Tag Archives: PIP statute

Motion for Rehearing of Florida PIP Injunction is Denied

On November 26, 2013, the First District Court of Appeals dismissed a motion for rehearing on its October ruling to reverse an injunction placed on reforms to Florida’s PIP system. The reforms, contained within HB 119 and signed into law by Gov. Rick Scott in 2012, ban PIP payments to acupuncturists and massage therapists. The reforms also require that claimants seek treatment from a physician or hospital within 14 days of an accident.

A group of acupuncturists, massage therapists, and chiropractors filed for an injunction, which was ultimately granted. The Court of Appeals ruled in October that the injunction should be reversed. It upheld this decision by denying a motion for rehearing on its ruling.

We wrote in September about reservations expressed by a three-judge panel from the 1st District Court of Appeals regarding the challenge made by acupuncturists, massage therapists and chiropractors to key parts of Florida’s 2012 landmark reform of the personal-injury protection (PIP) auto insurance law, in a blog post titled “Judges Question Challenges Brought to Florida’s No Fault Insurance Law.”

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

Judges Question Challenges Brought to Florida’s No Fault Insurance Law

A three-judge panel from the 1st District Court of Appeals expressed their reservations Tuesday about a challenge made by acupuncturists, massage therapists and chiropractors to key parts of Florida’s 2012 landmark reform of the personal-injury protection (PIP) auto insurance law, The News Service of Florida reports.

In the hearing, the three judges questioned how the modifications to the longstanding no-fault insurance system have diminished individual medical coverage or court access, as the Florida PIP Defense Fund and its representatives contend.

In the hearing, the three judges questioned the Florida PIP Defense Fund’s assertions that modifications to the longstanding no-fault insurance system have diminished individual medical coverage or court access.

The FL PIP Defense Fund named acupuncturist Robin Myers, chiropractor Gregory Zwirn and massage therapists Sherry Smith and Carrie Damaska as plaintiffs in the suit, as well as “Jane Doe,” which is being seen as a tactic by The Fund to qualify for standing in the case and represent individuals injured by motor-vehicle collisions.

According to Judge T. Kent Wetherell, this is not a real lawsuit, but a situation where an individual makes a claim against their own insurance company because many accidents conclude with no driver being found ‘at fault.’

The judges expressed a desire to expedite a ruling, but no timeline was given for a decision on the state’s request to overturn a temporary injunction that was imposed on certain parts of the law in March.

The 2012 reform law signed by Gov. Rick Scott requires those involved in motor vehicle crashes to seek treatment within 14 days, allows up to $10,000 in benefits for emergency medical conditions and $2,500 for non-emergency conditions. Scott and state Chief Financial Officer Jeff Atwater championed the 2012 reforms to reduce fraud in auto insurance, which they say costs motorists almost $1 billion a year through the increased costs of coverage.

The alternative is to replace the system with bodily-injury insurance, which could put more questions of medical coverage into the courts as injured parties seek to recoup expenses from at-fault motorists.

A bodily-injury insurance system is the most likely PIP alternative if further change is sought. This would push more medical coverage questions into the courts, since injured parties would seek to establish fault for expense reimbursement purposes.

If PIP is eliminated, Wetherell notes, challengers to the law would face a similar economic impact and future.

In March, Leon County Circuit Judge Terry Lewis sided with the challenge to sections of the law, criticizing it for depriving individuals of getting the medical care that they need.

Adam Levine, an attorney representing the FL PIP Defense Fund, praised Lewis for considering issues bigger than economic impacts, but Florida Solicitor General Allen Winsor said Lewis failed to determine that the law is unconstitutional.

The insurance industry has generally supported the changes to the law.

Reform efforts are being delayed as a result of the injunction, according to Donovan Brown, state government relations counsel for the Property Casualty Insurers Association of America.

“In order to address fraud and abuse within Florida’s no-fault auto insurance system and provide Floridians relief from being the number one state in the nation for questionable auto claims, it is imperative that consumers receive the benefit of the PIP reforms becoming fully effective,” Brown said in The News Service of Florida article.

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Filed under Case Law, Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012)

PIP Legislative Calendar Governs EUO Requirements

Florida insurers are now being forced to navigate between sometimes conflicting rulings on Examinations Under Oath (“EUO”) based on pre- and post-2012 changes to the PIP/No-Fault laws.

Insurance companies and their defense law firms were disappointed when the Florida Supreme Court ruled in late June that GEICO could not withhold benefits to a policyholder in a pre-2012 auto case based on the policyholder’s unwillingness to attend an EUO.

In the matter Merly Nunez v. GEICO General Insurance Company, the Florida Supreme Court was asked by the U.S. Court of Appeals for the Eleventh Circuit to rule on, “[w]hether, under FLA. STAT. § 627.736, an insurer can require an insured to attend an [examination under oath] as a condition precedent to recovery of [personal injury protection] benefits?”

