Author Archives: Michael A. Rosenberg, Esq.

Adjusters Unsure about Questionable Claims Delve into Accident Data

In an earlier FL-PIP Blog post titled “Accident Reconstructionists assist Insurance Adjusters in Uncovering Staged Accidents,” we reported how insurance companies may hire accident reconstructionists to analyze car crash data from police reports, photographs, incident descriptions, and repair records to help determine whether car accident claims are real or if crashes were staged.

A recent article in Property Casualty 360° took a look at common scenarios where accident reconstructionists provide input to insurance adjusters. A summary appears below.

Car Accident Scenario #1

The driver of a vehicle said another car hit him from behind when he was slowing for traffic. The other car did not stop to exchange information.

The claims adjuster, who photographed the damage, was suspicious because he thought the damage looked old, the vehicle had recently been added to the policy, and the claimant received a check a few months earlier on a different vehicle but with a similar story.

The data that the accident reconstructionist researched for the different model years and their variants found that the top of the bumper of these vehicles was always at or below 22 inches. It was also determined that the damage showed no signs of paint transfer. Using this information, the accident reconstructionist was able to definitively conclude that the damage seen on the vehicle did not match the driver’s testimony. The claims adjuster denied the claim in full.

Car Accident Scenario #2

Minor contact between the rear of a Chevrolet Malibu and the front of a Hyundai Elantra was reported with the scuff on the Elantra noted to be consistent with a sliding motion. Further investigation was called in uncovering that the Malibu was in a previous crash severe enough to be sold with a salvage title. No other details, including repair records, were available. The driver of the Malibu claimed that in addition to a small dented area on the right rear corner of the rear bumper cover, there was damage to the Malibu’s trunk area, more prominent on the left side of the vehicle.

The accident reconstructionist had test data run on an Elantra from the same model from a 3-mile-per-hour corner impact test and was able to determine that the damage for the Elantra involved in the incident is consistent with a collision at less than 4.2-miles-per-hour. A Conservation of Momentum analysis was then performed and found that an impact resulting in a Delta-V (the change in velocity of the vehicle from its pre-impact, initial velocity, to its post-impact velocity) of 4.2 miles per hour for the Hyundai Elantra would result in a Delta-V of 3.5 miles per hour for the Chevrolet Malibu.

Test data was obtained from the Insurance Institute for Highway Safety (IIHS) for the Chevrolet Malibu and it was determined that the claim was for more severe damage than was sustained and that the damage was partially in an area that was too far away from the actual point of contact.

It was found that not all of the claimed damages to the Malibu could be attributed to contact from the Elantra, and the insurance company subsequently denied all costs associated with the underlying damages.

Every case is unique, and claims with injuries will be treated differently.

Click on the link to read the full article, “Is that auto accident staged? Here’s how to tell.”

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Filed under Fla. Stat. 627.736 (2008), Insurance Fraud

JFK Medical Center Target of Lawsuit Alleging Excessive Billing in PIP Claims

Two women injured in unrelated 2013 car accidents have filed suit in Hillsborough County Circuit Court against a holding company that operates several hospitals in Florida, according to an article in The Tampa Tribune. The women allege that HCA Holdings grossly overcharged for emergency room radiological services.

The plaintiffs claim that the alleged overcharging harmed them in two ways:

  • First, because PIP covers only 80% of emergency medical care, they were left to pay 20% of the inflated charge.
  • Second, the excessively high rates prematurely sapped their $10,000 PIP benefits, leaving them each to pay the remainder of the costs.

One of the women, Marisela Herrera of West Palm Beach, underwent CT scans and x-rays at JFK Medical Center in Atlantis following her traffic accident. (JFK Medical Center is owned by HCA; it is the only HCA medical facility specifically named in the suit). The images done at JFK allegedly cost Herrera nearly $18,000. Plaintiffs say Medicare would typically pay only $465 for the same number and type of images.

Florida’s PIP statute mandates that insurers pay 80% of all reasonable expenses. Such exorbitant charges, plaintiffs allege, are well in excess of this reasonable amount. These charges form the basis of the plaintiffs’ claim that they were victims of “unreasonable, unconscionable and unlawful pricing and billing practices.”

