Posts Tagged ‘PIP lawsuit’

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.


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.


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.

What do Florida PIP claimants like to do? Sue, sue, sue.

Monday, July 14th, 2014

If you are wondering where your Personal Injury Protection (PIP) premiums go, look no further than the courthouse. More than half of Florida individuals and clinics hire lawyers to pursue insurance claims.

Those attorneys charge $300 to $500 an hour to fill out paperwork and shuttle it to the clerk of court. The lawyers then ask county court judges to approve their legal bills and order insurance companies to pay them. Sometimes, the lawyers who say they are working for the little guy collect tens of thousands of dollars when the client is seeking is a few dollars.

The percentage of PIP claimants nationwide represented by attorneys rose to 36 percent in 2012 from 31 percent in 2007, according to a study by the Insurance Research Council. It comes as no surprise to us or another auto insurer that Florida leads the nation, where more than half of claimants hired attorneys in 2012.

“The attorney involvement trends shown in this study undercut two of the envisioned benefits of no-fault auto injury systems: a less adversarial settlement process and more timely payments,”  Elizabeth Sprinkel, senior vice president of the council said in a press release. “The role of attorneys is implicated in many of the factors driving up the cost of auto insurance.”

The study found that in cases where attorneys represented claimants that individuals were much more likely than those without a lawyer to receive treatment in a pain clinic and were more likely to be involved in apparent claim abuse.

PIP fraud investigations have found that people involved in staged accidents and other illegal efforts to cheat the PIP system signed over their benefits to the clinic that was supposedly diagnosing and treating them. The clinics hired attorneys to sue auto insurance companies when the claims were investigated and sometimes denied.

The study was part of the council’s continuing research into auto injury claims. More than 35,000 auto injury claims were examined and 12 insurers that represent 52 percent of personal driver market participated.



Clinic sues for $14 in PIP benefits and loses not just trial, but the appeal

Friday, June 13th, 2014

Would you sue for $14? Wellness Associates of Florida did when an auto insurer reduced its Personal Injury Protection (PIP) claim.

Some medical clinics like to scream “Foul!” in court when they don’t receive everything they asked. PIP attorneys are all happy to accommodate them because they can bill upwards of $300 per hour — sometimes $500 an hour — to fill out the paperwork. Lawyers and their clients are happy when they win because the insurance company pays their damages and fees.

Wellness Associates went home unhappy after it lost its appeal to the Fourth District Court of Appeals. Northwood Sports Medicine was also disappointed when the court put the clinics’ two cases into one opinion.

Wellness had initially sued the insurer for damages and amended that to bad faith when the last $14 in PIP benefits were paid. The insurer moved for summary judgment, saying it had paid every dollar it owed, and won.

The clinic appealed, where its case was consolidated with that of Northwood. It had sued another insurer for damages and then bad faith, and also lost.

In its opinion on the Wellness case, the appellate court said that an insurer doesn’t have to pay anything more on a valid PIP when the full amount was paid if the insurer met certain legal requirements.  Also, an insurer doesn’t have to set aside the disputed dollar amount when it it denies or reduces a claim.

“Where the reasonableness of the provider’s claim is in dispute, post-suit exhaustion of benefits extinguishes the provider’s right to further payments, as long as exhaustion is prior to the establishment of the amount to which the medical provider is entitled to under PIP,” the court wrote in its opinion.

In other words, if the PIP benefits have been used up before the disputed amount is settled, the claim is considered settled. The court also said it didn’t matter whether the benefits were used up before or after the lawsuit was filed.

Maybe that will make some clinics think twice before picking up the phone and asking its lawsuit-happy attorney to run to the courthouse.

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

‘Ambulance-chasing’ attorneys run from spotlight

Monday, March 4th, 2013

If you’re wondering why personal injury lawyers are often called ambulance chasers, an open-and-shut civil suit among seven South Florida law firms provides an answer. Four firms that often represent people injured in accidents such as car crashes sued three competing firms, claiming that they illegally solicited clients.

