New Amendments Affecting Anti-Fraud Investigative Units

The Legislature has passed some amendments that are likely to affect your SIUs. We have reviewed the new law and would like to provide you with a summary of some of the most important points.

Chapter 2017-178, Laws of Florida, primarily amended § 626.9891, Florida Statutes and went into effect June 26, 2017, when the Governor signed the bill. These amendments deal with insurer “anti-fraud investigative units.” There is very little, if anything, that must be done now other than learn the law and know what your responsibilities and timelines are.

Although you have an SIU to cover the main features of the law, some new reporting requirements and designation of an anti-fraud unit with at least 2 hours of initial anti-fraud education and 1 hour per year after that, will require all insurers “to investigate and report possible fraudulent insurance acts” to Florida government. The amendments to § 626.9891 [insurer anti-fraud investigative units; penalties for noncompliance], Florida Statutes, provide the who, what, how, when and where.

SUMMARY

*There is no legislative staff analysis of this law

By December 18, 2018, DIFS shall create best practices for the detection, investigation, prevention, and reporting of insurance fraud and other fraudulent insurance acts. The report must be updated as necessary but at least every 2 years. The report must contain specified criteria set forth in the section.

The Department of Financial Services is authorized to create rules for the administration this section. This is neither the Office of Insurance Regulation nor the Financial Services Commission (Governor and selected cabinet).

While there are compliance dates for insurers and agencies, the bill became effective upon becoming a law on June 26, 2017. By December 31, 2017, each insurer must:

  • If not in-house, contract with others to provide anti-fraud services
  • Adopt anti-fraud plan (discussed below)
  • Designate at least one employee to provide these services
  • Electronically submit reports of anti-fraud plan with the name and contact information of designated person to DIFS
  • The additional cost to the insurer for compliance may be added as an administrative expense in rate requests

Each anti-fraud plan shall include:

  • Procedures for mandatory reporting of insurance fraud
  • Acknowledgement that the insurer provides education and training required by section
  • Description of anti-fraud education and training
  • Description or flow chart of anti-fraud unit
  • Rationale and justification for level of staffing and resources used by anti-fraud unit based upon specified criteria

By December 31, 2018, each insurer shall provide staff of the anti-fraud investigative unit at least 2 hours of initial anti-fraud training that is designed to assist in identifying and evaluating instances of suspected fraudulent insurance acts in underwriting or claims activities.

Annually, after the initial training, an insurer must provide such employees a 1-hour course that addresses detection, referral, investigation, and reporting of possible fraudulent insurance acts for the types of insurance lines written by the insurer.

The insurer shall report to DIFS specified information by December 19, 2019, and annually thereafter for each line carried:

  • Number of policies in effect
  • Amount of premiums written
  • Number of claims received
  • Number of claims referred to anti-fraud unit
  • Number of fraud related matters referred to anti-fraud unit that were not claim related
  • Number of cases referred to DIFS
  • Number of case referred to other LE agencies
  • Number of cases referred to other agencies
  • Estimated dollar exposure submitted to DIFS or other agencies

In addition to reporting for all lines, workers compensation lines shall also report by December 19, 2019, the following information:

*This is a decrease in the amount of information currently required for workers compensation fraud before the amendment

  • Estimated dollar amount lost due to workers comp fraud]
  • Estimated dollar amount recovered attributed to workers comp fraud for several designated criteria
  • Number of workers comp fraud cases referred to DIFS for several designated criteria

Creating § 626.9896 Dedicated insurance fraud prosecutors:

  • DFS shall collect specified data from each state attorney who has designated attorneys and paralegals exclusively for the prosecution of insurance fraud.  [criteria omitted]
  • DIFS shall report the data to the house and senate leaders by September 1, 2018, and annually after that.

Other provisions not discussed; viatical contracts; HMO anti-fraud unit requirements; stranger-originated insurance policies are now statutorily considered void and unenforceable; an insurer may opt out of preinsurance inspection of private motor vehicles.  Preinsurance inspection reports of DIFS are eliminated.

 

These are the highlights of the bill as it applies to automobile insurance.  It does affect other lines as mentioned and we would be happy to explain the law in greater detail should you request it. If you have any questions, suggestions or reservations, please do not hesitate to contact us so that we may assist you in not only understanding the new law but how it ought to be implemented and when.

