Uber and Lyft Oppose Florida Push for Increased Insurance Coverage

Florida Sen. David Simmons, R-Altamonte Springs, is pushing for stronger insurance requirements for transportation network companies that connect drivers with passengers through smartphone apps. According to a recent article in the Herald-Tribune, the Senate Banking and Insurance Committee supported the measure (SB 1298), despite opposition from Uber and Lyft—the two leaders in the burgeoning app-connected industry of for-hire drivers.

The proposed legislation would create the following distinctive coverage requirements:

  1. the “on call” period from when a driver is notified about a customer to pick up to when the passenger gets in the vehicle—which currently is considered a coverage gap
  2. when a customer is actually riding in the vehicle—called the ‘ride acceptance’ period

Sen. Simmons believes the proposal is necessary to protect people who may be harmed by ride-service drivers who are on their way to pick up a passenger. In addition, the proposed changes could protect the companies themselves if drivers bypass the app service and notify customers that they are available directly for future rides.

Lobbyists for the transportation network companies, however, dispute the necessity for “on-call” coverage, which they say, will lead to increased fares. Part of the success of Uber and Lyft is a result of traditionally lower fares than standard taxicab company rates.

Currently, these for-hire drivers only need the state minimum of insurance.

Under the proposed legislative bill, the driver or company would be required to carry liability coverage of at least $125,000 for death and bodily injury, at least $50,000 for property damage, and at least $250,000 in uninsured and underinsured motorist coverage. When a passenger is riding in the vehicle, the coverage would jump to at least $1 million for death, bodily injury and property damage, and $1 million in uninsured and underinsured motorist coverage.

Taxi and limousine services, the majority of which are currently controlled by local governments, must carry policies under Florida law that include minimum limits of $125,000 per person for bodily injury, up to $250,000 per incident for bodily injury, and $50,000 for property damage.

The proposal, which still has to clear two additional Senate committees and has not been heard in the House as of yet, comes on the heels of industry requests for the state to clarify insurance requirements in the “for hire” transportation industry.

Click on the link for more information about Florida SB 1298, Insurance for Short-term Rental and Transportation Network Companies.

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Filed under FL Legislation

Four Arrested in Medicaid Fraud Scam Targeting Orlando Homeless

The Florida Attorney General’s Office announced on March 20, 2015 that four people have been arrested for Medicaid fraud. Homeless people were allegedly recruited to pose as patients in the Orlando fraud scheme, frequently in exchange for gas cards and temporary housing.

The defendants in the case are identified as follows:

  • Christina Benson, arrested in Georgia
  • Demetrious Davis, arrested in Florida
  • Harold Harrison, arrested in North Carolina
  • Dr. Sabiha Khan, arrested in Florida

Each individual faces at least one count of Medicaid Provider Fraud and one count of Organized Scheme to Defraud.

According to the investigation, Christina Benson, owner of Tranquility Healthcare Solutions in Orlando, billed Medicaid up to $3.2 million for psychosocial rehabilitation services that were neither warranted nor provided in a period of just 18 months. The announcement cited fraudulent payments of $215,000.

The company claimed to have worked with a local doctor, Sabiha Khan, as a treating provider, but many recipients said they had never met her. Additionally, untrained personnel—including some with criminal records—were allegedly used to deliver some services.

Click on the link for the Florida Attorney General announcement.

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Filed under Insurance Fraud

Tampa Area $40K Tow Truck Fraud Leads to Four Arrests

On March 25, 2015, the Florida Department of Financial Services’ Division of Insurance Fraud announced the arrest of four Tampa Bay area men on charges of insurance fraud.  The men reportedly collected more than $40,000 in insurance payments after causing intentional damage to two tow trucks owned by Jimmy’s Towing and Recovery (Jimmy’s).

Leonard Bosi, 50, of Dunedin, Andrew Gentile, 25, of Palm Harbor, Edgar Gentile, 42, of Seminole, and Matthew Gentile, 23, of Dunedin face two charges each of insurance fraud over $25,000.