The lawsuit alleged that the three firms used non-employees, known in the legal trade as “runners,” to direct injured people to those law firms. You see, it’s illegal for attorneys to chase an ambulance up the street, down the hill and over to a hospital in order to sign the banged-up occupant as a client. It’s also against the law for attorneys to pay other people to knock on the doors of patients’ rooms and homes to do the same.

However, some law firms bend or break the solicitation rules. Almost every personal injury attorney knows of at least one firm that’s engaged in the practice. It’s a dirty, little not-that secret which the Florida Bar does little about.

When the situation gets out of control, the offended firms do what they know best: go to court. After all, top attorneys at firms like these regularly make $400 or more an hour suing insurance companies like ours for Personal Injury Protection (PIP) claims. One PIP case can produce upwards of $50,000 in fees, even if the client collects only a few bucks.

That makes runners a source of irritation to the firms that are losing out on the sprint to sign clients. Along with some language about how integrity and the reputation of lawyers are being damaged, the lawsuit says that people working indirectly for the defendants put injured people in touch with their lawyers. For example, an employee of Broward Health Medical Center arranged a meeting between an injured patient and an attorney, according to the lawsuit.

The defendants responded with threats and indignation.

“The true headline, if any, ought to be that these attorneys have abused the judicial process and are maliciously prosecuting false and unsustainable legal claims to serve their own personal and political interests,” one attorney told the Daily Business Review.

The news article may have also prompted the two sides to figure out that publicity helped no one. According to the Broward County Clerk of Court, the lawsuit is done. No details were available, but you can guess that if seven law firms shut down a case in less than two months, they have decided it is better to settle their differences in private.

We’re not going to publicize the names of the law firms here. They neither need nor deserve the attention. But if you want look them up, here’s the case number: CACE13-00031.

High-level working group seeks cure for PIP fraud in Florida

Monday, October 17th, 2011

The Office of the Insurance Advocate is investigating the causes and solutions to Personal Injury Protection (PIP) fraud. Its working group held an all-day meeting on the matter on Oct. 10.

Robin S. Westcott, Florida Insurance Consumer Advocate, leads the group, which includes representatives from the medical and insurance industries, including Michael Neimand, an appellate attorney with the Office of the General Counsel at United Auto Insurance Corp.

The group heard from two experts in its morning session:

  • Albert Rosati, General Manager of ExamWorks, said that the no-show rate for independent medical examinations is about 50 percent, and can be higher in cases involving attorney representation.
  • Dr. Ashley Booth-Norse of the Florida College of Emergency Room Physicians said that the current $5,000 set-aside for emergency care is being used to pay hospital liens, or is applied to a deductible. She suggested strengthening the language of the law to clarify that the set-aside may not be used to settle liens and that the deductible does not apply.

The working group also discussed licensing of medical clinics, as much of PIP fraud comes from that source. Most group members said that exemptions to the license requirements should be tightened to allow an exemption for only one location. Some argued for eliminating all exemptions.

In the afternoon session, a form titled “Application for Florida No-Fault benefits” was criticized first by Jeff Scott of the Florida Medical Association. He said it could be used as an administrative tool to reject legitimate claims.

Michael Neimand of UAIC said that instead of adding a claim form, the PIP statute should be amended to limit the ability to demand PIP benefits to policyholders and their attorneys.

Scott said that that limit would injure physicians. Niemand responded that an exception could be worked out for first responders and emergency medical providers.

The working group then discussed the idea of annually setting PIP reimbursement rates at the Medicare rate on a given date. The idea was proposed during the 2011 legislative session.  The group agreed that a schedule might reduce fee disputes. Scott stated the medical association would support the idea provided that the minimum PIP rate were based on the 2007 Medicare reimbursement rate.

The group agreed that changing the maximum PIP benefit, currently $10,000, was not central to PIP reform. Repeal of PIP would also not be essential. Ralph Gladfelter of the Florida Hospitals Association said replacing PIP with bodily injury coverage was a near-catastrophe for Colorado’s trauma care system.