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Filed under FL Legislation, Florida, Florida Division of Insurance Fraud, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud

Casselberry Residents Being Targeted by Windshield Replacement Scammers

Casselberry, Florida residents are victims of windshield replacement scammers. As reported by News 6, a Casselberry resident recently told police that two men came to her door claiming to work for the state government, insisting that a new law had been enacted that requires Floridians to replace their windshields every six months. As a result, the residents become victims, often times being exposed to an increased risk of a cheap windshield popping out and breaking during an accident. In turn, the scammers will contact the victim’s auto insurer and submit an inflated invoice for a service that was not necessary or properly done; potentially resulting in an increase in the victim’s auto insurance premium.

An increased premium is not the only risk insureds face with these scams, according to the Coalition Against Insurance Fraud, insureds could face possible fines and, even worse, jail time. Making a repair claim for a windshield you know is undamaged could get you convicted of insurance fraud.

Red flags should go up if someone shows up at your door or chases you down in a parking lot offering to fix your windshield for free. If you believe your windshield has sustained damage and needs to be repaired or replaced, call your insurance company for a list of rebuttable windshield repair/replacement companies.

For more information regarding the windshield repair scams and what you can do to fight back, visit http://www.insurancefraud.org/scam-alerts-windshield.htm.

Click here to read full article.

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Filed under Florida, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, Uncategorized, Windshield, Windshield Damage Scam

Relocation For Military Personnel Might Be An Order, But What About Vehicle Registration and Insurance?

During holidays such as Memorial Day and Independence Day, our nation pays tribute to all of our men and women, both past and present, serving in the Armed Forces. We look forward to celebrating with family and friends as we honor our military personnel and their service to this Country.

One of the things military personnel are likely to endure is moving their homes and bouncing around the Country or overseas to do their duty. These individuals often own motor vehicles and drive them across state lines to where they are newly stationed. Others are overseas for months, if not years, and have motor vehicles back at home that are not being used and are often garaged until their owners return.

So is a member of the military who is a Florida resident responsible for maintaining the registration and minimal automobile insurance on their vehicle when they are stationed out of the Country?

The answer to that is no, but be careful. Florida law makes an owner or registrant of a motor vehicle exempt from such registration and insurance requirements if a member of the United State Armed Forces is called to or on active duty outside the United States in an emergency situation. The exemption applies only as long as the member of the Armed Forces is on active duty outside the United States and applies only while the vehicle covered by the security required under Florida law is not operated by any person. However, the military insured must make a written request for this exemption and the insurer shall cancel the coverages and return any unearned premium or suspend the security required.

What does this mean? Well, the subject motor vehicle cannot be driven on the roads and highways of Florida during the time this exemption is in place. As such, if that military insured has leave and comes back to Florida, then they cannot operate that vehicle unless they renew the minimum insurance and their registration, if expired. Additionally, other individuals cannot drive that vehicle when that military insured is deployed. This can get tricky due to the fact that the worst thing that can happen to a motor vehicle is letting it sit idle for a long period of time. This can cause condensation in the fuel, carburetor issues, flat tires and other mechanical problems.

To be safe, advise everyone you know that may have access to the vehicle that it cannot be operated on the streets or highways of Florida until it is re-registered and insured. Putting a lock on the vehicle’s steering wheel or a note in the window as a reminder may also be a good practice. This does not mean you cannot start the vehicle and let it idle, it just means you cannot take it out for a drive. If you do, the driver/owner of the vehicle would become self-insured and could possibly be cited for failure to have the required insurance on the vehicle. Sorry neighbors, no favors to borrow the car for a quick trip to the market… That run for milk can leave the vehicle owner in a stale situation.

Now Florida residents are generally required every year to renew the registration on their vehicles.

However, is a member of the Armed Forces, who is a resident of another State and is ordered to be stationed in Florida, required to register their personal vehicle in Florida and maintain the minimum Florida insurance on that vehicle if they want to drive that vehicle on the roads and highways of Florida?

The answer is no. Any motor vehicle or mobile home owned by, and operated exclusively for the personal use of, any member of the United States Armed Forces who is not a resident of Florida and who is stationed in Florida while in compliance with military or naval orders, are exempt from registering and insuring their personal vehicle in Florida during that time as long as it is registered and insured in accordance with the laws of their home State.

Now the military insured may want to renew their registration and obtain the minimum Florida insurance if they know that they will be stationed in Florida for a long period of time. However, they are not required to do so as long as they have military orders keeping them stationed in Florida. Consequently, this means that the military insured will only get the benefit of the coverage’s that are available under their insurance policy and would not qualify for additional Florida Personal Injury Protection coverage benefits if they are in a motor vehicle accident in the State.

