Posts Tagged ‘Florida legislature’

Florida PIP reform law withstands legal challenges on payments

Monday, July 28th, 2014

Can’t get what you want from Florida’s Personal Injury Protection (PIP) reform law? You could try suing your insurance company, but don’t expect good results.

Two individuals claimed in U.S. District Court for the Southern District of Florida that their auto insurers denied them proper PIP benefits. They both lost.

LAWSUIT #1

Glenaan Robbins went after her insurance company, claiming in a lawsuit that it violated a provision that that limits PIP benefits based on whether an emergency medical condition exists. The reform law tries to cut down on inflated claims by limiting the reimbursement to $2,500 if there was no emergency. The insurer must pay up to $10,000 if a qualified medical provider says there was an emergency.

Robbins was injured April 2013 and claimed in her lawsuit that “no determination was made that she did not have an emergency medical condition.” That’s a double negative for those of you that pay attention to grammar rules. The insurer disagreed and paid $2,500.

The court was not sympathetic to her argument. It ruled that there must be an emergency condition before an insured person can qualify for the higher PIP amount. Case dismissed.

LAWSUIT #2

Sendy Enivert also said her insurer erred by not paying $10,000 in PIP benefits. She argued that the $2,500 limit applies when a medical provider says there is no emergency. Because no medical provider said that the conditions were not met (There’s that double negative again.) she was entitled to the higher limit of $10,000.

Again, the court disagreed. “A medical provider did not determine that Enivert had an EMC [emergency medical condition], and she concedes that she did not have one. Therefore, Enivert is not entitled to the full $10,000 in benefits and her claim fails,” the court said in its opinion.

The court went a step further and recited statistics about the widespread problem of PIP fraud, especially in South Florida.

“The Court finds it clear that the legislative intent behind the PIP Statute is to decrease PIP fraud in Florida by placing more stringent requirements on the insured in order to receive the full amount of benefits and to efficiently allocate maximum benefits to the insured who have severe medical conditions. Therefore, the PIP Statute’s clear language and legislative intent are consistent,” the court wrote. Case dismissed.

Florida’s highest court removes obstacle to lower PIP premiums

Monday, May 5th, 2014

The forces trying to slow or stop Personal Injury Protection (PIP) reform have been dealt a serious blow. In late April, the Florida Supreme Court declined to hear an appeal that kept key provisions of the 2012 PIP  law in place.

A circuit court judge in Tallahassee had issued an injunction blocking parts of the law at the request of chiropractors, acupuncturists and others who claimed the law violated the state constitution by prohibiting them from providing services. An appeals court lifted the injunction, and the Florida Supreme Court declined to hear an appeal that could result in a reinstatement of the injunction.

“Recent evidence reveals implementation of the 2012 PIP reforms led to reduced fraud and suppression of the PIP portion of auto rates, yet certain individuals still sought to put the brakes on the reforms benefiting Florida’s drivers,” the The Property Casualty Insurers Association of America said in a statement.

“Floridians deserve better,” the association said, “and its members wish to see that Florida’s consumers are provided with much needed relief once and for all as we move forward. The decision by the Florida Supreme Court today is just that, a step forward.”

The business associations that brought the initial lawsuit said they will be back in court, trying again to undo the law.

 

 

 

 

 

PIP reform produces premium savings across the board

Monday, January 27th, 2014

The naysayers of Personal Injury Protection reform in Florida should take a good look at a preliminary report just out from the Florida Office of Insurance Regulation. The 20 largest insurers writing PIP insurance have lowered rates an average of 13.2 percent.

The analysis covers the period starting in October 2012 to a second rate filing on Jan. 1 of this year. The cuts came after a PIP reform bill (HB 119) went into effect in 2012.

“The anticipated cumulative effect of these two rate filings in the legislation was a 25 percent overall decrease in PIP rates,” according to a news release from the regulator. “Most insurers calculated their rates using a Pinnacle study, which projected that reforms contained in HB 119 would generate PIP premium savings ranging from 14 percent to 24.6 percent.”

“Based on the Office’s analysis, all of the top 20 personal auto insurers accounted for and recognized the projected savings from HB 119 in PIP rates filed with the Office,” the release said.

