Shaw Capital Management: Industry Groups Seek Crackdown On Insurance Scams

Seoul, South Korea (PressExposure) March 21, 2011 -- BY: KENRIC WARD

Calling Florida the epicenter of an auto insurance "fraud epidemic," industry groups want the Legislature to crack down on scam artists who are driving up motorists' premiums.

"Floridians need to know that our state, unfortunately, continues to have the highest number of questionable, or 'staged,' auto accidents of any other state in the country," said William Stander, assistant vice president for Property Casualty Insurance Association.

Stander's group was joined by the Florida Chamber of Commerce and the Associated Industries of Florida in calling for reform - but not abolition - of the state's no-fault (PIP) insurance program.

"Florida's business community can no longer afford to stand by and expect PIP fraud to go away. We must do something now," said Teye Reeves, the Chamber's director of business climate and quality-of-life policy.

Noting that Miami, Tampa, Orlando and Hialeah rank among the U.S. cities with the highest rates of questionable claims, Stander said Florida motorists pay the second-highest auto liability insurance premiums in the nation.

The 2008 average annual liability premium is $736 - 56 percent higher than the national mean of $471, he said.

The Insurance Information Institute estimates that, if left unchecked, the increase in premiums related to insurance fraud could reach $946 million for insured Florida drivers this year.

"PIP fraud is out of control in Florida," said Jose Gonzalez, vice president of governmental affairs for Associated Industries of Florida. Gonzalez said AIF supports the efforts of a new industry-launched website,, to highlight PIP fraud in the state.

The industry consortium said it will propose a series of legislative remedies during the 2011 session, including:

EXAMINATIONS UNDER OATH: Stander said court decisions have "created confusion" regarding an insurer's ability to investigate claims by using a procedure called an examination under oath. These are routinely used to determine if fraud exists by interviewing the policyholder or provider regarding the alleged benefits received, under penalty of perjury for lying. The insurance industry recommends specifically authorizing the use of EUOs by insurers to investigate fraud.

INDEPENDENT MEDICAL EXAMS: In the course of investigating a claim, an insurer can conduct an independent medical examination on an insured to determine the extent of injuries and what sort of treatment is reasonable. If an insured is participating in a fraud ring, or even if an honest insured is just following directions from a clinic or PIP lawyer who is part of a ring, the insured often misses or never goes to these appointments, in order to keep the crime a secret.

Stander said courts have allowed motorists' lawyers "to keep making excuses for never showing up to an IME." The insurance industry recommends specifically stating that a refusal to submit to an IME is a rebuttable presumption that the failure was unreasonable.

ARBITRATION: When disputes exist, they can often be resolved faster and more efficiently by using arbitration, which also saves the taxpayer money by reducing the caseload on the court system, Stander said. The industry recommends allowing an insurer to offer a policy that includes arbitration as an alternative dispute resolution mechanism available to both the insured and the insurer, while preserving everyone's right to access the court system if necessary.

PIP LAWYER FEES: Florida PIP law requires an insurer to pay both its lawyers' and the insured's lawyers' fees if the insurer loses in court, even if the insurer thinks the claim is a scam.

"Sometimes the insured's lawyers' fees total more than the original $10,000 in PIP coverage. This causes an insurer to think twice about challenging suspicious claims or medical treatments," Stander said.

Likewise, he added, "lawyers have an incentive to file as many lawsuits as possible for any reason, all the while driving up insurance costs for everyone else."

Since a similar change to the workers' compensation laws in 2003 resulted in substantial savings for policyholders, the industry recommends capping lawyers' fees in PIP litigation to a percentage of benefits obtained.

PIP LAWYER FEE MULTIPLIER: In addition to their regular hourly fees, PIP lawyers can also obtain something called a "contingency risk multiplier." Originally developed to encourage attorneys to take on difficult civil rights cases, the multiplier now regularly shows up in PIP cases, and multiplies up to 2 1/2 times the amount of money a PIP lawyer can make in litigation.

"These inappropriate multipliers dramatically increase the PIP lawyer's incentive to sue in a no-fault system that is supposed to be free of litigation," Stander said. The industry recommends prohibiting the award of contingency risk multipliers in calculating PIP lawyers' fees.

EXPANDED INVESTIGATION AND PROSECUTION: Among the many reforms that could help solve this problem, the industry seeks crash reports that include the names and addresses of all passengers, better licensure and inspections of PIP clinics, and more authority and funding for Chief Financial Officer Jeff Atwater and the Department of Financial Services.

Critics of the industry proposals question the scope of the problem, alleging that little specific data exist on PIP claims because insurance companies closely guard such information. The Florida Department of Financial Services Division of Insurance Fraud only tracks complaints of possible fraud reported to its agents.

Ed Domansky, spokesman for the Hollywood Rehabilitation Center, said the envisioned PIP changes would sow confusion and uncertainty in the system, and could hurt legitimate health-care providers who could be left to absorb the costs of uncompensated care.

While Reeves called the reform package "a top priority" for Chamber of Commerce members, Stander said he expects that consumer groups will sign on to many components of the effort as well.

"High insurance costs are a concern for everyone," he noted.

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Press Release Submitted On: March 21, 2011 at 2:11 am
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