The lawsuit seeks reimbursement for the plaintiffs of the out-of-pocket expenses due to the “excessive and artificially inflated medical bills.” Plaintiffs also request that the court prohibit HCA from charging those fees and order it to stop efforts to collect outstanding emergency radiological bills. The lawsuit seeks class-action certification.

The case brought by Ms. Herrera is Herrera, Marisela v. JFK Medical Center Limited Partnership, Case No. 14-CA-008372, filed on 8/18/14 in Hillsborough County Circuit Court.

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Filed under Insurance Fraud

Labor Day Highway Safety Programs Underway in Florida

Florida drivers will see more speed traps and DUI checkpoints this holiday weekend as law enforcement personnel hit the roads with several safety initiatives aimed at stopping risky drivers.

Drive Sober or Get Pulled Over, supported by The Florida Highway Patrol, is a national campaign that began on August 15 and will run through Labor Day on September 1. FHP officers will be on the lookout for impaired drivers across the state.

“Take a shot at drinking and driving, and we’ll provide the chaser,” said FHP Director Col. David Brierton. “The choice to drink and drive is a bad decision that could have grave consequences. Be responsible, don’t drink and drive.”

The annual “Hands across the Border” is a separate Southeastern U.S. regional campaign coordinated by highway safety agencies from Florida, Georgia, Alabama, and Tennessee, among others, to look for drivers under the influence (DUI) of alcohol as they cross state lines.

The blood alcohol content (BAC) is .08 in all 50 states, note the program sponsors, meaning that impaired drivers cannot claim ignorance of the law. Drivers who fail a sobriety test are likely to be arrested.

The “Hands across the Border” program, which is now in its 23rd year, also encourages safe driving habits such as the use of seat belts and observance of speed limits.

AAA Travel predicts that almost 35 million Americans will travel 50 miles or more from home during the Labor Day holiday weekend, defined as Thursday, August 28 to Monday, September 1. Automobile travel makes up the largest portion of this number, with 29.7 million travelers planning a road trip. The overall traffic projections represent a 1.3 percent increase from 2013 and the highest Labor Day traffic volume since 2008. Recent reductions in gas prices are contributing to increased travel plans, notes AAA.

Drive safely!

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Filed under Uncategorized

Chiropractor & Receptionist Connected to Operation Sledgehammer Get Prison Sentences

Convicted for their role in a massive insurance fraud ring involving staged accidents in South Florida, two more people were sentenced in Operation Sledgehammer last week.

Chiropractor Lawrence Schechtman from Parkland, whom we reported about on our FL-PIP Guide on December 19 when he pleaded guilty to mail fraud conspiracy and mail fraud, was sentenced to four years and four months in federal prison. In addition to his sentence, he was ordered by U.S. District Judge Kenneth Marra to pay more than $2.4 million in restitution.

According to federal prosecutors, Schechtman worked at clinics in Palm Springs and Miami, where he signed off on treatments for people who fraudulently claimed they were accident victims as part of the staged-accident ring which operated in several counties.

According to a story in the August 8 Sun-Sentinel, the 45-year old Schechtman, who suffers from heart and back problems, was granted a request to serve his confinement at the Federal Medical Center, a medical prison in North Carolina. Judge Marra gave the chiropractor two months to turn himself in and begin serving his term.

Another co-conspirator from Palm Springs was sentenced for her role in Operation Sledgehammer. Sircy Sacerio, also known as Sisi or Sircy Santos, received four years in federal prison by Judge Marra.

Under the terms of her sentence, the Palm Beach Post reported, the 31-year old reception and office assistant must also repay $1,146,824.26 and will have two years of supervised release following her time in prison.

She originally pleaded guilty to one count of conspiracy to commit mail fraud and five counts of mail fraud.

Part of the fraud activity in Operation Sledgehammer, which was recorded by investigators, included co-conspirators damaging vehicles with sledgehammers to give the appearance of a crash. The participants in the staged accidents would then go to clinics involved in the ring to receive bogus treatment which, according to the U.S. Attorney’s Office, brought in millions of dollar to chiropractors on false and fraudulent insurance claims. The scheme began around October 2006 and continued through December 2012.

