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)

Safe Driving Tips for the Fourth of July

As Florida residents make last minute plans to celebrate the Fourth of July holiday, drivers are encouraged to take a few minutes to conduct a quick safety check.

The Florida Department of Highway Safety and Motor Vehicles offers the following travel tips for those planning a road trip this weekend.

  • Plan a safe return trip before you leave for holiday activities.
  • Buckle Up. Seat belt use is the most effective way to save lives and reduce injuries.
  • If you plan to drink, appoint a designated driver.
  • If you find that you have had too much to drink, call a taxi or a sober friend or family member for a ride.
  • If you notice an impaired driver on the road, notify local law enforcement or dial *347.
  • If friends or family members who have had too much to drink plan to drive home, take their keys away and help them arrange safe travel.
  • Remember that possession of an open alcoholic beverage container in a vehicle (in motion or stopped) by the driver and or the passenger(s) is a violation of Florida law.

This is a public service message from Roig Lawyers. Have a safe and happy holiday.

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Filed under Uncategorized

Woman Arrested for Forging Doctors’ Signatures to File $80,000 in Fraudulent Medical Insurance Claims

A Florida woman, who recently moved to Georgia with her family, had racked up more than $80,000 in false medical insurance claims when she was arrested last week.

According to a news release by Florida Chief Financial Officer Jeff Atwater, Tawania Weekley faces 80 different criminal counts after illegally filing claims for emergency room care, hospital stays, medical equipment, and multiple medical tests including MRIs, EKGs and x-rays that were never performed.

Weekley’s insurance carriers tipped off the Department of Financial Services’ Division of Insurance Fraud (DIF).

A subsequent investigation uncovered a plan where Weekley doctored and created new medical claim forms with forged physicians’ signatures, and then submitted those documents for reimbursement under her accidental and cancer indemnity policies.

The DIF found that she filed a total of 20 claims under the accidental policy for herself and immediate family members, and one additional claim under the cancer policy for herself.

“Every fraudulent claim drives up the cost of insurance in Florida,” CFO Atwater said. “I’m grateful to our investigative team and partners for working tirelessly to protect the hard working and honest people of Florida from harmful acts of fraud.”

DIF investigators worked with the Grady County Sheriff’s Office in Cairo, Georgia, to make Weekley’s arrest. She remains in jail while awaiting extradition to Florida.

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Filed under Insurance Fraud

Fraudulent PIP Billings of $80K Lead to Fort Lauderdale Arrests

Three Fort Lauderdale residents—Claudio Boyett, Leslie Sanchez Martinez and Claudia Hoy—were arrested for participating in a staged accident that resulted in the submission of $80,000 in fraudulent PIP claims, according to Florida Chief Financial Officer Jeff Atwater.

The three participants allegedly staged an accident involving a U-Haul truck, which hit a parked Dodge Caravan carrying eight occupants. Fraudulent claims were then filed with multiple clinics across South Florida. More arrests are expected in the case.

In other PIP fraud news across the state, David Torres was convicted for his work as a recruiter on behalf of the Indian Rehabilitation Center in Jacksonville. He was charged with eight counts involving a staged accident. Torres was ordered to repay $109,000 in restitution to eight insurance companies, and will serve five years in jail.

“PIP fraud schemes drive up auto insurance rates for all Floridians, which is why we are working day and night to prevent it from happening in the future and hold the fraudsters who have broken the law accountable,” said CFO Atwater.

The Florida Department of Financial Services reports that it has made almost 2,000 PIP fraud arrests since early 2011. Convictions are up 17% for the current fiscal year, with a total of 1,225 to date.

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Filed under Insurance Fraud

“Family & Friends” Staged Accident Ring Uncovered in Duval County

A couple faces 20 years in prison as a result of their participation in a PIP insurance fraud scheme which involved staging a car accident, and subsequently collecting money from the false insurance claims they filed.

Jose Alberto Velez, 30, and April Rosita Wynn, 23, were both convicted of knowingly participating in an intentional motor vehicle crash and four counts of false insurance claims, according to a news release issued by the Office of the State Attorney for the Fourth Judicial Circuit of Florida.

Their convictions stem from a staged car crash that happened in May 2012, the same year that the State Attorney’s Office (SAO) and the Division of Insurance Fraud (DIF) began investigating a series of questionable car accidents in Duval County.

Their investigation uncovered a larger Personal Injury Protection (PIP) insurance fraud scheme where nearly 100 individuals have been arrested over the past 18 months.

