Category Archives: Fla. Stat. 627.736 (2012)

The High Cost of Auto Insurance Fraud

Auto insurance fraud hits drivers’ wallets hard, not only with the apparent increase in premiums, but also indirectly, through higher costs that are eventually passed down to consumers. A recent story on Fox Business reported about the heavy toll this type of fraud takes on many Americans.

According to the National Insurance Crime Bureau’s (NICB) 2013 report, 78,024 suspected cases of auto insurance fraud were reported nationwide in 2012, an increase of 12.7% from 2011 to 2012. Those numbers helped to raise a three-year total—from 2010 through 2012—to more than 209,000 questionable claims (QCs).

Out of all the types of insurance fraud, auto insurance makes up the largest piece of the fraud pie, the NICB says. There were 4.5 times more questionable auto insurance claims than homeowners’ personal property QC’s (17,183), and almost 17.5 times more than the third highest category—workers’ compensation, including employers’ liability.

Industry studies have estimated that almost a quarter of the bodily injury claims related to auto accidents are false.  In addition, there is almost a 10 percent fraud rate for property and casualty claims made against auto insurance.

This adds up to about $200-$300 per year in extra costs on each auto insurance premium.  But, these are just considered the direct costs.  As far as indirect costs, the Texas Department of Insurance estimates that they add up to about $1,000 per family each year.  These costs are the portion of inflated expenses that businesses have to pay to insurers as a result fraudulent crime. This portion translates into increased costs of goods and services that are passed along to consumers.

In addition, hard fraud, or when the insurable event is fabricated outright or a staged accident, appears to be on the rise and feeds into auxiliary hazards of auto insurance fraud.  Because staged car crashes often exploit people who happen to be in the wrong place at the wrong time, these victims unintentionally become involved in the accidents or in the subsequent series of events, which can have severe consequences such as injury or even death.

According to the Fox News story, there have been numerous incidents where staged accidents have spiraled out of control, resulting in critical injuries and fatalities.  Although the instigators of these types of accidents have been prosecuted, it does not end the motivation to engage in auto insurance fraud.

Overall, the Coalition Against Insurance Fraud estimates that the total cost of fraudulent claims is in the range of $80 billion annually. The group has found that claims tend to rise during difficult economic times, which was evident during the recent recession.

The NICB has a toll free hotline to report fraud anonymously for further investigation.  The number is 1-800-835-6422 or 1-800-TEL-NICB.

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Filed under Fla. Stat. 627.736 (2012), Insurance Fraud

Court Order Issued in PIP Case Alleging Exorbitant Hospital Fees

On February 20, 2015, Judge James S. Moody, Jr., of the U.S. District Court, Middle District of Florida, issued a ruling in the case Herrera, et al. v. JFK Medical Center, et al. That suit, brought in 2014 by four Florida drivers, alleges that the defendant hospitals are exhausting Personal Injury Protection (PIP) benefits by grossly overcharging for services—at up to 65 times what Medicare pays. The lawsuit names JFK Medical Center in Atlantis, Memorial Hospital Jacksonville, North Florida Regional Medical Center in Gainesville, and HCA Holdings, Inc. as defendants.

The plaintiffs, injured in separate motor vehicle accidents, received emergency radiological services at the named HCA-operated defendant hospitals. The services were covered by the plaintiffs’ PIP insurance. The plaintiffs allege that they were charged an “exorbitant” rate for these services, thereby prematurely exhausting their PIP benefits and leaving them with medical expenses in excess of what they would otherwise have to pay.

Plaintiffs allege causes of action for violation of the Florida Deceptive Unfair Trade Practices Act (“FDUTPA”), breach of contract, and breach of the implied covenant of good faith and fair dealing. Plaintiffs sought to have the case certified as a class action.

At a February 17, 2015 hearing, the defendants made motions to dismiss the plaintiffs’ complaint and motions to strike the class allegations. Judge Moody granted the motions in part and denied them in part, as discussed below.

