. The home health agency should continue providing care to the patient until definitively told not to do so by the patient.

COPING WITH THE ABUSIVE PATIENT

Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor may not be a result of the medical condition for which the care is being provided. Personal safety of the individual health care provider should be paramount. Should the patient pose a physical danger to the individual, he or she should leave the premises immediately. The provider should document in the medical record the facts surrounding the inability to complete the treatment for that visit as objectively as possible. Management personnel should inform supervisory personnel at the home health provider and should complete an internal incident report. If it appears that a criminal act has taken place, such as a physical assault, attempted rape, or other such act, this act should be reported immediately to local law enforcement agencies. The home care provider should also immediately notify both the patient and the physician that the provider will terminate its relationship with the patient and that an alternative provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to determine that it should terminate its relationship with a particular patient. Examples may include particularly abusive patients, patients who solicit -the home health provider professional to break the law (for example, by providing illegal drugs or providing non-covered services and equipment and billing them as something else), or consistently noncompliant patients. Once treatment is undertaken, however, the home health provider is usually obliged to continue providing services until the patient has had a reasonable opportunity to obtain a substitute provider. The same principles apply to failure of a patient to pay for the services or equipment provided.

As health care professionals, HHA personnel should have training on how to handle the difficult patient responsibly. Arguments or emotional comments should be avoided. If it becomes clear that a certain provider and patient are not likely to be compatible, a substitute provider should be tried. Should it appear that the problem lies with the patient and that it is necessary for the HHA to terminate its relationship with the patient, the following seven steps should be taken:

1. The circumstances should be documented in the patient's record.

2. The home health provider should give or send a letter to the patient explaining the circumstances surrounding the termination of care.

3. The letter should be sent by certified mail, return receipt requested, or other measures to document patient receipt of the letter. A copy of the letter should be placed in the patient's record.

4. If possible, the patient should be given a certain period of time to obtain replacement care. Usually 30 days is sufficient.

5. If the patient has a life-threatening condition or a medical condition that might deteriorate in the absence of continuing care, this condition should be clearly stated in the letter. The necessity of the patient's obtaining replacement home health care should be emphasized.

6. The patient should be informed of the location of the nearest hospital emergency department. The patient should be told to either go to the nearest hospital emergency department in case of a medical emergency or to call the local emergency number for ambulance transportation.

7. A copy of the letter should be sent to the patient's attending physician via certified mail, return receipt requested.

These steps should not be undertaken lightly. Before such steps are taken, the patient's case should be thoroughly discussed with the home health provider's risk manager, legal counsel, medical director, and the patient's attending physician.

The inappropriate discharge of a patient from health care coverage by the home health provider, whether because of termination of entitlement, inability to pay, or other reasons, may also lead to liability for the tort of abandonment. [8]

Nurses who passively stand by and observe negligence by a physician or anyone else will personally become accountable to the patient who is injured as a result of that negligence... [H]ealthcare facilities and their nursing staff owe an independent duty to patients beyond the duty owed by physicians. When a physician's order to discharge is inappropriate, the nurses will be help liable for following an order that they knew or should know is below the standard of care. [9]

Similar principles may apply to make the home health provider vicariously liable, as well.

Liability to the patient for the tort of abandonment may also result from the home health care professional's failure to observe, examine, assess, or monitor a patient's condition. [10] Liability for abandonment may arise from failing to take timely action, as well as failing to summon a physician when a physician is needed. [11] Failing to provide adequate staff to meet the patient's needs may also constitute abandonment on the part of the HHA. [12] Ignoring a patient's complaints and failing to follow a physician's orders may likewise constitute a tort of abandonment for a nurse or other professional staff member.

1. Lee v. Dewbre, 362 S.W.2d 900 (Tex. Civ. App. 7th Dist. 1962).

2. Kattsetos v. Nolan, 368 A.2d 172 (Conn. 1976).

3. 61 AM. Jur. 2d, Physicians and Surgeons § 237 (1981).

4. See, e.g., Tripp v. Pate, 271 S.E.2d 407 (N.C. App. 1980).

5. Ricks v. Budge, 64 P.2d 208 (Utah 1937).

6. M.D. Nathanson, Home Healthcare Answer Book: Legal Issues for Providers 212 (1995).

7. See, generally, E.P. Burnzeig, The Nurse's Liability for Malpractice (1981).

8. Sheryl Feutz-Harter, Nursing Caselaw Update: In appropriate Discharging of Patients, 2 J. Nursing L. 49 (1995).

9. Id., 53.

10. See, e.g., Pisel v. Stamford Hosp., 430 A.2d1 (Conn. 1980) (nurses were held liable for failing to monitor the condition of a patient).