It was discovered that Velez and Wynn, who are now married, persuaded family and friends to participate in their staged car crashes. After the accidents, Velez, Wynn and their accomplices would go to designated rehabilitation clinics that would provide mock therapy for fictional injuries, and then file PIP claims through those clinics.

One of the ringleaders of the scheme, David Rodriguez Lopez, was sentenced to 15 years on charges of schemes to defraud over $50,000, false insurance claims over $100,000, and knowingly participating in an intentional motor vehicle crash. Other cases resulting from the investigation are currently pending.

Besides their present charges, Velez and Wynn are still awaiting other charges for allegedly staging additional accidents. They will be sentenced the week of July 28.

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Filed under Insurance Fraud

Three Arrests Made in Connection to a Fort Lauderdale Staged Auto Crash

Three people in Fort Lauderdale have been arrested for their involvement in staging an auto accident in a church parking lot in order to collect $80,000 from an insurance company, a June 19 article in the Sun Sentinel said.

According to police records, Claudio Boyett, 44, Leslie Martinez, 45, and Claudia Hoy, 31, all of Fort Lauderdale, are accused of grand theft and insurance fraud. Boyett was arrested earlier this week while the other two were arrested last week.

A report from Florida’s Division of Insurance Fraud showed a U-Haul truck struck a Dodge Caravan in the parking lot of the Pare De Sufrir Church on August 7, 2012. Martinez was driving the Caravan, which had Hoy and six others as passengers. Boyett struck the van with the U-Haul he was driving, the report said.

After the accident, Martinez, Hoy and Boyett allegedly went for medical treatment and filed a personal injury protection claim with United Auto Insurance worth $80,000, according to insurance company investigators.

Officials from the insurance company said investigators found that one witness was offered $1,500 for the use of her Caravan; another acknowledged the accident was staged.

These arrests have come as a result of Operation Sledgehammer, the effort between the FBI and state authorities which launched three years ago to crack down on insurance fraud from staged auto accidents.

According to the story, investigators have found almost $20 million in illegal payouts and have charged almost 100 people in Broward, Palm Beach and Miami-Dade counties. Also, $5 million in restitution has been ordered to be paid back to insurers by some of those convicted.

These types of efforts have been making an impact in Florida, according to a study by the nonprofit National Insurance Crime Bureau. The organization has found fraudulent claims from staged crashes have actually been falling since Florida’s PIP reform has been enacted in the past two years, as our FL-PIP Blog reported in March.

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Filed under Insurance Fraud

Ridesharing Services UberX and Lyft Test the Market in Miami

Miami is one of the latest cities to be targeted by the controversial ride-sharing services of Lyft and UberX. Using smartphone apps, the companies connect drivers with riders via the Internet.

The taxi industry is mounting strong objections to the new services. In Miami, licensed taxi drivers have called on Miami-Dade County Commissioners to jail drivers who have been hired by the rideshare services. The City has already levied fines, conducted undercover sting operations, and impounded vehicles of Lyft drivers, according to a recent Miami Herald article.

Uber has a big war chest to withstand legal challenges. The company recently raised $1.2 billion in new funding, giving it a valuation of $18 billion. Started as a luxury car service in 2009, the company later rolled out the UberX low-cost service featuring non-professional drivers who use their personal cars.

Many questions about insurance coverage cloud the controversy, including the items outlined below.

  • The transporting of people or goods for hire is normally excluded under a personal auto policy.
  • Rideshare drivers who operate a personal auto covered by a consumer auto policy run the risk of being denied coverage in the event of an accident. In a tragic New Year’s Eve accident, for example, an Uber driver struck and killed a 6-year old pedestrian.
  • Passengers and third parties that sustain personal injury or property damage may not have access to full insurance benefits when an accident involves a rideshare driver operating a private auto under a personal auto policy.
  • If the rideshare driver fails to inform the insurance carrier of livery-related usage of their private auto, the carrier may attempt to void the policy for misrepresentation.
  • Private vehicle insurance coverage for a blended use of personal and commercial applications is not a standard industry practice, meaning that states and courts have not had a chance to consider and test all the legal implications.

Uber now operates in 128 cities across 37 countries, according to Reuters. Competitors include Lyft, Sidecar, Flywheel, and Hailo. Some services use mobile apps to hail a licensed taxi, while others rely on private individuals as drivers.

Click on the links to read more about Uber and Lyft.

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Filed under Licensing