First, HCA argued in its motion to dismiss that, since it is the ultimate parent company of the hospitals, it has no direct liability for the hospitals’ actions. The court, however, held that plaintiffs’ had sufficiently pled a cause of action when they pled that HCA is directly involved in setting and enforcing hospital guidelines and that the hospitals acted as agents of HCA.

Second, the defendants argued that plaintiffs FDUTPA claims fail because plaintiffs cannot allege that HCA was engaged in “trade or commerce” as required by the statute. Recognizing that other courts have held that the types of allegations the plaintiffs are making support a FDUTPA claim, the court held that plaintiffs may proceed to attempt to prove their case.

Third, plaintiffs allege breach of contract based on incorporation of the PIP statute into plaintiffs’ contracts with the hospitals. Because the PIP statute requires that only “reasonable” amounts may be charged, plaintiffs allege that defendants breached the contracts by charging unreasonable rates. The court concluded that plaintiffs may incorporate the PIP statute’s reasonable requirement into the contracts and therefore proceed with the breach of contract claim.

Third, in Count III of their amended complaint, plaintiffs allege that the defendant hospitals breached their duty of good faith and fair dealing by charging them unreasonable rates for medical services. Because plaintiffs failed to allege that an express term of the contract had been breached, the court granted the defendants’ motion to dismiss for failure to state a claim.

Finally, defendants moved to strike the class allegations because individual issues predominate. The court agreed that, given the nature of the claims and individual factual inquiries required, the individualized issues are predominant and the suit cannot proceed as a class action. As a result of that ruling, only one of the plaintiffs—Marisela Herrera—may proceed with the action. The remaining plaintiffs were dismissed without prejudiced to file separate, individual actions.

Click on the link to view the court order in Marisela Herrera et al., v. JFK Medical Center Limited Partnership, et al., Case No. 8:14-cv-2327-T-30TBM in U.S. District Court for the Middle District of Florida.

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Filed under Case Law, Fla. Stat. 627.736 (2012)

Hialeah Police Crack Down on Drivers with Fake Insurance Cards

On February 12, 2015, authorities in Hialeah, Hialeah Gardens, and Medley clamped down on drivers carrying fake insurance cards, according to a news report on CBS Miami.

Officers stopped randomly-selected cars and asked drivers for their license, registration, and proof of insurance. Police then contacted the insurance companies to verify coverage. If the card turned out to be fraudulent, the driver was arrested.

Two drivers were arrested for carrying fake insurance cards, while 27 other arrests were made for various traffic violations.

According to the National Insurance Crime Bureau, the use of fake insurance cards has become a national epidemic.  “If you have a printer and you have a computer, you can download a fake insurance card and it looks real,” said Hialeah Police spokesman Carl Zogby.

The use of fake or fraudulent insurance cards affects legal Florida drivers when an uninsured driver is involved in a motor vehicle accident, according to the report. The costs incurred in these accidents are eventually passed on to legal drivers in the form of higher insurance rates.

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Filed under Fla. Stat. 627.736 (2012), Insurance Fraud

Drugged Drivers Increase as Drunk Driving Drops

Although the nationwide effort to raise awareness about the dangers of drunk driving have been fruitful, two recent studies show that there is a troubling escalation in the use of marijuana and prescription drugs behind the wheel that could jeopardize the progress to make roads safer. The ground-breaking studies were recently released by the National Highway Traffic Safety Administration (NHTSA).

The first study, which is the latest version of NHTSA’s Roadside Survey of Alcohol and Drug Use by Drivers, found that the number of drivers with alcohol in their system has declined by nearly one-third since 2007 and by more than three-quarters since 1973. However, figures also revealed that the number of drivers using marijuana or other illegal drugs jumped to almost one in four drivers who test positive for at least one drug that could affect road safety. According to the data, the number of weekend nighttime drivers with evidence of drugs in their system climbed from 16.3 percent in 2007 to 20 percent in 2014, while the number of drivers with marijuana in their system grew by nearly 50 percent.

The study, which has been conducted five times in the last 40 years, gathers data from anonymous voluntary participants throughout the U.S.

