Category Archives: Fla. Stat. 627.736 (2008)

Pilot program of self-driving cars comes underfire

It has come to light through an investigation conducted by the Associated Press that four of the 48 self-driving cars on California’s roads have been involved in four accidents since September 2014. In a recent article published on Quartz.com, two of the accidents occurred while the self-driving vehicle was driving, and the other two accidents occurred while the human safety driver was in control.  The two companies responsible for the self-driving vehicles were Google and Delphi. Google’s Director of self-driving program, Chris Urmson, revealed that the tech giant’s fleet has experienced 11 minor accidents in 1.7 million miles in six years since the driverless car program began.

The AP reported that the national rate for reported “property damage only crashes” is about 0.3 per 100,000 miles driven, according to data from the National Highway Traffic Administration.  If one uses this statistic and compares Google’s crashes in about 140,000 miles the crash rate seems high.

The self-driving car program is required to submit data to the California Department of Motor Vehicles; however this information has not been readily released to the public based on the state’s Vehicle Code which requires accident reports concerning traffic injuries or fatalities to remain confidential.

Many believe that as a matter of public policy the government does not want to reveal to much information since they do not want these tech companies to be put under a microscope while this program is still in its testing phase.

The self-driving car program has yet too prove to be as flexible and responsive as humans on the road in dealing with unpredictable situations on the road.

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Filed under Fla. Stat. 627.736 (2008)

Insurance agent sentenced for 8 years for racketeering

On May 12, State Attorney Bill Eddins announced the arrest of Randall Peterson. Peterson was a Cantonment insurance agent who conducted a fraudulent insurance scheme while operating under multiple business names which involved the theft of several hundred thousand dollars of commissions and bonuses from American National Insurance Company and Liberty National Insurance Company.

Peterson’s scheme began with him advertising job opportunities on the Internet for his fictitious company, College Consultants of the Gulf Coast. He then had hundreds of applicants provide information for life insurance which  he and his associates expressed to the job applicants as a free job benefit. The prosecutor’s office showed that Peterson used the information from the job applicants to complete life insurance applications that he submitted to the insurance companies in order to receive advanced commissions, which were as much as 130 percent of the first year premiums and bonuses.

Randall Peterson was found guilty of racketeering and money laundering by Circuit Court Judge Ross Goodman.  The state will request at a future hearing that restitution be set at an amount over $500,000.

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Filed under Fla. Stat. 627.736 (2008)

Three Arrested in Lauderdale-by-the Sea PIP Scam

On May 6, 2015, the Florida Department of Financial Services’ Division of Insurance Fraud announced the arrest of three Broward County men on charges of insurance fraud. The men reportedly collected more than $77,000 in insurance payments after staging a Lauderdale-by-the-Sea car crash, recruiting and paying people to feign injuries and undergo unnecessary therapy.

Ronie Petidos, 34, of Coral Springs, Patrick Logene, 39, of Fort Lauderdale, and Marc la Pierre, 27, of Coconut Creek, each face a single count of insurance fraud. Each of these felony charges carries a maximum penalty of 15 years in prison.

The arrested individuals staged an automobile accident using a hotel van filled with passengers who participated in the scam and sent the participants to clinics that they controlled.  The arrested van passengers include Shaeronda Jackson, Kennsly Giles and Jeffrey Louis of Fort Lauderdale, Jean Regisma of Lauderhill, Stephen Blanc of Lauderdale Lakes.

Ronie Petidos and Marc La Pierre were previously arrested in 2014 for their role in another staged accident that occurred in 2012. The criminal case is still pending in Broward County Court.

Clink on the link for the Florida Department of Financial Services announcement.

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Filed under Fla. Stat. 627.736 (2008)

Allstate battles in Appellate courts

Allstate is under fire in various courts addressing the language of its policy following the Florida Supreme Court’s ruling in Geico Gen. Ins. Co. v. Virtual Imaging Services, Inc., 141 So.3d 147 (Fla.2013). In Virtual Imaging, the Court ruled in favor of Virtual Imaging finding that GEICO had not made the election in the policy that they would use the Medicare fee schedules of Florida’s PIP statute to reimburse the medical providers.

Multiple appellate courts have been asked to address the issue of the language in Allstate Insurance Co.’s policy regarding its election to use the Medicare fee schedules to limit benefit reimbursements. The various Appellate courts are addressing the following question: “Did Allstate provide the requisite notice that it would use the fee schedule payment limitations authorized by Subsection 5(a)(2)?”

The following cases are under review throughout Florida’s Appellate courts:

Allstate v. Stand-Up MRI

Case No. 1D-14-1213

First District Court of Appeal

This case includes several consolidated county court appeals. Allstate is the Appellant, and former Judge Gary Farmer represents the Plaintiffs. The First DCA ruled in favor of Allstate in March (see earlier post titled, 1st DCA Upholds Allstate Use of Medical Fee Schedules). On April 24, the First DCA denied Appellee’s April 2nd motion for rehearing, rehearing en banc and certification.

Allstate v. Markley Chiro.

