Category Archives: Fla. Stat. 627.736 (2008)

State Farm Granted Summary Judgment in Lake Worth Chiropractic PIP Benefits Case

On July 14, 2014, the 15th Judicial Circuit for Palm Beach County affirmed a lower court decision granting summary judgment to State Farm in a claim for PIP benefits brought by Lake Worth Emergency Chiropractic Center.

In the underlying case, Judge Bosso-Pardo granted defendant’s Motion for Final Summary Judgment, entering final judgment for the defendant, State Farm, upon finding that the pre-suit demand letter, required by Florida Statute 627.736(10) (2010), was insufficient in that it demanded payment for services that were never billed to State Farm.

Judge Bosso-Pardo found that the Plaintiff’s “withdrawing” the unbilled service after suit had commenced was insufficient to cure the defect and that the demand letter requirements under Florida Statute 627.736(10) must be strictly construed and adhered to by those seeking to initiate litigation against a Florida PIP insurer.

The Circuit Court affirmed this decision, concluding that section 627.736(10) requires strict compliance and that, in this case, the demand letter did not strictly comply with the PIP statute requirements. As such, Lake Worth Emergency Chiropractic Center failed to satisfy the condition precedent to filing its law suit, and the trial court was correct in awarding final summary judgment in favor of State Farm.

The case is Lake Worth Emergency Chiropractic Center v. State Farm, in the Fifteenth Judicial Court for Palm Beach County, Case No. 502012AP000034XXXXMB. Click on the link to read the court opinion.

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

Vehicular Arson Cases Climbing Nationwide

The slow economy could be contributing to an increase in claims involving auto fires, according to an official with the Washington, D.C.-based Coalition Against Insurance Fraud.

“Common sense tells you that more desperate people will take more desperate measures to get themselves out of trouble,” said Coalition representative James Quiggle in a News 4 I-Team report.

Cracking the case on vehicular arson is difficult to prove in court, as Maryland officials are discovering. Of more than 2,000 suspected auto arsons in the state during 2013, fewer than 50 cases had sufficient evidence to turn the matter over to prosecutors.

Findings from a 2009 report of the U.S. Fire Administration’s (USFA’s) National Fire Incident Reporting System (NFIRS) reveal the following:

  • Approximately 10 percent of all vehicle fires are intentionally set.
  • Intentional vehicle fires are at their highest during the summer, with a July peak.
  • Matches are the leading heat source (20 percent) of intentionally set vehicle fires.
  • Vehicle seats (34 percent) and uncontained fuel (14 percent) represent the starting point of many intentionally set vehicle fires.

Arson generally has a low clearance rate, according to crime reports from the U.S. Department of Justice. Arson involving motor vehicles, which represent 20 percent of all arson cases, have a particularly low closure rate of approximately 7.4 percent nationwide.

The Florida Department of Law Enforcement statistics indicate that motor vehicle arson may not be a major concern in the state, with fewer than 300 cases of auto arson reported for 2012.

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

More Than Half of Florida PIP Claimants Hire an Attorney

PIP claimants are increasingly being represented by legal counsel, according to a new study released by the Insurance Research Council (“IRC”) titled Attorney Involvement in Auto Injury Claims.

In 2012, the study notes that 36 percent of auto injury PIP claimants nationwide were represented by attorneys, compared to 31 percent in 2007. For bodily injury claims, representation rose slightly to 50 percent.

Compared to claimants without legal representation, PIP claimants with attorneys were found to have a greater likelihood of the following behavior:

  • Sought more treatment in a pain clinic, including MRIs
  • Experienced longer waiting times for claim payments
  • Collected lower net payments
  • Involved in alleged fraudulent claims

Historical trends from 1977 to the present are outlined in the IRC chart below.

Attorney_Involvement_Fig 1_cr

Attorney involvement was also measured by state. Florida ranked at the top of the list, with more than 50% of claimants represented. Kansas, where 12% of PIP claimants are represented, was the lowest ranking state.

Data is drawn from 12 participating insurers and 35,000 auto injury claims closed with payment under the five principal passenger coverage areas, according to survey sponsors.

Click on the link to read more about the Attorney Involvement in Auto Injury Claims study.