11. See, e.g., Sanchez v. Bay General Hosp., 172 Cal. Rptr. 342 (Cal. App. 1981); Valdez v. Lyman-Roberts Hosp., Inc. 638 S.W. 2d 111 (Tex. 1982).

12. Czubinsky v. Doctors Hosp., 188 CAl. Rptr. 685 (1983).

Getting Insurance To Pay For Preventive Health Under The ACA

2016-11-22T17:59:00.000-08:00

The Affordable Care Act (ACA) mandates that health insurance companies pay for preventive health visits. However, that term is somewhat deceptive, as consumers may feel they can visit the doctor for just a general checkup, talk about anything, and the visit will be paid 100% with no copay. In fact, some, and perhaps most, health insurance companies only cover the A and B recommendations of the U.S. Preventive Services Task Force. These recommendations cover such topics as providing counseling on smoking cessation, alcohol abuse, obesity, and tests for blood pressure, cholesterol, and diabetes (for at risk patients), and some cancer screening physical exams. BUT if a patient mentions casually that he or she is feeling generally fatigued, the doctor could write down a diagnosis related to that fatigue and effectively transform the "wellness visit" into a "sick visit." The same is true if the patient mentions occasional sleeplessness, upset stomach, stress, headaches, or any other medical condition. In order to get the "free preventive health" visit paid for 100%, the visit needs to be confined to a very narrow group of topics that most people will find vert constrained.

Similarly, the ACA calls for insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once again there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code other than "routine preventive health screening," the insurance company may not, and probably will not, pay for the colonoscopy directly. Instead, the costs would be applied to the annual deductible, which means most patients would get stuck paying for the cost of the screening.

This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone - those at risk as well as those facing no known risk - to get checked. But if people go into the procedure expecting insurance to pay the cost, and then a week later receive a surprise letter indicating they are responsible for the $2,000 - $2,500 cost, it will give people a strong financial disincentive to getting tested.

As an attorney, I wonder how the law could get twisted around to this extent. The purpose of a colonoscopy is determined at the moment an appointment is made, not ex post facto during or after the colonoscopy. If the patient has no symptoms and is simply getting a colonoscopy to screen for colon cancer because the patient has reached age 45 or 50 or 55, then that purpose or intent cannot be negated by subsequent findings of any condition. What if the doctor finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? If so, it gives patients a strong incentive to tell their GI doctors that they are only to note on the claim form "yes or no" in response to colon cancer and nothing else. Normally, we would want to encourage doctors to share all information with patients, and the patients would want that as well. But securing payment for preventive services requires the doctor code up the entire procedure as routine preventive screening.

The question is how do consumers inform the government of the need for a special coding or otherwise provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I could write my local congressman, but he is a newly elected conservative Republican who opposes health care and everything else proposed by Obama. If I wrote him on the need for clarification of preventive health visits, he would interpret that as a letter advising him to vote against health care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They have stand pat reply letters on health care reform that they send to all constituents who write in regarding health care matters.

To my knowledge, there is no way to make effective suggestions to the Obama administration. Perhaps the only solution is to publicize the problem in articles and raise these issues in discussion forums

There is a clear and absolute need for government to get involved in the health care sector. You seem to forget how upset people were with the non-government, pure private sector-based health care system that left 49 million Americans uninsured. When those facts are mentioned to people abroad, they think of America as having a Third World type health care system. Few Japanese, Canadians, or Europeans would trade their existing health care coverage for what they perceive as the gross inequities in the US Health Care System.

The Affordable Care Act, I agree, completely fails to address the fundamental cost driver of health care. For example, it perpetuates and even exacerbates the tendency of consumers to purchase health services without any regard to price. Efficiency in private markets requires cost-conscious consumers; we don't have that in health care.

I am glad the ACA was passed. It is a step in the right direction. As noted, there are problems with the ACA including the "preventive health visits" to the doctor, which are supposed to be covered 100% by insurance but may not be if any diagnostic code is entered on the claim form.

