Florida CFO Advises Homeowners that Insurance Coverage is Vital to Hurricane Preparedness

Florida Chief Financial Officer Jimmy Patronis reminds Florida homeowners that the 2018 Hurricane Season is in full swing and the importance of reviewing their insurance policies to understand the type of coverage it provides.

According to CFO Jimmy Patronis, “Last year, Hurricane Irma alone resulted in more than $8 billion in insured losses. If you haven’t already, now is the time to financially prepare for the 2018 Hurricane Season.” He advises that a vital part of hurricane preparedness is making sure that you understand what is and is not covered under your homeowner’s insurance policy so that you can have adequate coverage.

There are eight insurance coverages homeowners may want to consider for hurricane season:

  • Windstorm Coverage
  • Flood Insurance
  • Food Spoilage
  • Sinkhole Coverage
  • Additional Living Expenses/Loss of Use
  • Inflation Guard Endorsement
  • Replacement Cost Endorsement
  • Law and Ordinance

Once a storm develops, insurance companies may be under binding restrictions and may be unable to obtain a separate policy or add these essential coverages to the current policy. It is imperative that homeowners speak to their insurer to confirm these coverages as soon as possible.

Click here for press release.

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Filed under Florida, Hurricane Andrew, Hurricane Irma, Hurricane Matthew, Insurance, Insurance Claims, Property Insurance, Uninsured

Pending PIP Litigation on the East and West Coasts Could Impact States In Between

PropertyCasualty360 published a report about pending automobile personal-injury litigation in California and New York that could have a lasting impact if the decisions spread to other jurisdictions. Courts will determine allowable evidence for suits involving these insurance claims.

East Coast

In New York, insurers investigated radiologist Andrew Carothers, a suspected illegal straw owner after he filed 20,000 lawsuits against auto-insurance carriers. After insurers refused to pay Carothers, he flooded the state’s courts with more than 20,000 lawsuits seeking collection for unpaid “services.” The civil cases were consolidated, and the jury agreed Carothers was fraudulently engaged in the corporate practice of medicine. The Appellate Division affirmed, so Carothers went to the New York Court of Appeals, where the case awaits a decision.

A favorable decision can deter scams like Carothers’ in other states that forbid the corporate practice of medicine. Fraudsters who often quickly expand operations to line their pockets in other states could be deterred. A decision is expected in 2019.

West Coast

Dave Pebley was involved in a serious vehicle accident, sought medical care and filed suit. He had health coverage but decided not to submit his bills for payment. That is because, under California law, the jury would only hear about the amount paid by his health insurer as the measure of his medical expense while Pebley was billed at the top rate for medical services by refusing to use his health insurance.

The insurer cried foul, asserting that such actions mislead the jury, and are fraudulent because medical providers never expect to receive such high payments. They argued the plaintiff may present the higher medical bills but must provide expert testimony to prove the charges are fair and reasonable. Similarly, the defendant or their insurer may present counter-evidence as to what the health providers normally accept for payment of those services.

The California Second District Court of Appeal reasoned that juries should be allowed to ultimately decide the appropriate charge for the medical services. Parties are lining up to support an appeal of the case to the state Supreme Court. If Pebley succeeds in California, potentially winning the $3.6 million he seeks, the strategy of refusing to use health insurance can be expected to spread rapidly to other states.

Click here for full article.

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Filed under auto insurance, Auto Insurance Fraud, Fraud, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, PIP, PIP/No Fault, Uncategorized

Two GEICO Adjusters Charged in Miami Insurance Fraud Ring

On Monday, July 10th, 14 people were charged in “Investigation Vehicle Roulette” conducted by Florida’s Bureau of Insurance Fraud and the State Attorney’s Office. Two GEICO insurance adjusters, Juan Carlos Diaz and Cesar Santiago Tapanes, prosecutors say got cash kickbacks for helping defraud their own company were among those arrested.

In September 2016, a Lexus GS350 was involved in a fender bender with a Chrysler 320 in North Miami-Dade. The rogue insurance adjusters reported inspecting the Lexus and authorized a series of payments totaling over $16,000. However, investigators say the accident never actually happened.

In fact, the same Lexus had been the subjection of 10 previous claims involving crashes that never occurred, all signed off by Diaz and Tapanes. The scam ended up costing GEICO more than a million dollars.

According to an arrest warrant by detectives, at least 45 bogus claims were made. The group faces charges including grand theft, insurance fraud, and racketeering.

Click here for full article.

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Filed under auto insurance, Auto Insurance Fraud, Florida, Florida Division of Insurance Fraud, Fraud, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud

The Evolution of Investigative Tools in Insurance Investigations

Since Hurricane Season is underway, here’s a Daily Business Review article published by Roig Lawyers Partner Patricia Preciado that still holds true today.

Click here to view the article.

Aerial image of Florida Keys after Hurricane Irma

Aerial image of Florida Keys after Hurricane Irma

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Filed under AOB, Assignment of Benefits, Claims Handling, Florida, Hurricane Andrew, Hurricane Irma, Hurricane Matthew, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, Lawsuits, Property Insurance

Contractor Charged with Grand Theft and Racketeering in AOB Fraud Scheme

According to the Florida Department of Financial Services, Timothy Matthew Cox, owner of Nationwide Catastrophe Services, Inc. and Restoration Response Services, Inc., has been arrested for an alleged Assignment of Benefits (AOB) fraud scheme, stealing nearly $140,000 for home repairs due to tropical weather events that he never provided. Cox’s scheme impacted 19 homeowners throughout Florida and Texas, leaving the victims’ homes to sustain additional damage from other tropical weather events, including Hurricane Irma.