The first of two events occurred in Clearwater on June 17, 2014 when one of the tow trucks was involved in an accident. After being returned to Jimmy’s, the truck was reportedly hit by another truck multiple times until it was rendered inoperable.  An insurance claim was paid to Jimmy’s and shared among the four suspects.

Several days later on June 20, 2014, a second tow truck from Jimmy’s caught on fire while out on assignment. The flames were extinguished by an onlooker, and the truck was returned to Jimmy’s. Upon its return to the shop, additional damage was reportedly inflicted on the engine to the point that it could not be repaired.  An insurance claim was again paid to Jimmy’s and distributed among the four suspects.

The suspects were released on $10,000 bond each on the same day as their arrest. They face jail terms of up to 15 years.

The case will be prosecuted by the office of the Sixth Judicial Circuit State Attorney.

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Filed under Insurance Fraud

Fort Lauderdale residents arrested for PIP Fraud

The Florida Department of Financial Services’ Division of Insurance Fraud announced on March 19, 2015 the arrest of two Fort Lauderdale Residents for PIP fraud following a staged accident. Kendrick Callins and Lashaunda Gibbs were arrested for staging auto accident, patient brokering and personal injury protection insurance fraud.

The Division of Insurance Fraud, Federal Bureau of Investigation, Broward County Sheriff’s office and the Fort Lauderdale Police Department investigation revealed that Callins and Gibbs organized and participated in a staged accident on September 22, 2012, in Fort Lauderdale. The staged accident involved participants, recruited by Callins and Gibbs, who intentionally drove a rented U-Haul truck into a passenger vehicle occupied by arrestees. The arrestees submitted fraudulent insurance claims which were paid by the insurers. Callins and Gibbs each face a maximum sentence of 25 years.

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Filed under Insurance Fraud

Insurance Bill addresses issues with Assignment of Benefits

Florida House of Representative, John Tobia of the 53rd district, has introduced CS/HB 669 which addresses consumer issues related to “Assignment of Benefits”. The bill is still alive after a hearing on March 19, 2015 in front of the House Insurance and Banking Subcommittee. The bill addresses insurance-claims issues regarding AOB’s dealing with property insurance. An AOB occurs when a policyholder has a loss and signs a contract with a third party to reconcile the damage. Once the AOB is signed the contract allows for the third party to be assigned the proceeds from the homeowner’s insurance policy. AOB’s are currently a hot topic with property insurance carriers and for years have been the keystone of PIP/No Fault Litigation.

CS/HB 669

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Filed under FL Legislation

Cape Coral Cracks Down on Drivers without Insurance

Representatives from the National Insurance Crime Bureau (NICB), the local police department, and 17 state and national auto insurance carriers conducted an insurance crackdown in Cape Coral, Fla. on Tuesday, March 17. More than 35 police officers split into three groups, all on the lookout for uninsured motorists and motorists with fraudulent insurance.

The officers pulled over speeders and drivers not wearing their seatbelts, and then checked whether they had valid proof of insurance in hand. Drivers who were stopped for speeding or being unbuckled, but had valid paperwork available, could be let go with a warning. At the end of the day, officers had given out 230 written warnings and 68 uniform traffic citations, 15 of which were for no proof of insurance.

“We try to do an operation like this at least once a year,” Cape Coral Police Department spokesman Sgt. Dana Coston said. While the officers pulled over drivers, the NICB and dozens of insurance representatives were back at the police station, working directly with the officers to verify coverage.

A common scheme, Sgt. Coston explained, is for an individual to apply for auto coverage, get the paperwork, cancel the insurance, and then use the now-invalid insurance card as proof of coverage. Officers usually have to rely on state data, which is often outdated, to verify coverage, but because officers had “real time” access to insurance representatives on Tuesday, they could confirm on the spot if the insurance coverage was valid.

Sgt. Coston was heartened by the results of the day’s work. “Seeing that [only] about 5 percent of the drivers had any type of problem when stopped today is very encouraging. That’s probably one of the highest rates of compliance we’ve seen in years.”

Coston went on to explain that, because it is likely that at least some of those ticketed will show up in court with their missing paperwork, “the rate of compliance is actually even higher than the 95 percent we saw today.”