A representative of the Florida Justice Association stated that most states have made bodily injury coverage mandatory because too many accident victims were left uncompensated under PIP systems.  Colorado’s problems were solved through adoption of a medical payment system. The association thinks a combination of bodily injury and personal injury protection coverage would be the most effective solution.

Allen McGlynn of State Farm said that other states have healthy auto insurance markets because they have attorney fee schedules, utilization controls, “loser pays” attorneys’ fees, appropriate investigation tools, no contingency risk multipliers, and no threat of a catastrophic bad faith claim.

The attorneys’ representative responded that insurance companies have long sought a fee schedule and now want further reform of litigation that would encourage underpayment of benefits. He said that more than 10,000 lawsuits for underpayment have been filed over the last 18 months against State Farm, USAA and United Auto.

Neimand said that of United Auto’s 790 open cases, 600 were claims of underpayment by providers. United was paying the prescribed Medicare rate, but providers demand higher payments because the Medicare fee schedule was not incorporated in United’s contract.

Westcott concluded the meeting by restating the group’s desire to reform PIP instead of repeal it, while aggressively seeking PIP policy that would reduce litigation.

PIP attorney suspended; he put ‘his personal interest above the interests of his client’

Tuesday, July 5th, 2011

Here’s an insight into personal injury protection (PIP) lawsuits that plaintiff PIP attorneys don’t want you to know: They sue for the money that they will make – not for their clients.

Case in point: Attorney Timothy Allen Patrick, whom the Florida Supreme Court ordered suspended for one year for his mishandling of a PIP lawsuit for a chiropractor. The court said in a decision released June 23, 2011, that Patrick “had encouraged his client to proceed with the cases and not accept the offer at mediation because [he] wanted to be paid his attorney’s fees.”

Patrick’s misdeeds show just how far PIP attorneys will go to collect the money they want and how little they care about their clients. Attorneys like Patrick demonstrate that contrary to the oath they take to practice law in Florida, they are willing to put their clients at financial risk.

Patrick broke several rules, and it wasn’t the first time. In handing down the one-year suspension, the Florida Supreme Court wrote that he had “previously been before this Court for the same form of serious misconduct, and he has now harmed three clients by his continued misdeeds.”

The Florida Bar brought a complaint against Patrick in November 2009 over his handling of two PIP claims by a chiropractor, Dr. Newman, against Progressive Insurance Co. The claims totaled $48. That’s right, just $48.  Sound familiar?

When the claims reached mediation, Patrick said he had spent 60 hours on the case. His normal billing rate is $225 per hour, according to court records.  (Clearly Patrick doesn’t practice in Dade and Broward counties where Judges award far in excess of $225 per hour for PIP cases).

Progressive offered $2,500 to settle the claim, with $48 going to Newman and the rest to Patrick. The Bar referee who investigated the complaint reported that “Newman could not have gained or benefited any more than the offer made at mediation.” So suing posed a financial danger to Newman, because if he lost, he would have to pay Progressive’s legal bills.

The referee found that Patrick pushed Newman to pursue the lawsuit, for which he won $24 on one claim and Patrick hit a payday of $120,772.50 based on his bill for 235.5 hours.

Progressive won the other case and the court awarded the insurance company $10,200 in legal fees and costs. Both sides appealed, with an appellate lawyer representing Newman.

Progressive won a first round of appeals, which meant that Newman didn’t get his $48 and was liable for Progressive’s much larger legal expenses. Patrick didn’t get paid because he took the case based on a winning contingency.  If he didn’t win, he didn’t get paid.

Patrick, not Newman, hired a second attorney for more appeals. That attorney lost too, and Progressive sought payment from the chiropractor. When the bill came, Patrick refused to pay any of it.

In his investigation, the Bar referee found that Newman rejected the initial offer to settle based upon Patrick’s inducements so Patrick could pursue the full claim for attorney’s fees. Further, Patrick stretched out the litigation by paying some of the legal bills of the second appeals attorney.