The second NHTSA survey, which is the largest of its kind ever conducted, assessed whether driver use of marijuana is tied to greater risk of crashes.  The study not only found that marijuana users are more likely to be involved in accidents, but revealed that this increased risk may partially be attributed to the demographics of marijuana users—in particular young men—who are more likely to be part of a group that is at higher risk of crashes overall.

The study also found that drivers who had been drinking above the 0.08 percent legal limit had about 4 times the risk of crashing as sober drivers, and those with blood alcohol levels at 0.15 percent or higher had 12 times the risk.

Conducted in Virginia Beach, Va., the study gathered data over a 20-month period from more than 3,000 drivers who were involved in crashes, in addition to a comparison group of 6,000 drivers who did not crash.

Results from the NHTSA surveys are consistent with a June study by Public Health Reports, a recent article in Claims Journal pointed out. This study, which was funded by Public Health Law Research program of the Robert Wood Johnson Foundation, found that the profile of a ‘drugged driver’ has changed considerably since 1993. Not only are more drivers testing positive for prescription drugs, cannabis, and multiple drugs, they are increasingly likely to be older than 50. The study noted almost 60 percent of marijuana-only users were younger than 30 years old, but 39 percent of prescription drug users were 50 years old or older.

“America made drunk driving a national issue and while there is no victory as long as a single American dies in an alcohol-related crash, a one-third reduction in alcohol use over just seven years shows how a focused effort and cooperation among the federal government, states and communities, law enforcement, safety advocates and industry can make an enormous difference,” said NHTSA Administrator Mark Rosekind. “At the same time, the latest Roadside Survey raises significant questions about drug use and highway safety. The rising prevalence of marijuana and other drugs is a challenge to everyone who is dedicated to saving lives and reducing crashes.”

A series of additional studies to further understand the risk of drugged driving is being planned by the NHTSA, including the Washington State Roadside Survey, which will assess risk in a state where marijuana has recently been legalized, and a simulator study with the National Institute on Drug Abuse to assess how drivers under the influence of drugs behave behind the wheel.

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Filed under Fla. Stat. 627.736 (2012)

11th Circuit Appellate Division Rules Insurer’s Adjuster Notes not Discoverable

On January 5, 2015, the Appellate Division of the Eleventh Judicial Circuit in and for Miami-Dade County issued a ruling reversing the lower court’s order compelling production of the insurer’s pre-litigation documents.  The court held that such documents are not discoverable in a first-party coverage lawsuit between the insured and the insurer.

In 2011, respondent Yesenia Romero sued State Farm for PIP benefits, alleging State Farm breached the insurance contract and violated the Florida PIP statute in not paying for claims resulting from a 2009 motor vehicle accident. Romero filed a request for State Farm’s “entire claims file concerning the case,” including all of the adjuster’s notes made prior to the pre-suit demand letter.  State Farm objected to the production, asserting work-product privilege.

A hearing on the issue was held in the trial court.  Following an in camera inspection of the adjuster’s notes, the judge determined that they were not protected under the work-product doctrine because they were not prepared in anticipation of litigation.  The court ordered State Farm to produce all the adjuster’s notes.  State Farm sought to have the appellate division quash the order.

In its analysis, the appellate division noted that all three levels of Florida’s judiciary, including its own court, have said that an insurance company’s claims file documents are not discoverable in a first-party coverage and damages lawsuit between an insurer and the insured. The court cited a Third District case, Castle Key v. Benitez, in concluding that “where the insured is not seeking a bad faith claim, but rather seeks relief for breach of contract,” the insurer’s claims file documents are not discoverable.

In this case, where the plaintiff was alleging breach of contract and not bad faith, the appellate division determined that the trial court erred in ordering State Farm to produce the documents and therefore quashed the trials court’s order.

State Farm v. Yesenia Romero, Case No. 13-48 AP (Fla. 11th Circuit January 5, 2015).

Castle Key Ins. Co. v. Benitez, 124 So. 3d 379 (Fla. 3d DCA 2013).

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Filed under Case Law, Fla. Stat. 627.736 (2012)

Google May Be on the Verge of Selling Auto Insurance in the U.S.