Congress is so polarized on health care that the only way to get changes is with a groundswell of popular support. I don't think a letter writing campaign is the correct way to reform payment for the "preventive health visits." If enough consumers advise their doctors that this particular visit is to be treated solely as a preventive health visit, and they will not pay for any service in the event the doctor's office miscodes the visit with anything else, then the medical establishment will take notice and use its lobbying arm to make Congress aware of the problem.

COMMENT: Should there not be an agreement up front between both parties on what actions that will be taken if said item is found or said event should be seen or occur? Should their be a box on the pre-surgical form giving the patient the right to denying the doctor to take proper action (deemed by whom?) if they see a need to? Checking this box would save the patient the cost of the procedure, and give them time for a consult. If there is not a box to check, why isn't there one?

There are two separate questions posed by the checkbox election for procedures. First, does a patient have a legal right to check such a box or instruct a physician/surgeon orally or in writing that he does not give consent for that procedure to be performed? The answer to that question is yes.

The second question is does it serve the economic interest of the patient to check that box? For the colonoscopy, in theory the patient would get his or her free preventive screening, but then be told the patient needs to schedule a second colonoscopy for removal of a suspicious polyp. In that case, the patient would eventually have to pay for a colonoscopy out of pocket (unless he had already met his yearly deductible), so there is no clear economic rationale for denying the physician the right to remove the polyp during the screening colonoscopy.

But we are using the much less common colonoscopy example. Instead, let's return to preventive care with a primary care doctor. Should a patient have the right to check a box and say "I want this visit to cover routine preventive care and nothing more"? Certainly. There is way too much discretion afforded physicians to code up whatever they want on claim forms such that two physicians seeing the exact same patient might code up different procedures and diagnostics for the exact same preventive health screening visit.

When I expect to receive a "zero cost to me" preventive screening, I do not imply that I am willing to accept a "bait and switch" change of procedure and payment due to the doctor from me. The "zero cost to me" induces consumers to go to the office visit; it is actually paid for out of the profits earned by the health insurance firms to whom consumers pay monthly premiums. Consumers need to hold doctors financially accountable for their claim billing practices. If you are quoted a "zero price" for a visit, the doctor's office better honor that price, or it amounts to fraud.

It is all too easy to find any little old thing to justify billing a patient for a sick visit instead of a wellness visit. However, it is up to the patient to prevent that kind of profiteering at his or her expense.

It would be wonderful if HHS would give carriers the proper code or specify that other diagnostic codes cannot negate the preventive screening code used for a wellness visit. That is not happening now. DHS has been bombarded with so many questions and suggestions for health care reform that the department has a fortress like mentality. So realistically, consumers cannot expect DHS to address the coding issue for preventive health screenings any time soon. That leaves the full burden to fall on each consumer to ensure the doctor's billing practices match the patient's expectations for a free preventive health office visit.

I investigated the web site http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html and discovered some inconsistencies. For example, the site purports to list the services covered under the "preventive health" coverage benefit, yet it omits the annual physical exam. Also, the site states that colorectal cancer screening are provided for people age 50 or older. However, I have been advised in writing that United Healthcare will cover preventive screening colonoscopies for people under age 50. In essence, that government web page is a good start to learn about preventive health care benefits, but a better source would be each consumer's own health insurance carrier. For those with temporary insurance or who are without any insurance coverage, unfortunately, the preventive health benefit of the ACA will not have any practical consequence.

Where will the money come from for the preventive health screening visit to a primary care doctor as well as the screening colonoscopy? We have to look at different scenarios. If the patient indeed has preventive health screenings with no other medical diagnoses, then the patient will be charged $0 for these services, and they will be paid for by the insurance carrier. The insurance carrier will pay these costs out of its operating income or profits. There is simply no other source for payment. The government has not offered to pay the insurance companies for these services.

If the patient is hit with various medical diagnostic codes during these preventive health screenings, then he or she will pay his customary charge for the primary care doctor's office visit and the contract-negotiated price for the diagnostic colonoscopy. In that scenario, the consumer will be paying most of these costs, although the visit to the primary doc may be limited up to any applicable copay amount.

It is not a big shock or surprise to say preventive health care is going to be borne by health insurance carriers. The extent to which these carriers can pass along costs to consumers through higher rates depends on the degree of competition in their markets. Ehealthinsurance.com advises me that for the vast majority of states, the insurance carriers have NOT been able to shift these costs onto consumers through higher rates. That may change in 2013 or 2014. However, the trend is clearly moving in the direction of more power for consumers, more options and carriers available to supply health insurance in their states, which means greater competition and lower prices.