The decreases have a double benefit to drivers. In 2011, 86 percent of rate filings proposed increases in PIP premiums, most of them 10 percent or more. Had the law not taken effect, policyholders would have been paying even more to cover their vehicles.

PIP insurance accounts for about one-fourth of an insurance premium cost, the regulator said. The decrease in PIP rates should reduce the overall cost of insurance 3 percent to 4 percent depending on the coverage purchased.

Some drivers are saving more. Customers of some of the largest insurers in Florida – Geico, Progressive and USAA — saw their PIP premiums decrease 25 percent to 34 percent. Customers of UAIC experienced a decline of 7.7 percent.

PIP premiums have room to fall even more. If the courts continue to stay or turn aside challenges to the law, insurers can use the reforms to bring down costs. Increased investigation of PIP fraud – a big driver of premium increases – will also benefit drivers and insurance companies.

Florida PIP reform law stays in place as 1st District Court of Appeals denies motion for rehearing

Tuesday, November 26th, 2013

The Florida Personal Injury Protection (PIP) reform law enacted in 2012 has withstood another legal challenge as the 1st District Court of Appeals denied a motion for rehearing on its reversal of an injunction that prevented a significant part of the law from taking effect.

In March, a coalition of acupuncturists, chiropractors and licensed massage therapists persuaded a Leon County circuit court judge to grant a temporary injunction that blocked the portion of the law banning payments to them and requiring that injured person seek treatment within 14 days of an accident from a physician or hospital except under certain conditions.

Those provisions were put in place because of widespread PIP fraud in Florida. Much of that fraud was generated through falsified claims for medical need and treatment.

The victory for those business groups was short-lived, as the 1st District Court of Appeals reversed the circuit court on Oct. 23. The appeals court said the business groups failed to show a specific instance that supported their claim of denial of access to the courts. The court also said that the claim of economic harm was insufficient to assert the potential access-to-courts claims of other parties.

“The real parties in interest—injured motorists whose ability to sue tortfeasors has been impermissibly limited—are absent from this case,” the court wrote in a unanimous decision. “The Provider Plaintiffs’ attempt to bootstrap the standing requirement by joining the fictional ‘Jane Doe,’ purporting to represent all Florida citizens that were, are, or will be injured as a result of a motor vehicle collision, must likewise fail. The instant record does not provide a factual context or legal basis to support this hypothetical claim.”

The business groups were denied a rehearing in late November, which means those provisions of the PIP reform law will remain in effect unless the business groups file a successful appeal with the Florida Supreme Court.

“In order for Florida to no longer be the No. 1 state in the nation for questionable auto claims, and stop the $1 billion fraud tax on Florida consumers, the PIP reforms passed by the Legislature must have time to be fully implemented,” Donovan Brown, state government relations counsel for the Property Casualty Insurers Association of America, told the website Property Casualty 360.

“We are cautiously optimistic that once these reforms are fully implemented and have been given time to work, the fraud and abuse in Florida’s no-fault auto insurance system that so adversely impacts Floridians will subside, and Florida consumers may be provided with much needed relief once and for all,” he said.

New standard of evidence could affect PIP claims

Monday, September 23rd, 2013

Some personal injury protection (PIP) lawsuits in Florida involve expert testimony to help determine liability. A new law is changing the way expert testimony is accepted and treated.

UAIC appellate attorney Thomas L. Hunker says that under the new Daubert standard, “the trial judge acts as gatekeeper to determine whether the testimony is based on sufficient facts or data, whether the testimony is based on reliable principles and methods, and whether the expert has reliably applied the principles and methods to the facts of the case.”

Writing in the Daily Business Review, Hunker said that “the expert must employ in the courtroom the same level of intellectual rigor that characterizes the practice of an expert in the relevant field. Courts may also exclude expert testimony if there is too great an analytical gap between the underlying science and the expert’s opinions.”

The new standards give trial judges more responsibility. That could affect how PIP cases — and their appeals — are handled. For the full story, read here.

Hunker DBR PIP op-ed May 28 2013

Florida CFO Atwater says new law sets up fresh challenges in fight against PIP fraud

Friday, July 6th, 2012

Florida CFO Jeff Atwater, whose office enforces the personal injury protection (PIP) law that took effect on July 1, says that provisions to reduce fraud will take time to take effect. Drivers should see some benefit. Just how soon and what to degree will become known over time.