This was not the first time that Patrick had been accused of such conduct. In handing down the one-year suspension and requiring the attorney to take an ethics course, the Florida Supreme Court found that Patrick failed to tell one client that her insurance company had won a $15,300 judgment against her for attorney’s fees and costs.

In another instance, Patrick did not tell his client, a doctor, that Progressive had offered a payment to settle. The claim went to court, where the client lost and had to pay Progressive $13,000.

The facts, read them at Florida Supreme Court’s website, show how PIP lawsuits can be so little about justice and so much about greed.

Judge: ‘I don’t believe a PIP attorney is entitled to $450 an hour’

Monday, May 23rd, 2011

Personal Injury Protection (PIP) attorneys don’t deserve the fat fees they try to collect for filing PIP lawsuits, says one well-respected South Florida judge.

“I don’t believe a PIP attorney is entitled to $450 an hour, Miami-Dade County Judge Marvin H. Gillman said at a hearing held May 10, 2011. “There is nothing so complicated about PIP that deserves a neurosurgeon attorney to handle it.”

Well put! We’ve been saying all along that attorneys who charge upwards of $350 an hour to file basic paperwork are using the legal system for personal gain and forcing honest drivers to pay too much for their auto insurance. We applaud the courage Judge Gillman showed.

At issue was a demand by the Patino Law Firm of Hialeah to be paid more than $40,000 in legal fees for 98.5 hours of work at $425 per hour. Attorney Ryan Peterson of the firm represented one of his bosses, Richard Patino, who worked on the case when it was originally filed in 2001. Peterson sought to block UAIC’s request to take a deposition of Patino.

“I don’t understand why anybody who is seeking, in this case $40,000 in attorney’s fees ten years after the fact would object to being deposed to defend their claim for $40,000 in fees,” Judge Gillman said, according to a transcript of the hearing.

Judge Gillman went on to question the fees that PIP lawyers demand of insurance companies as part of a legal settlement.

“You know, some guy swinging a hammer playing ordinary lawyer should be able to handle these cases for $150 to $200 an hour,” Judge Gillman said. “You don’t need somebody at $450 an hour to handle PIP, not unless it’s become so complicated in the past ten years that it’s beyond my comprehension.”

“People two years out of law school are doing PIP cases, Judge Gillman said. “And they don’t get $450 an hour. They wouldn’t even dare ask for that amount of money.”

“It just offends me that Mr. Patino asks for that kind of money from a third party,” Gillman said. “Now, if he wants to get [that] from his client, that is his client’s deal and himself. But not from the third party with the court’s approval. I can’t condone that at all.”
UAIC argued before Judge Gillman that it was entitled to know more information before going into a fee hearing over the amount. Peterson had objected, arguing that “other county courts have called depositions after the fact ‘Rambo-like overkill,’” according to a court transcript.

Judge Gillman disagreed, saying, “Why should that be treated any differently than a plaintiff who is seeking to collect a judgment against somebody?”

Peterson’s response carried no weight. Judge Gillman ordered a deposition, saying that the UAIC attorney could “take his deposition until the cows come home as long as it pertains to the point about the $40,000. Or why he’s entitled to $450 an hour, which, in my opinion is an outrageous amount of money.”

We hope the other county court judges take notice of Judge Gillman’s comments. Too often we hear from plaintiff attorneys that they have no incentive to settle because they know the judges are going to give them everything they want.

Some judges have even mentioned that they know the rates awarded to plaintiff PIP attorneys are out of control, but they can’t do anything about it because they fear they won’t be re-elected.  It’s a very sad state of affairs, and one of the reasons South Florida is rated the Number One judicial hellhole year after year.

Confusion in the courts: PIP ruling thwarts justice

Monday, January 24th, 2011

It’s a matter of law in Florida that when you send a check to someone with a note that says, “If you cash this, you are accepting payment in full,” then the matter is settled.

Not so, one of Florida’s top courts now tells us. United Automobile Insurance Company (UAIC) thought it had settled a PIP bill with Palm Chiropractic Center when the Pembroke Pines clinic cashed a check that had “full and final payment” written on it.