Case No. 2D-14-3818 in the Second District Court of Appeal on cert. question of great public importance

Allstate is Appellant

The case was fully briefed in February, 2015 and argument is requested.

Fla. Wellness v. Allstate

Case No. 3D-15-0151

Third District Court of Appeal

There are five consolidated county court appeals. Allstate is the Appellee. Marlene Reiss represents the Plaintiffs/Appellants. The briefing has not yet begun.

Ortho. Specialists v. Allstate

Case No. 4D-14-0287

Fourth District Court of Appeal

There are several consolidated county court appeals. Allstate is the Appellee. Former Judge Gary Farmer represents the Plaintiffs. The appeal was argued on April 14th.

Florida Wellness v. Allstate

Case No. 15-11590

The U.S. Court of Appeals for the Eleventh Circuit

The federal district court’s summary judgment order is being appealed by Plaintiff South Florida Wellness. Allstate is the Appellee. The briefing has not yet begun.

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Filed under Case Law, Fla. Stat. 627.736 (2008)

Two operators of Lake Worth clinic arrested

Janio Vico and Jharildan Vico, were arrested April 30th for PIP fraud, according to the Palm Beach Post.  Janio Vico and Jharildan Vico owned and operated V & C Rehabilitation Center in Lake Worth which offered chiropractic and message therapy to those involved in auto accidents and solicited patients who were involved in auto accidents.

The two individuals operated the unlicensed clinic since 2009 and have filed at least $1 million in fraudulent insurance claims.  The two men, solicited patients who were involved in auto accidents even though the individuals did not require any treatment.

Janico Vico and Jharildan Vico along with other co-conspirators have been charge with 12 counts of mail fraud and one count of conspiracy to commit mail fraud.  The two individuals face 20 years of imprisonment per count if convicted of the charges.

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Filed under Fla. Stat. 627.736 (2008)

The 11th Judicial Circuit Court Issues Key Ruling in Health Care Clinic Licensure Case

On March 10, 2015, the Eleventh Judicial Circuit in and for Miami-Dade County issued a ruling in favor of Imperial Fire & Casualty Insurance in a mandatory licensing (House Bill 119) case. The Court found that the charges submitted for Personal Injury Protection (PIP) benefits to Imperial Fire & Casualty, to be unlawful and thus, noncompensable pursuant to Florida’s Motor Vehicle No-Fault Law.

Imperial Fire & Casualty issued a policy of automobile insurance to the Insured under which the Defendant, Magic Hands Solutions Inc. sought payment. Magic Hands Solutions operated as a medical clinic and allegedly rendered medical treatment to the Insured who was injured in an automobile accident. Subsequently, Magic Hands Solutions submitted charges for payment of PIP benefits to Imperial Fire & Casualty. Magic Hands Solutions was advised that the claim submitted for PIP benefits was not payable because the clinic was not properly licensed pursuant to Section 627.736, Florida Statutes (2013).

In 2012, the Legislature required mandatory licensing for all clinics holding an exempt status, whether by issuance of Certificate of Exemption or self-determined, in order for clinics to receive reimbursement pursuant to the “PIP Statute.” Hence, a clinic must be licensed under Part X, Chapter 400 to receive reimbursement for PIP benefits, unless it qualifies for an exception listed in Section 627.736(5)(h).

The Court found that the Magic Hands Solutions being wholly owned by a license massage therapist does not qualify for any of the exceptions delineated in §627.736(5)(h)(1)-(6) and was required to obtain a Health Care Clinic license as a condition precedent to receiving reimbursement of PIP benefits.

As a result of Magic Hands Solutions’ failure to obtain a Health Care Clinic License, the Court found that the charges submitted were unlawful and thus, noncompensable pursuant to Florida’s Motor Vehicle No-Fault Law and that Imperial Fire & Casualty.

Imperial Fire & Casualty Insurance Company vs. Magic Hands Solution Inc., Case No. 2014-2211 CC 24 (01) (Fla. 11th Circuit March 10, 2015).

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Filed under Fla. Stat. 627.736 (2008)

CFO Jeff Atwater Supports Fighting Fraud During 2015 Legislative Session

CFO Jeff Atwater supports the Health Care Clinic Proposed Legislation House Bill 1127 and Senate Bill 1306 that strengthen the Agency for Health Care Administration’s (“AHCA”) Health Care Clinic Act (“HCCA”). The proposed legislation:

  • Creates new certificate of exemption mandates for clinics exempted from mandatory licensure in HB 119 and criminal penalties for certain AHCA clinic violations;
  • Increases the number of crimes that may be investigated by the Division of Insurance Fraud;
  • Requires insurers to have SIU departments with specific requirements and establishes state oversight to help fight insurance fraud;
  • Creates additional criminal penalties for unlawful claims, whether paid or not.

Please click here to review the full summary.

For additional information you may visit http://www.flhouse.gov.

If you have any questions concerning this topic, please contact any member of the Roig Lawyers Insurance Services Group.

Contributing Authors:

MICHAEL A. ROSENBERG

MARK J. ROSE

MIGUEL R. ROURA

DENNIS LAROSA

 

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Filed under Fla. Stat. 627.736 (2008)