The Court’s answer was in the negative, in a split 5-2 vote. The majority ruled that, “[t]he Florida No-Fault statute is mandatory and does not recognize such a condition. It is therefore invalid and contrary to the statutory terms.”

“Swift and virtually automatic payment” is the primary intent of PIP laws, notes the majority. While GEICO argued the need for fraud prevention and claims investigations, the Court viewed these actions as contrary to a fast case resolution.

The majority opinion was written by Justice Perry, with Justices Pariente, Lewis, Quince, and Labarga concurring. Justice Canady wrote a dissenting opinion, in which Justice Polston concurred.

“Insurers have relied on the discretionary use of examinations under oath (EUOs) in appropriate cases to obtain relevant, needed information not only for the assessment of claimed losses, but for the prevention of fraud and abuse of the PIP system,” said Donovan Brown, Florida counsel and regional manager for the Property Casualty Insurers Association of America as quoted in an Insurance Journal article. “This ruling is another blow to Florida’s consumers in the fight against PIP fraud because the ruling further exposes consumers to the rampant PIP fraud that has plagued the Florida auto insurance system for far too long.”

Florida Governor Rick Scott approved changes to the state’s PIP statutes in May, 2012. As of January 1, 2013, insureds must now comply with all terms of a No-Fault policy, including any requirement to submit to an Examination Under Oath.

Click on the link to read the Supreme Court of Florida ruling in Merly Nunez v. GEICO General Insurance Company, No. SC12-650, dated June 27, 2013.

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Filed under Case Law, Examinations Under Oath (EUO), Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Insurance Fraud

Fort Myers Chiropractor Arrested, Caught Paying Confidential Informant to Fake Injuries

Fort Myers, FL chiropractor, Dr. David Greydinger, was arrested last week after investigators caught Greydinger submitting fraudulent insurance claims for non-existent auto accidents.  Reports indicate Greydinger, of MYO Health Clinic, paid informants kickbacks to submit claims totaling $6,000 arising out of non-existent accidents.  Reports indicate that MYO Health Clinic remains open for business at this time.

Detective William Quick of the Florida Division of Insurance Fraud stated, “Greed is the primary force behind everything with insurance fraud. It all comes down to money.”

The full report is available here.

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

PIP Clinic Owner Arrested for Improper Campaign Donations

Florida Wellness & Rehabilitation Center owner, Mark Cereceda, surrendered Friday to charges of illegal campaign donations throughout Florida.  The owner of the Hialeah injury clinic, a chiropractor himself, donated over $25,000.00 from 2010 to 2012 to the campaigns of: Florida Senate President Don Gaetz, state Sen. Joe Negron and Miami-Dade County Commissioner Rebeca Sosa in addition to candidates for state representative Carlos Trujillo, Katie Edwards and Eddy Gonzalez.  Cereceda and his brother, Kemel Cereceda, were in jail Friday night on felony charges.  Cereceda is charged with illegally forcing his employees to donate to these campaigns and reimbursing them for these donations in violation of Florida law.

Mark Cereceda was recently in the news due to his involvement with former county court judge Ana-Maria Pando.  According to the Miami Herald:

Detectives began investigating after news broke last year that Ana Maria Pando, a Hialeah-branch county court judge, had penned a letter to state authorities — on official letterhead — asking that Cereceda’s company be reinstated.

The clinic had let its business license lapse. The Florida Division of Corporations treated the judge’s letter as a court order and reinstated the company for free.

Pando was investigated for ethics violations, a probe eventually dropped when she lost a reelection big last year and she agreed not to run again. At the time, companies affiliated with Cereceda had cases pending before Pando. And Cereceda also contributed to her reelection campaign. The Florida Judicial Qualifications Commission accused Pando of not reporting a “financial gift” from Cereceda.

The full article from the Miami Herald is available here.

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

Suit to Deem Florida’s PIP Law Unconstitutional Blocked in Florida Federal Court

On December 12, 2012, Federal Court Judge Richard A. Lazzara entered an Order denying a group of medical provider’s attempt at a prelimary injunction, blocking the implementation of changes in Florida’s new PIP law which take effect January 1, 2013. Judge Lazarra found, ” that the motion is due to be denied without the necessity of a hearing because Plaintiffs have utterly failed to demonstrate that there is a substantial likelihood they will eventually prevail on the merits.”

The Federal lawsuit filed by attorney Luke Lirot on behalf of a group of chiropractors, acupuncturists massage therapists and a “John Doe” plaintiff, sought to block the implementation of changes to the amended Florida PIP law, effective January 1, 2013. Among other issues, the plaintiff’s sought to block the law’s ban on PIP benefit reimbursement to acupuncturists and massage therapists.