The new law prohibits payments for massage or acupuncture treatments and restricts the payout for non-emergency treatment of accident-related injuries to $2,500. That should make a dent in the rampant PIP fraud perpetrated by unscrupulous clinics.

The law also requires more details in accident reports, which could reduce the number of staged accidents that are designed to generate fake PIP claims.

Will the provisions of the PIP law work? “We will know the answer to that in the next 12 to 24 months,” Atwater told the Orlando Sentinel.

As part of the new law, Atwater is creating a group to fight PIP fraud that self-funds investigations.  The money could come from the insurance and medical companies, and Atwater said fundraising details are still being worked out. He wants the group to pay for and share technology or data rather than fund prosecutions.

“That’s a bit of a pressure issue,” he said. “You don’t buy justice.”

Auto insurance companies are waiting to see how much the new law and new group can accomplish. The new law has an Oct. 1 deadline by which auto insurers must cut premiums 10 percent or give reasons why that’s not possible.  On Jan. 1, 2014, insurers must cut 25 percent or explain to the state why not.

“I really believe that the expectation that a 10 percent reduction and to follow with a 25 percent reduction is achievable,” Atwater told the Sentinel. “And even if it falls slightly short of those benchmarks, the people of Florida deserve that relief.”

Gov. Scott and CFO Atwater see how PIP fraud accidents are staged

Monday, February 20th, 2012

On Feb. 16, Gov. Rick Scott and Chief Financial Officer Jeff Atwater saw first-hand how car crashes are staged. The fake accidents are part of a larger scheme to file phony Personal Injury Protection (PIP) claims and defraud insurance companies and their customers.

At the driving instruction area of Pat Thomas Law Enforcement Academy, the Florida Highway Patrol showed how people commit accident fraud. In one instance, people hide on the side of the road near a staged crash. After the vehicles collide, the people jump into the vehicles and claim they were injured.

Fraud from this and other staged accidents has pushed PIP insurance rates 30 percent higher each year, Scott said. He urged lawmakers to pass legislation that would reform PIP.

“That’s money back into somebody’s pocket so they can afford food or shelter, transportation, things like that, education for the kids,” Scott said in an article posted at WFCN, Jacksonville.

“This is the same thing. This is a billion dollars of fraud on the citizens of our state, money that should be back in their hands, not to somebody who’s running a clinic that’s taking advantage of the system, lawyers that are taking advantage of the system. So this to me is a no-brainer. Why we wouldn’t want to fix this and be aggressive at fixing this?”

Radio station WFSU in Tallahassee covered the event: WFSU report on staged accidents

 

Government, business leaders call for PIP reform law with teeth

Monday, February 13th, 2012

Floridians are calling for reform of personal injury protection (PIP). Will legislators listen, or will all the bills that contain meaningful changes be killed, just as they were in 2011?

Gov. Rick Scott and CFO Jeff Atwater joined a broad coalition of Florida consumers, business leaders, law enforcement officials and concerned citizens in Tallahassee on Jan. 25. They urged legislature to “Put the Brakes on Accident Fraud and Abuse.

Scott, Atwater and former Florida Insurance Commissioner Bill Gunter said that fraud, abuse and excessive litigation were identified as problems in 1975. However, “PIP remains the domain of those who exploit the broken system in order to enrich themselves at the expense of consumers — further illustrating that the PIP system is long overdue for meaningful reform and the Legislature must act this session to end the nearly $1 billion fraud tax and stop accident fraud,” according to a joint statement.

“I urge the Senate and the House to work together on a comprehensive package that will actually get to the root of the problem and address this issue once and for all,” said Gov. Scott.

Others spoke out on the need for reform:

“I am a good driver, but with current trends, I will soon be priced out of the automobile insurance market.”

“Every day, I hear more and more deceptive and coercive advertisements that seem to encourage fraudulent claims,” said Cydnee Knoth, a Tampa resident who traveled to Tallahassee to urge the legislature to act on PIP.

“We cannot wait any longer for relief from the expense of fraud and litigation abuse.