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Filed under Fla. Stat. 627.736 (2008)

Another Staged Accident Story Reminds Drivers to be Alert to Florida Auto Insurance Scams

Florida State Rep. Jim Boyd, R-Bradenton, helped pass legislation in 2012 aimed at reducing the tremendous number of staged accidents and injuries in the state, and deter claims made after accidents in which victims had not even been present.

Once estimated as a billion-dollar industry in Florida due to the ease of receiving PIP payouts from insurance companies, Boyd’s changes helped strengthen requirements for medical evidence and stipulated that police reports list everyone involved, including all of the passengers.

Credited with reducing personal injury insurance costs and premiums, Boyd feels that the updated law put a dent in a serious problem where opportunistic scam artists still turn dents and dings into major injuries.

One such example of heavy-duty suspicions stemming from a marginal accident was featured in a recent Tom Lyons’ column in the Herald-Tribune.

In Lyons’ piece, a Sarasota retiree was supposedly involved in an accident when backing out of an on-street parking spot. This driver felt the accident was so small that he wasn’t even sure it happened. However, the driver of the other car claimed that he caused the collision and filed a police report. The retiree was issued a ticket.

He later found out from his insurance company that the woman driving the other car filed an insurance report claiming she and her passenger suffered trauma and were feeling pain in their neck, legs and back. The retiree says, “his insurance company is about to take a hit, but he’s not at all sure it is a legitimate one.”

Some unscrupulous staged accident rings rely on each other to carry out these scenarios to receive insurance reimbursement, according to the article. Although some parties face charges in the end, it isn’t easy to know when someone is faking an injury. It is even harder, as demonstrated in the retiree’s case, to prove the circumstances surrounding the injury are bogus.

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

4th District Court of Appeal Denies Rehearing in PIP Benefit Dispute

The Fourth District Court of Appeal has denied motions for rehearing by appellants in a PIP case decided in the insurer’s favor. The case was the consolidation of two separate PIP cases.

Insureds in both cases sought treatment for injuries sustained in separate accidents and assigned their PIP benefits to their treatment providers. One of the insurers, State Farm, reduced the amount paid to Northwood Sports Medicine, and Northwoods subsequently sued. Prior to that filing, the insured’s PIP benefits were exhausted. State Farm moved for summary judgment; Northwoods amended its complaint to allege that State Farm reduced payments in bad faith. The trial court granted the motion for summary judgment on the sole ground of exhaustion of benefits.

Likewise, in the second case, the insured assigned his benefits to Wellness Associates of Florida. USAA Insurance Co. reduced the payments to Wellness, and Wellness filed a complaint for damages. At the time the suit was filed, less than $14 in unpaid PIP benefits remained and, while the lawsuit was pending, PIP benefits were exhausted. USAA moved for summary judgment, Wellness amended its complaint to allege bad faith, and the trial court entered summary judgment based upon exhaustion of benefits.

For jurisdictional reasons, the appellate court transferred the Northwoods case to the circuit court. The question that the appellate court answered in the affirmative in the Wellness case is whether post-suit exhaustion of benefits absolves the insurer from responsibility to pay an otherwise valid claim where the exhaustion occurred after the insurer: (1) paid an amount that the provider claims is less than required by the contract; (2) received a pre-suit demand letter notifying the insurer of the medical provider’s dispute; and (3) was served with the filed complaint.

In its rationale, the court extended its decision in Simon v. Progressive, rejecting the “reserve or hold” theory by which an insurer is to put money in reserve if it denies or reduces a claim until that claim is resolved. The court concluded that “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 concluded that post-suit exhaustion of benefits—as was the case in Wellness—should be treated no differently than pre-suit exhaustion of benefits, as long as the amount of PIP benefits to which the provider is entitled has not been established. The court therefore affirmed the final judgment of the trial court in Wellness.

The case in the District Court of Appeal of The State of Florida Fourth District, January Term 2014, is Northwoods Sports Medicine and Physical Rehabilitation, Inc., (A/A/O Suzanne Cabrera), and Wellness Associates of Florida, Inc., (A/A/O Daniel North), Appellants, v. State Farm Mutual Automobile Insurance Company and USAA Casualty Insurance Company, Appellees, Nos. 4d11-1556 and 4d11-3796, [March 5, 2014]. Click on the link to read the June 4, 2014 ruling in the case.

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

Bill to Allow 75 MPH Speed Limit will be Vetoed, Florida Gov. Scott Says

On our April 4 blog post on the FL-PIP guide, “Florida Speed Limits May Rise to 75 MPH,” we discussed the contentious debate surrounding Senate Bill 392, a bill that proposed to raise the speed limit on Florida highways from 70 mph to 75 mph.