There has been much speculation of late surrounding Google and whether the online giant will soon be entering the U.S. auto insurance market to sell policies online. The tech giant is expected to facilitate insurance sales from existing insurers, in a role similar to that of an insurance agent, rather than becoming an actual insurance company.

Google has been offering online auto insurance in the United Kingdom for the past two years via Google Compare (google.co.uk), which also enables users to comparison shop for credit card offers, travel insurance and mortgages, according to an Insurance Journal article on January 9.

The signs have certainly been pointing in that direction, the article said.

  1. A post in the New York Times technology blog ‘Bits’ reported that Google entered a partnership with CompareNow.com, a site which compares auto insurance quotes from fully licensed insurance providers. On-site users, who fill out one simple form, can then buy a policy online, by phone or through a local agent.
  2. Another indication recently came from Forrester Research analyst Ellen Carney who said in her blog that Google’s online auto insurance shopper—Google Compare Auto Insurance Services Inc.—has been licensed to sell insurance in at least 26 states with authorized carriers including Dairyland, MetLife, Mercury, Permanent General Assurance, Viking Insurance, and Workmen’s.
  3. Carney reported that Google may also be working with CoverHound, a site that provides online quotes for numerous insurance companies including Hartford, esurance, 21st Century, Travelers, Safeco, National General, Progressive, Foremost, Plymouth Rock, and more.

She also believes a launch could happen later this quarter, starting in California, and rolling out to Illinois, Pennsylvania and Texas, even though the pilot program has supposedly been delayed before.

Despite results from a survey by TransUnion last year that found online shopping for auto insurance rates declined about 3 percent in the 12 months ending February 2014 compared to a year earlier, industry analysts believe that Google could still make a dent in the market.

Global research by Accenture found that 67 percent of insurance customers said they would consider buying insurance products from organizations other than the insurers themselves.  In addition, 23 percent indicated that they would consider buying from online service providers such as Google and Amazon.

Google Inc. does own GoogleCompare.com; however, the site is not operational, according to Insurance Journal.  The publication also received no response from Google as expected. The tech company has previously told Reuters and the Wall Street Journal that it does not comment on speculation.

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Filed under Fla. Stat. 627.736 (2012)

Legislators Unlikely to Change Florida’s No-Fault Auto Insurance Law Right Now

Chief Financial Officer Jeff Atwater wants Florida’s legislators to continue to be patient before considering any rash actions that would change personal injury protection (PIP) coverage in the state. That’s because a recent report released by the state Office of Insurance Regulation (OIR) shows that increases in fraudulent PIP claims have basically been stopped.

The Florida Department of Financial Services is attributing these results to the passage HB 119, effective January 1, 2013, which created some exclusions for coverage under PIP insurance and limited for non-emergency conditions. The amended No-Fault Law excluded PIP reimbursements to massage therapists and acupuncturists, and also required individuals involved in car crashes to seek treatment within 14 days of a motor vehicle accident. PIP allows up to $10,000 in benefits for emergency medical conditions, but places a $2,500 cap on non-emergency conditions. It is mandatory for all Florida drivers to carry PIP.

According to a story in the Sun-Sentinel on January 7, the law set benchmarks for insurance carriers to lower rates. The OIR report showed that from 2011 through September 2014, the average medical cost paid through PIP claims dropped 14 percent statewide.  In South Florida, a hotspot of fraudulent PIP activity, the average payment decreased 28.7 percent, the article reported.

However, it is thought that these numbers are too preliminary and do not show the full impact of the law, yet.

House Insurance & Banking Chairman John Wood, R-Winter Haven, noted in the article that he would be “surprised if there was ‘major’ PIP legislation before the issue is settled in court.”

Senate Banking and Insurance Chairwoman Lizbeth Benacquisto, R-Fort Myers, said that she is still reviewing the OIR report, and likes to ensure that if changes are made, they have “a very positive effect on policyholders and our constituents.”

The annual legislative session begins in March.

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Filed under Fla. Stat. 627.736 (2012), Insurance Fraud