Instead, the center, which assumed the claim of a UAIC policyholder, said in a lawsuit filed in county court in Broward County that it was owed more money.

The judge ruled in favor of Palm Chiropractic without a trial and a circuit court panel acting as an appeals court agreed. UAIC went a rung higher on the legal ladder to the 4th District Court of Appeals. It said that both the county and circuit courts were wrong, but that a correction wasn’t warranted.

What? Two courts make mistakes and when a third discovers it, it says only, “Sorry”? The 4th District court said that the county judge should have ruled in favor of UAIC. The appeals court also said while the mistake cost the insurance company $55,000 in legal fees paid to Palm Chiropractic’s attorney, the lower court’s error was not “a miscarriage of justice” and did not establish a legal precedent that would enable anyone else who cashed a PIP claim check to sue.

We beg to differ. UAIC being forced to pay $55,000 in attorney’s fees when it followed the law is certainly a miscarriage of justice. PIP law says that insurers are liable for attorney fees only if they wrongfully withhold the proceeds of the policy.

Second, the 4th District’s opinion means that any business that thinks a matter is settled when a check marked “full and final payment” is cashed is in for a rude surprise. It’s not! A person or company can pocket the money and sue for more.

Not only that, the plaintiff attorney can bill the other party for fees. In this instance, the clinic collected a few dollars while its lawyer took home tens of thousands of dollars.

The business being sued may not get its day in court. The county judge ruled in favor of the clinic without a trial. The higher courts did not see the need for a trial, either.

The legal system has protections to keep innocent people out of prison and help blameless companies from being harmed. When a court makes a mistake, there’s supposed to be a way to set things right.

But when those safeguards fail, then everyone suffers. We hope that the 4th District Court understands that by correcting the error in this case, everyone in Florida will benefit.

Sun-Sentinel shines light on how plaintiff attorneys abuse PIP

Monday, January 17th, 2011

The Sun-Sentinel has exposed how Florida’s plaintiff attorneys exploit Personal Injury Protection (PIP) lawsuits in a front-page investigative report published Jan.16.

The Fort Lauderdale-based newspaper shows that plaintiff PIP lawyers collect huge court fees for themselves and force all drivers to pay higher insurance premiums.

We thank the Sun-Sentinel for exposing attorneys who abuse the legal system. The public needs to know that their PIP insurance premiums are going to pay off greedy plaintiff lawyers.

The lengthy article and accompanying stories document how plaintiff lawyers have charged as much as $500 an hour while arguing in court that their clients were due as little as 1 cent.

“Lawyers and other people in this field have found ways to make some money here,” the article quoted Florida Deputy Insurance Commissioner Belinda Miller as saying. “The lawsuits are increasing because this has become a fairly well-oiled machine on the side of the people that bring those cases, and it’s lucrative.”

How lucrative? The Sun-Sentinel uncovered a PIP lawsuit against UAIC in which a Miami-Dade attorney received $13,370 in fees while winning only $2.53 for his client. UAIC appealed and won.

Another lawyer collected just $2,000 for his client and took home $160,000 for himself in a PIP lawsuit, the article reported.

It’s our view that plaintiff attorneys are running PIP mills. The article says one attorney in Broward County has filed 3,300 lawsuits in 5 years. Those numbers are ridiculous.

The article also found that Gulfstream Medigroup of Palm Beach Gardens had filed almost 1,200 PIP lawsuits through early November, and that attorney Brian LaBovick owns Gulfstream while having his law firm handle the lawsuits.

LaBovick is essentially double-dipping, we think, putting court awards in one pocket and legal fees in the other.

The rising costs from PIP lawsuits and big attorney fees are hurting Florida drivers, the Sun-Sentinel article said.

“The cost of this coverage is going up,” deputy insurance commissioner Miller told the newspaper. “I think it’s going to be hard to keep insurance affordable to everybody.”

We say it’s time to do something about the problem. When the legislature meets in March, it must pass laws that give drivers much-needed financial relief.