Christian Camara, Florida Director at R Street, a non-profit public policy research organization stated: “While this is just a short-term procedural victory and the case will now go on to trial, [Judge] Lazzara has handed down a defeat to the opponents of reform. This also marks a win for Florida consumers, who stand to benefit from containing the escalating costs in our auto insurance market.”

The PropertyCasualty 360 article is available here. For more information on the ruling and it’s effect on Florida insurers please contact Mark Rose (mrose@roiglawyers.com) or Michael Rosenberg (mrosenberg@roiglawyers.com).

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Filed under Fla. Stat. 627.736 (2012)

Insurance Information Institute Comments on PIP Premium Changes and Significance of the January 1, 2013 Effective Date of 2012 PIP Law Changes

Tampa Bay Fox 13 recently featured a segment regarding the effect of House Bill 119, the 2012 PIP law change, on PIP premium rates.  Lynne McChristian of the Insurance Information Institute, shed some light what appears to be a lack of a premium decrease.  McChristian indicates that the recent insurer reports are not indicative of what could likely be the case after January 1, 2013, when all of HB119′s changes take effect.

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

Office Manager of Two Chiropractic Clinics, Maria Molina, Pleads Guilty to Mail Fraud Conspiracy, Submitting False Claims for Staged Accidents

Maria “Cary” Molina of West Palm beach plead guilty to one count of “mail fraud conspiracy” in Federal court last Thursday.  Molina was accused of perpetrating an insurance fraud scheme at two chiropractic clinics, OVY Rehabilitation Medical Center and HHR Medical Center, where Molina served as an office manager.  Records indicate Molina submitted bills for individuals known to be involved in staged motor vehicle accidents.  Prosecutors stated that the clinics received $540,000 from PIP insurers as a result of the fraud.

Molina’s co-defendant, Obelio “Ovy” Rodriguez, 43, has been declared a fugitive.

The full report from the Sun-Sentinel is available here.

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

Eight Arrested for Staging Accidents in Miami-Dade County, Connections to Six Different PIP Fraud Rings

Florida’s Chief Financial Officer, Jeff Atwater, announced Tuesday that eight individuals involved in multiple staged accidents in Miami-Dade County were connected to six different PIP fraud rings.  The press release from the the CFO states:

An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Alexander Cid, 47; Luis Rivero Dominguez, 35; Franklyn Chaviano, 38; Robert E Bayona, 55; Carlos Padron Fernandez, 38; Yosmel Ramos Peraza, 24; Andres Vega Fleites, 61; and Jorge Fernandez Rodriguez, 52, participated in staged accidents in coordination with six fraud rings as organizers or drivers between May 2009 to May 2011.

The staged auto accidents resulted in more than $340,000 in fraudulent auto insurance claims.  If convicted, the eight individuals involved could serve a total of 455 years in prison.

The Division of Insurance Fraud (DIF) recently entered into a partnership with the Florida Highway Patrol (FHP), which will include the assignment of FHP Troopers to the Miami and Tampa DIF offices to work in the investigation of staged accident ring activity.

The full press release is available here.

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Filed under Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Insurance Fraud

Property Casualty Insurers Association of America: Allow the New PIP Law Adequate Time to Take Effect to Achieve its Full Potential

Donovan Brown, state government relations counsel for the Property Casualty Insurers Association of America (PCI),  recently issued a statement in response to the Office of Insurance Regulation’s (OIR) recent analysis of the Pinnacle Actuarial Resources, Inc. impact report on Florida’s new PIP law.

In the statement Brown emphasizes patience with the expected results of the new law.

PCI has ongoing concerns with the study’s conclusions and the fact that they are based on a law which does not fully take effect until next year. Although we commend Pinnacle for its diligent and thorough work, the study cannot anticipate changes to Florida’s legal, social or economic environment which will directly influence the impact of the new PIP law. The study also cannot calculate the scope of detrimental challenges to the new PIP law that will be filed by plaintiffs’ attorneys or the manner and extent to which corrupt providers will attempt to game the system. In addition, we note that the study cannot foresee the overall impact the PIP law may have on the Bodily Injury and Uninsured Motorist portions of drivers’ auto policies.

Therefore, in order for the new PIP law to achieve its potential, PCI encourages policymakers, regulators and Florida drivers to allow the law adequate time to take effect. PCI also urges policymakers to protect the law from any distortion that will negatively impact its ability to deter fraud and abuse in the PIP system. As with any comprehensive legislative package, there will be implementation processes and other issues that must be addressed in order for the PIP law to attempt to stabilize our auto insurance market.

The full press release is available here.

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