“Florida cannot sustain the ever-growing burden of a broken PIP system. Florida families and businesses continue to take the brunt of this unresolved billion dollar problem,” said David Hart, executive vice president of the Florida Chamber of Commerce. “We are hopeful and expectant that the 2012 Session will be marked by comprehensive change.

Florida’s no-fault system is creating problems for Florida’s businesses and consumers.”

“In order for this legislation to successfully impact Florida consumers and businesses, we truly believe it must have teeth to it,” said Tom Feeney, president and CEO of Associated Industries of Florida. “Florida consumers and businesses deserve nothing less.”

The coalition urged lawmakers to include these key reforms in a final bill:

  1. Reasonable limitations on attorneys’ fees to remove the incentive to file frivolous lawsuits at the expense of Florida drivers.
  2. Increased anti-fraud controls to identify suspicious claims and allow insurers time to investigate those claims to avoid unnecessary payments paid by innocent consumers.
  3. Enhanced controls on medical costs, through clarification of the medical fee schedule and other tools that rein in high utilization of questionable medical procedures, the costs of which are passed on to consumers.

A leading business group, Associated Industries of Florida also participated in the event. In a separate editorial for a Florida newspaper, Jose L. Gonzalez, vice president of governmental affairs, said effective legislation is needed because PIP fraud affects, “the neediest Floridians most, particularly those on fixed incomes.”

 

‘Four Pillars’ of Florida can bring PIP insurance relief to drivers

Monday, November 28th, 2011

Personal Injury Protection (PIP) insurance is in desperate need of reform, and Florida’s government leaders have outlined a plan to do just that. We should all show our support for changes that would that would reduce the PIP fraud premium that all Florida drivers pay.

Gov. Rick Scott, Chief Financial Officer Jeff Atwater and legislative leaders have pinpointed four areas where executive and legislative action can reduce PIP fraud and possibly auto insurance rates. The four pillars would attack the problem at its roots.

“Regrettably, our state’s auto insurance system has been taken over by a circling pool of pariah — fraud clinics, lawyer referral services and organized crime — that have been making their millions on the backs of every Floridian with a car in the driveway,” Florida CFO Atwater said in an official statement on Nov. 15, 2011.  “Today, we stop throwing consumers to the wolves and take action to drive down the cost of auto insurance for Florida’s consumers.”

The four areas of action:

  1. Fraud Prevention. Florida leads the nation in staged crashes and questionable claims, and often individuals not involved in the crash receive PIP benefits.
  2. Litigation Reform. From 2006 to 2010, PIP-related lawsuits pending at year-end increased by 387 percent. Attorney fees often far exceed the value of the $10,000 coverage and the damage amounts in dispute.
  3. Utilization and Provider Reform. Florida is above the national average in the amount of medical provider charges per claim and the number of procedures per claim. Florida must address fraud and abuse to reduce these occurrences.
  4. Accountability. Governor Scott and CFO Atwater called for a plan to gather the data needed to evaluate the legislation’s overall effectiveness to stop PIP fraud and abuse and drive down rates.

Florida drivers can help reform the PIP system by telling their state senators and representatives that reform is needed now. Drivers can also send statements of support to Gov. Scott and CFO Atwater.

Tampa Bay Times: Criminals take Florida’s auto insurance for ride

Thursday, November 3rd, 2011

The St. Petersburg Times has published an editorial that’s a must-read for anyone who has his or her car insurance in Florida. It calls for state legislators to take action on the rampant fraud that’s driving up premiums.

The editorial, published Oct. 31, 2011, begins:

Crime pays, but increasingly it’s Tampa Bay’s law-abiding drivers who are footing the bill. Enterprising criminals are taking Florida’s no-fault auto insurance law for a ride, fueling soaring insurance rates for everyone else.

The editorial describes how the Tampa Bay area has become a hotspot for auto insurance fraud, including staged accidents, phony personal injury protection (PIP) claims and the like. The problem has gotten out of hand and action is needed at the state level.

The editorial concludes with this thought:

Floridians need Tallahassee’s help to curb this so-called fraud tax. But they also need to be assured that lawmakers are looking out for their interests if they are in an accident.

We ask you to read the editorial in its entirety here, at the tampabay.com website.