For additional sections of this article, please see http://www.michaelguth.com

Michael A. S. Guth, Ph.D., J.D., directs Health Economics & Outcomes Research (HEOR) at Risk Management Consulting, a contract research organization based in Oak Ridge, Tennessee, where he has successfully managed the HEOR consulting business for the past ten years. He is also a licensed attorney at law with an active practice of more than 200 clients and has developed expertise on the Affordable Care Act and its implementing regulations. Dr. Guth's principal research focus has been preventing the onset of age-related diseases known collectively as the metabolic syndrome. In the area of diabetes, he is familiar with all of the drugs used to treat the disease and their potential drawbacks. Low thyroid hormones (T3 and T4) may represent one of the most unrecognized and under-treated causes of prediabetes status affecting some 75 million Americans. His current research comprises the optimal design of health care insurance and total health/wellness programs including preventive health strategies and employee health engagement and resiliency. Working as part of a global benefits team, he creates an integrated wellness-benefits strategy and executes programs aimed at changing mid- and high-risk behaviors. He positions wellness and disease-prevention as part of a larger strategy for medical cost containment, and contributes innovative ideas for achieving this desired result. He demonstrates thinking "outside the box" to rein in health care spending costs and reform patient utilization of medical services. A second area of current research is the use of Clomiphene in men for hormone modulation to prevent cardiovascular disease and other consequences of the metabolic syndrome. He is Principal Investigator of a clinical study that compares use of Clomiphene with external sources of testosterone given to men; the study includes safety, efficacy, cost, and value comparisons.

Health Care Reform - Why Are People So Worked Up?

2016-11-08T09:30:00.000-08:00

Why are Americans so worked up about health care reform? Statements such as "don't touch my Medicare" or "everyone should have access to state of the art health care irrespective of cost" are in my opinion uninformed and visceral responses that indicate a poor understanding of our health care system's history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let's try to take some of the emotion out of the debate by briefly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let's look at the pros and cons of the Obama administration health care reform proposals and let's look at the concepts put forth by the Republicans?

Access to state of the art health care services is something we can all agree would be a good thing for this country. Experiencing a serious illness is one of life's major challenges and to face it without the means to pay for it is positively frightening. But as we shall see, once we know the facts, we will find that achieving this goal will not be easy without our individual contribution.

These are the themes I will touch on to try to make some sense out of what is happening to American health care and the steps we can personally take to make things better.

A recent history of American health care - what has driven the costs so high?

Key elements of the Obama health care plan

The Republican view of health care - free market competition

Universal access to state of the art health care - a worthy goal but not easy to achieve

what can we do?

First, let's get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

To begin, let's turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail's pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

Let's skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a "wait and see" approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

This very basic review of American medical history helps us to understand that until quite recently (around the 1950's) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; "nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor's offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the "perfect storm" for higher and higher health care costs. And by and large the storm is only intensifying.

At this point, let's turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?

The Obama health care plan is complex for sure - I have never seen a health care plan that isn't. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let's look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.

Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance.

To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don't comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.

To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans.

The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs.

The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide "free" (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently decided to hear arguments as to the constitutionality of the health insurance mandate as a result of a petition by 26 states attorney's general that congress exceeded its authority under the commerce clause of the U.S. constitution by passing this element of the plan. The problem is that if the Supreme Court should rule against the mandate, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance to all would be severely limited if not terminated altogether by such a decision.

As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals that have to pay them. Medical device companies, pharmaceutical companies, hospitals, doctors and insurance companies all had to "give up" something that would either create new revenue or would reduce costs within their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1,000 employee reduction in part to cover these new fees. This is being experienced by other medical device companies and pharmaceutical companies as well. The reduction in good paying jobs in these sectors and in the hospital sector may rise as former cost structures will have to be dealt with in order to accommodate the reduced rate of reimbursement to hospitals. Over the next ten years some estimates put the cost reductions to hospitals and physicians at half a trillion dollars and this will flow directly to and affect the companies that supply hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an effect both positive and negative.

Finally, the Obama plan seeks to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like the rest of us and their training and day-to-day experiences dictate to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to physicians as to the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps a third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary test and procedures that do not compare favorably with health care interventions that are better documented as effective. Now the Republicans and others don't generally like these ideas as they tend to characterize them as "big government control" of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction.