The latest development, according to an article in the May 15 Insurance Journal, is that the Governor plans to veto the bill amidst growing concern for the safety of state highway patrol troopers, among others.

Narrowly passing in the Florida Legislature last month, the bill would have allowed the Department of Transportation to increase speed limits on roads that are part of the National System of Interstate and Defense Highways and have at least four lanes. The department could have also raised the speed limit from 65 to 70 mph on rural, four-lane divided highways and up to 65 mph on other roads. Speed limits would have been increased at the department’s discretion, not automatically.

Scott said that he decided to “stand with law enforcement,” in light of the death of Master Trooper Chelsea Richard. She and two others were struck by a vehicle on May 3 while standing on the side of Interstate 75 near a traffic accident.

Sen. Jeff Clemens, D-Lake Worth, and one of the sponsors of the bill, pointed out that having speed limits raised in Florida in the past has not resulted in more fatalities, and said misgivings about safety and motorists driving even faster were inaccurate, according to the article.

The Florida branch of AAA and the president of the Florida Sheriffs Association are in favor of the veto and commended the Governor for his choice.

Since 1996, the maximum speed limit on Florida highways has been 70 mph.

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Filed under Fla. Stat. 627.736 (2008)

Wal-Mart Adds Car Insurance to its List of Services

Wal-Mart is branching out into auto insurance.

The nation’s largest retailer has teamed with AutoInsurance.com to offer a free price comparison service that lets its customers quickly find and choose car insurance policies online and in real time in order to lower their costs.

While Wal-Mart is not selling car insurance, shoppers can log on to AutoInsurance.com or access the site through Wal-Mart’s website at http://www.walmart.com/autoinsurance.

According to a story on Claims Journal, the site will retrieve customers’ current auto insurance policy information to those who log on and provide their name, address, date of birth and contact information. AutoInsurance.com can then automatically complete the required coverage information for a side-by-side comparison. Within minutes, the service provides multiple quotes from some leading insurance companies including Esurance, Safeco and Progressive, the article reported.

Customers can then opt to buy the policy online right away, speak with a licensed agent at 800-700-7500, or save their information and purchase a policy later.

The service is currently up and running in eight states: Arkansas, Louisiana, Mississippi, Missouri, Oklahoma, Pennsylvania, Tennessee and Texas, and will be rolled out nationwide in the next few months. Wal-Mart shoppers will see in-store displays promoting the service.

In a recent media briefing, Daniel Eckert, senior vice president of services for Wal-Mart U.S., said that the company will be AutoInsurance.com’s exclusive retail partner and collect promotion payments in its role as marketer. In turn, AutoInsurance earns a commission every time a policy is sold.

AutoInsurance.com is a division of Fort Lee, N.J.-based Tranzutary Insurance Solutions LLC, a licensed property and casualty insurance agency that was created after Wal-Mart saw an opportunity to improve this market. Wal-Mart noted that car insurance is among the biggest monthly expenses of its customers, sometimes even topping health care costs for some of them.

Joshua Kazam, founder of AutoInsurance.com and the founder and chairman of Tranzutary, surveyed people and found that 90 percent comparison price shop for online for products and services like airline tickets, but only one in five do so for auto insurance because the process is so complicated.

Together, they’ve created a quicker service where shoppers can buy and save on car insurance and where shoppers receive their final price—no bait and switch tactics.

Before deciding on its current program, Wal-Mart tried out several pilot programs with Tranzutary, including one frontrunner where customers in Pennsylvania, who purchased policies from AutoInsurance.com, saw annual savings of $1,168, on average, Claims Journal reported.

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Filed under Fla. Stat. 627.736 (2008)

Roig Lawyers Partner, Jeff Tutan, Speaks at 2014 Medical Claims Defense Network on Topic of Use of Mobile X-rays

On April 16, 2014, Roig Lawyers Partner, and Board Certified Trial Attorney, Jeff Tutan presented at the Medical Claims Defense Network Conference in Orlando, Florida.  Jeff Tutan, head of the firm’s trial practice group, discussed his recent success at jury trial in a case involving a medical provider’s claim for reimbursement for “mobile x-ray” services.  During the round table presentation, Attorney Tutan discussed how he, partner Jessica Martin, and senior associate attorney Jenna Hackman, successfully defended such a case involving these increasingly prevalent medical services.