Cox’s team never started any of the work they were contracted to perform on the 19 homes after receiving insurance payments. He was arrested and booked into the Polk County Jail facing multiple counts of grand theft and racketeering. Cox could face up to 30 years in jail.

Click here for press release.

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Filed under AOB, Assignment of Benefits, Fraud, Hurricane Irma, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud

Roig Lawyers Orlando Managing Partner to Present at DRI Marijuana Law Seminar

If you’ve never attended a DRI seminar, you don’t know what you’re missing in terms of networking and education!

Roig Lawyers’ Orlando Managing Partner, Scharome Wolfe, will present “How High? Insurance and MedicalMarijuana” at the 3rd Annual DRI Marijuana Law Seminar in Chicago from June 26-27. It’s a fascinating area of rapidly-changing law. We encourage you to attend!

Click here for more information.

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Filed under Insurance, Marijuana, Uncategorized

Appeal Court Backed Air Ambulance Firm in PIP Dispute

The 11th U.S. Circuit Court of Appeals backed air-ambulance firm Air Methods Corp. in a dispute stemming from a traffic accident that resulted in the death of accident victim Lemar Bailey about whether the amount paid for helicopter services should be limited by Florida’s no-fault auto insurance law. The federal appeals court ruled that the air-ambulance firm is considered an air carrier under federal law and should be able to bill the child’s father, Lenworth Bailey, for costs that exceeded the limits in the state’s no-fault system.

Following the March 2013 accident, Air Methods Corp. billed $27,975 for its services. Bailey’s auto insurer, State Farm Mutual Automobile Insurance Co., paid $6,911 under the fee schedule. His health insurer, Aetna Life Insurance Co. paid another $3,681. However, Bailey did not pay the remaining balance of nearly $17,400. He filed a potential class-action lawsuit alleging that the air ambulance company was trying to improperly collect amounts in excess of the fee schedule. However, the judge ruled in favor of the Air Method, which led Bailey to the appeals court that also rejected such arguments.

Click here to view the full article.

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Filed under auto insurance, FL Legislation, Florida, Insurance, Insurance Claims, Insurance Defense, Lawsuits, Personal Injury Protection, PIP, PIP/No Fault

Roig Lawyers Partner Keith Hernandez Publishes Article in CLM Magazine on Autonomous Vehicle Technologies and its Impact on Insurance

ROIG Lawyers Deerfield Partner Keith Hernandez has published an article in CLM Magazine entitled “Keep Your Eyes Off the Road.” In the article, Keith discusses the emergence of autonomous vehicle technologies and its impact on traditional insurance.

Click here to read the entire article.

CLM Magazine is the premier source for content that addresses trends, topics of interest, and industry challenges for those in the claims and litigation management industry.

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Filed under auto insurance, Autonomous Technology, Claims Handling, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, PIP/No Fault, Uncategorized

UPDATE: Ringleader Pleads Guilty To His Role In $23 Million Auto Insurance Fraud Crime Ring

Andrew Rubinstein of Miami and the self-confessed ringleader, Felix Filenger of Sunny Isles pleaded guilty to a racketeering conspiracy charge last year. Rubinstein and Filenger were paying kickbacks to tow truck drivers and body shop workers who illegally steered accident victims to chiropractic clinics they owned at a rate of $1,500 to $2,000 per “patient.” Clinic workers would then have patients attend multiple visits, document exaggerated pain levels, and bill insurance providers for treatment in the amount of $10,000, the maximum allowed under Florida law.

According to Prosecutors, the clinics were located throughout south and central Florida, including Sunrise, Hollywood, Hallandale Beach, Pompano Beach, Delray Beach, West Palm Beach, Miami, Orlando and Kissimmee.

Under the terms of his plea agreement, both sides had agreed to recommend the six-year sentence for Rubinstein. Filenger’s sentencing has been postponed. Several other people who also admitted their roles in the fraud are scheduled for sentencing later this year.

Click here to view the full article. (Previous post)

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Filed under Auto Insurance Fraud, Florida, Fraud, Insurance, Insurance Fraud, Personal Injury Protection, PIP, PIP/No Fault

Florida Insurance Agent Suspended Indefinitely for Committing ID Fraud

According to the Ocala StarBanner, Kevin M. Day, 46, used forged documents to open an Allstate branch in Dunnellon. Day pleaded guilty to the fraudulent use of personal identification information of a former client.

Day used the personal information and forged documents signed in the name of a client of his former employer, saying the client would give Day $100,000 to start his own business. At least $100,000 in liquid assets is required by Allstate to open a business.

Day’s former boss investigated the situation and contacted Dunnellon police after Day first tried to buy her business, then opened his own Allstate branch. Day was sentenced to 24 months of probation, his insurance license is suspended indefinitely and he must complete 200 hours of community service.

Click here to read the full article.

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Filed under Florida, Fraud, Insurance