As for those who continue to drive without insurance or with fraudulent insurance? “They’ll get caught eventually, it’s just kind of rolling the dice,” said Cape Coral Police Sergeant Jon Kulko.

Cape Coral, Fla. is located on the Gulf Coast in Lee County, just south of Fort Myers.

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Filed under Insurance Fraud

1st DCA Upholds Allstate Use of Medical Fee Schedules

In an opinion filed March 18, 2015, Florida’s First District Court of Appeal held that language in an Allstate Insurance Co. policy gave sufficient notice to an assignee of its election to use Medicare fee schedules to limit benefit reimbursements under a PIP policy. Stand-Up MRI of Tallahassee, an assignee of 14 named insureds, sued Allstate in county court, contending that Allstate’s alleged failure to give adequate notice was contrary to the Florida Supreme Court’s decision in Geico v. Virtual Imaging. The trial court agreed with Stand-Up MRI and certified a question of great public importance to the Appellate Court.

In Virtual Imaging, as here, an MRI provider had supplied services and then disputed the insurer’s authority to limit reimbursements under Medicare fee schedules. Pursuant to the Florida PIP statute, automobile insurers are required to provide PIP coverage for 80 percent of all “reasonable expenses” for medically necessary services.

The dispute here centers on whether Allstate’s policy language provided adequate notice of its election to limit reimbursements via the Medicare fee schedules or if, as Stand-Up MRI contends, the policy fails because it is ambiguous. Allstate points to the following language in the policy as having satisfied the Virtual Imaging notice requirement:

In accordance with the Florida Motor Vehicle No-Fault Law, [Allstate] will pay to or on behalf of the injured person the following benefits. . . .

Medical Expenses

Eighty percent of reasonable expenses for medically necessary … services. …

Any amounts payable under this coverage shall be subject to any and all limitations, authorized by section 627.736, or any other provisions of the Florida Motor Vehicle No-Fault Law, as enacted, amended or otherwise continued in the law, including, but not limited to, all fee schedules.

The appellate court agreed with Allstate, concluding that the policy gives sufficient notice of its election to limit reimbursements by use of the fee schedules. In making its decision, the court pointed to language in the policy stating that reimbursements “shall” be subject to the limitations of §627.736, including “all fee schedules.”

Section 627.736(5)(a) 2 refers to Medicare fee schedule-based limitations and provides that insurers “may limit reimbursement to 80 percent of the … schedule of maximum charges.” Thus, concluded the court, the notice requirement was satisfied by Allstate’s language limiting “any amounts payable” to the fee schedule-based limitations found in the statute.

Furthermore, the court also distinguished the language in Allstate’s policy from that found deficient in Virtual Imaging. There, the Florida Supreme Court concluded that Geico’s policy failed to “indicate in any way” that it intended to limit its reimbursement amounts using the fee schedules. Here, Allstate’s policy expressly limits reimbursements by “all fee schedules” in the statute, satisfying the Virtual Imaging notice requirement.

Stand-Up MRI also contended that Allstate’s use of the phrase “subject to . . . all fee schedules” fails to provide sufficient notice that reimbursements will always be limited by the fee schedules, arguing that “subject to” means only that Allstate had the option to limit reimbursements per the Medicare fee schedule , not that it would so limit reimbursements. The court, however, found no such ambiguity, stating that the language of the policy makes reimbursements subordinate to the fee schedule in “rather unmistakable terms.”

In sum, the court concluded that Allstate’s policy language gave legally sufficient notice to its insureds of its election to use the Medicare fee schedules as required by Virtual Imaging. The trial court’s decision was reversed and the case remanded for further proceedings.

The cases cited are listed below for reference.

Allstate Fire and Casualty Ins. v. Stand-Up MRI of Tallahassee, Case No. 1D14-1213, et al., 1st DCA Fla. (March 18, 2015).

Geico Gen. Ins. Co. v. Virtual Imaging Servs. Inc., 141 So. 3d 147 (Fla. 2013).

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Filed under Fla. Stat. 627.736 (2012), The Statutory "Fee Schedules"