A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their ability to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost reductions and efficiencies we need. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would begin to drive cost down by the choices we make. This works in many sectors of our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The general population, however, is not so informed and besides we have all been brought up to "go to the doctor" when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the feeling that health care is something that is just there and there really isn't any reason not to access it for whatever the reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to those with serious problems.

OK, this article was not intended to be an exhaustive study as I needed to keep it short in an attempt to hold my audience's attention and to leave some room for discussing what we can do contribute mightily to solving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are put in place to provide better insurance coverage and access to care will cost more. And somehow we have to find the revenues to pay for these changes. At the same time we have to pay less for medical treatments and procedures and do something to restrict the availability of unproven or poorly documented treatments as we are the highest cost health care system in the world and don't necessarily have the best results in terms of longevity or avoiding chronic diseases much earlier than necessary.

I believe that we need a revolutionary change in the way we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should arbitrarily and drastically reduce spending on health care you would be wrong. Here it is fellow citizens - health care spending needs to be preserved and protected for those who need it. And to free up these dollars those of us who don't need it or can delay it or avoid it need to act. First, we need to convince our politicians that this country needs sustained public education with regard to the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of U.S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the myriad of life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far earlier than in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an acute emergency or chronic condition.

Let's go deeper on the first issue. Most of us refuse do something about implementing basic wellness strategies into our daily lives. We don't exercise but we offer a lot of excuses. We don't eat right but we offer a lot of excuses. We smoke and/or we drink alcohol to excess and we offer a lot of excuses as to why we can't do anything about managing these known to be destructive personal health habits. We don't take advantage of preventive health check-ups that look at blood pressure, cholesterol readings and body weight but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much earlier than necessary to chronic diseases like heart problems, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because "health care is there" and somehow we think we have no responsibility for reducing our demand on it.

It is difficult for us to listen to these truths but easy to blame the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a genetic condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as a way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the blame.

There are a huge number of free web sites available that can steer us to a more healthful life style. A soon as you can, "Google" "preventive health care strategies", look up your local hospital's web site and you will find more than enough help to get you started. Finally, there is a lot to think about here and I have tried to outline the challenges but also the very powerful effect we could have on preserving the best of America's health care system now and into the future. I am anxious to hear from you and until then - take charge and increase your chances for good health while making sure that health care is there when we need it.

Rebuilding the Tower of Babel - A CEO's Perspective on Health Information Exchanges

2016-11-04T03:07:00.000-07:00

Defining a Health Information Exchange

The United States is facing the largest shortage of healthcare practitioners in our country's history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.

This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, "Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective."

United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the "art of medicine" is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.

History of Health Information Exchanges

Major urban centers in Canada and Australia were the first to successfully implement HIE's. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it's third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.

In the United States one of the earliest HIE's started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.

In Tennessee Regional Health Information Organizations (RHIO's) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark's HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children's Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.

Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE's. These communities' health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.

A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.

Regulatory Aspects of Health Information Exchanges and Healthcare Reform

The department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.

The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE's (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH's goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.

History of Health Information Partnership TN (HIPTN)

In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee's Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN's first initiatives involved connecting the work through Carespark in northeast Tennessee's s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.

By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN's CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN's mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, "We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health". HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it's new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark's closure clarifies the need to build a network that is not solely reliant on public grants to fund it's efforts, which we will discuss in the final section of this paper.

Current Status of Healthcare Information Exchange and HIPTN

Ten grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it's Docs for Docs program and the manner in which collaboration has taken place since it's conception in 2004. Kathleen Sebelius, Secretary of HHS commented, "The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care." Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.

A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA's conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.

The Future of HIP TN and HIE in Tennessee

Tennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor's report Richard Lang states that instead of a top down approach "A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE's and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development."22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.

One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR's like Memitech's 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.

The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won't happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE's, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE's were concerned about future sustainability while only 35% of private HIE's shared this concern.

Hospital Implications of HIP TN (A Call to Action)

From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE's. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.

Perhaps the most compelling argument to building a functional Health Information Exchange is patient and community safety. The Healthbridge reduction in disease outbreak detection of 3-5 days is a perfect example of this safety benefit. Imagine the implications in the case of a rampant virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza outbreak and ultimately save the lives of our most at risk. Rick Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and homeless. As the taxpayers ultimately bear the societal burden for our country's healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the United States is imperative. Right now our healthcare is in the Critical Care Unit it's time to stabilize it through operational excellence starting with our hospital. Let's rebuild the Tower of Babel and enhance communication to provide our patients the healthcare they deserve!