For more information, contact attorney Jeff Tutan at jtutan@roiglawyers.com.

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Filed under Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Licensing

Florida Speed Limits May Rise to 75 MPH

Posted speed limits on I-95 and other Florida interstate highways could increase from 65 to 75, if legislation introduced in the Florida legislature by Florida Senator Jeff Clemens (D-Lake Worth) passes.

Senate Bill 392 would allow the Department of Transportation to raise the maximum allowable speed limit on certain highways like Interstate 95 that are part of the National System of Interstate and Defense Highways and have at least four lanes.

There are critics on both sides of the proposed speed limit changes.

Senator Clemens claims that drivers are already traveling at speeds in excess of the posted speed limits, and does not anticipate any increase in the number of accidents. Others fear that any increase in speed limits will result in increased accidents.

Speeding is the third leading contributing factor in traffic crashes, according to the National Highway Traffic Safety Administration.

The Insurance Institute for Highway Safety reports that the likelihood of being severely injured or killed in a crash increases with vehicle speeds.

The www.FLPIPGuide.com reported in a December 27post that Florida Ranks #6 in Worst Drivers Nationally. As mentioned in that article, auto insurance premiums tend to increase as safe driving habits decline in a state. Florida ranks among the top 10 most expensive states for car insurance, at #10, according to a 2012 article in the Palm Beach Post.

SB 392 is scheduled for at least one more vote in the Florida Senate before moving on to the House. If passed, the law would take effect on July 1, 2014.

Click on the link to read the proposed bill on Florida speed limits.

Click on the link to read a fact sheet on speed and safety published by the National Safety Council.

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Filed under Fla. Stat. 627.736 (2008)

Questionable PIP Claims Decline in Florida, Reports NICB

Tighter legislation, enhanced public awareness, and coordinated law enforcement efforts appear to be having a positive effect on PIP fraud in Florida, according to a recent report by the National Insurance Crime Bureau (NICB).

The new study published by the organization showed Florida’s personal injury protection (PIP) questionable claims (QCs) have dropped 7.6 percent from 2012 to 2013. More striking, however, was the extraordinary decline from 2010 through 2013, when Florida’s staged accident QCs decreased 61.82 percent during that time period.

Compare those statistics to 2009, when Florida not only topped the nation in PIP QCs reported to the NICB, but also had twice as many as the second-highest state, New York. From 2008 through 2010, the total number of QCs in Florida increased by 34 percent.

When NICB delved further into these results, it found that about 62 percent of total PIP costs and about 43 percent of PIP treatment costs came from soft tissue treatments. Massage treatments accounted for 22 percent of those treatments, and massage therapists had the largest increase in charges per patient at 51 percent from 2005 through 2010, after factoring in for medical inflation.

“We are encouraged by the decline in questionable claims that we’ve seen recently, but by no means are we declaring victory in Florida,” said NICB President and CEO Joe Wehrle.  “Florida remains a hotbed for fraudulent activity and we can’t afford to ease up for a moment in our fight against those who would abuse the system and burden Florida consumers.”

In September 2011, the Hillsborough County Commission was one of the first legislative bodies to enact a county ordinance to license PIP clinics and deter suspicious vehicle collisions in the county. Although an injunction against the law remains in effect, it hasn’t stopped other legislation. In February 2012, Miami-Dade County passed a similar ordinance requiring registration of PIP clinics, and the Florida legislature passed House Bill 119 in May 2012.

This two-part legislation institutes stronger penalties for medical providers who commit PIP fraud, including a five-year license suspension and a ten-year restriction from PIP reimbursement. It also imposes a 14-day post-accident window for accident victims to seek medical treatment and reduces specified PIP benefits and treatments. A lawsuit and injunction ensued, but eventually, the law was put into effect in late October 2013.

Although NICB does not receive all QC data in Florida, the data used to produce this report came from the same sources used in previous Florida QC reports. “Combining these legislative and regulatory efforts with a robust public awareness campaign and aggressive law enforcement response, the modest improvement in 2013 PIP QC data does suggest the initial stages of a positive downward trend,” NICB confirmed.

Click on the link to read the NICB Data Analytics ForeCAST Report regarding Florida Personal Injury Protection (PIP).

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