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Filed under Fla. Stat. 627.736 (2008), Insurance Fraud

Texting Laws Appear to Reduce Traffic Fatalities

States with primary enforcement laws against texting while driving appear to be having an impact on reducing traffic deaths, a new study released by the University of Alabama at Birmingham (UAB) – School of Public Health has found.

Primary enforcement means that there doesn’t have to be another reason for a police officer to stop a vehicle.

A recent Claims Journal article summarized some of the UAB findings, one of the most notable being a three percent decrease in fatalities among all age groups associated with states supporting primary texting bans. This translates to an average of 19 deaths prevented per year in states with such bans.

However, researchers revealed that states with secondary enforcement of texting bans (an officer must have another reason to stop a vehicle) didn’t see any real decrease in fatalities. Researchers also found bans on texting are most effective with young drivers, while bans on handheld cell phones are most effective with older adult drivers.

According to 2011 data from the Centers for Disease Control and Prevention, 31 percent of U.S. drivers, aged 18-64 years, said that they had read or sent text or email messages while driving at least once in the 30 days prior. That year saw 3,331 fatalities and 387,000 injuries involving distracted drivers.

Using roadway fatality data captured in the Fatality Analysis Reporting System between 2000 and 2010, Alva O. Ferdinand, Dr.P.H., J.D., led the longitudinal panel study. She wanted to examine what impact texting laws have had on roadway crash-related fatalities and how variations in states’ laws affect those results to ultimately determine which laws are most beneficial in improving roadway safety.

Researchers’ results indicated that states with primary texting bans:

  • Were “significantly associated” with reduced traffic fatalities in all age groups
  • In all age groups, a 3 percent reduction in traffic deaths equates to 19 deaths prevented each year
  • Reduced fatalities 11 percent among 15- to 21-year olds when targeted to young drivers.

States with secondary enforced restrictions also saw no significant reduction in traffic fatalities. In addition, states that prohibit use of cell phones without hands-free technology saw significant reductions in fatalities among the 21- to 64-year old age group.

Ferdinand hopes the findings help policymakers implement laws that are most effective in reducing traffic deaths. Her results are published in the August issue of the American Journal of Public Health.

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Filed under Fla. Stat. 627.736 (2008)

FL PIP Guide Readers: Vote Now for the 100 Best Legal Blawgs

Readers of the FL PIP Guide are invited to show their support for the blog by voting in the ABA Journal’s annual competition for the 100 Best Legal Blawgs.

Please nominate Roig Lawyers’ FL PIP Guide blog by clicking here to provide a brief explanation on why you like the blog!

In addition to your name and affiliation, you will be asked to provide the URL to the FL PIP Guide (www.flpipguide.com).

You also have the chance to identify a specific blog post that you consider to be representative of the quality of coverage provided by the FL PIP Guide.

Click on the link below to get started.
http://www.abajournal.com/blawgs/blawg100_submit/

Friend-of-the-blawg briefs are due no later than 5 p.m. ET on Friday, August 8, 2014.

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Filed under Uncategorized

Fraud Charges Filed in West Palm Beach False Insurance Claim Case

The fact that Frank Assouman was not even in his truck at the time it was hit in a Boca Raton parking lot did not stop him from filing more than $25,000 in false insurance claims.

The crash report and a witness statement taken at the time of the accident indicate that the West Palm Beach resident was not in his parked vehicle when it was struck by another driver. Damage to Assouman’s vehicle was estimated at $1,500.

Days later he sought medical care, including an MRI at Delray Diagnostics and other treatment obtained from Modern Medicine, Inc.

In addition to filing a claim for property damage, Assouman reportedly filed a $21,815 injury claim with State Farm and a $3,035 claim with his own carrier of Windhaven Insurance.  Both claims were denied.

The Florida Division of Insurance Fraud filed a fraud charge against Assouman for less than $20,000.

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Filed under Insurance Fraud