There are certain insurers that cater to the Armed Forces personnel. However, there are other insurance options for these individuals based on the competition between insurers. Thus, insurance agents and adjusters should become knowledgeable about the insurance exemptions provided to the Armed Forces personnel so to better service these special clients.

This article is not intended to create an attorney-client relationship by offering this information, and anyone’s review of the information shall not be deemed to create such a relationship. The content provided is intended to provide information of general interest to the public and is not intended to offer legal advice about specific situations or problems. You should consult a lawyer with regard to specific legal issues that require attention.

For additional information, please contact Stephen Mellor of Roig Lawyers at 954-354-1541 or by email at smellor@roiglawyers.com. Stephen G. Mellor is a partner in the Deerfield Beach office of Roig Lawyers who primarily focuses on out-of-state policy claims for insurance carriers. 

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Filed under auto insurance, FL Legislation, Florida, Insurance, Insurance Claims, Insurance Defense

Updates to Florida’s Fictitious Name Statute

We get questions regarding the Fictitious Name Statute from many of you fairly often. The legislature has made some changes to the Fictitious Name Statute that closes holes, but quite possibly opens some new ones. Whether this creates a private cause of action to enforce the new provisions (affirmative litigation) is to be seen. However, it may provide a defense. Click here for the Bill Analysis and Fiscal Impact Statement.

A summary of the new changes can be found below. If you have any questions or would like to discuss this issue in greater detail, please feel free to contact ROIG Lawyers Healthcare Policy Advisor Dennis LaRosa at dlarosa@roiglawyers.com or (850) 264-6389.

CS/CS/SB 346 updates the Florida Fictitious Name Act, s. 865.09, F.S., which requires any person or business entity doing business in Florida under a name other than their legal name to register a fictitious name with the Division of Corporations of the Department of State. Specifically, the bill:

  • Defines the term “registrant” to clarify and standardize who is required to file a fictitious name;
  • Clarifies that foreign business entities must be in active status with the Division of Corporations to file a fictitious name;
  • Updates the process for cancellation, registration, and renewal of a fictitious name, including clarifying the term of registration;
  • Standardizes language to include varied business entities, rather than just corporations;
  • Changes the penalty for failure to comply with the Fictitious Name Act from a misdemeanor to a noncriminal violation; and
  • Makes technical and conforming changes throughout.

The bill takes effect on July 1, 2017.

Click here for the Amended Bill.

ROIG Lawyers is a minority-owned litigation firm with a primary focus on Insurance Defense Litigation. We serve as primary counsel for numerous national and regional carriers and corporations related to all aspects of insurance litigation. ROIG Lawyers does not intend to create an attorney-client relationship by offering this information, and anyone’s review of the information shall not be deemed to create such a relationship. You should consult a lawyer with regard to specific legal issues that require attention.

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Filed under FL Legislation, Florida, Florida Fictitious Name Act

New Florida Law Deems Ridesharing Drivers As Independent Contractors & Provides Minimum Insurance Requirements

You may or may not be aware that there is a new Florida law deeming Uber, Lyft and other ridesharing drivers as independent contractors and NOT employees that is going to be taking effect on July 1st. The new Florida law also provides for insurance coverage requirements that will now be mandatory for such drivers and companies. We want to make sure you know how this legislation is going to affect your business.

On May 9, 2017, Florida Governor Rick Scott signed the Transportation Network Companies Act (HB 221), designating drivers for ridesharing companies in the on-demand or gig economy as “independent contractors” as long as the “transportation network company” meets four criteria that are currently met by Uber, Lyft, and other similar companies.

Under this newly enacted legislation, insurance coverage requirements are now also being made mandatory for the drivers and the ridesharing companies when they are engaged in the online application of the ridesharing company and/or in a prearranged ride. The coverage requirements under the new law can be satisfied in one of three ways. The new law also discusses the responsibilities of the driver’s personal auto insurance carrier when an accident occurs and provides avenues for the insurer to investigate the claim with the cooperation of the ridesharing company.

We recently presented a continuing education course at the 25th Annual Florida Insurance Fraud Education Committee (FIFEC) Conference called The Ridesharing Generation: Insurance Implications & Complications which discusses this topic. We are happy to provide a copy of the presentation to you if you are interested.

For questions, or to discuss this issue in greater detail, please feel free to contact Lissette Alvarez or Cecile Mendizabal.

For more information on how to schedule a complimentary continuing education course via webinar or live presentation, please contact the Marketing Department of ROIG Lawyers.

ROIG Lawyers is a minority-owned litigation firm with a primary focus on Insurance Defense Litigation. We serve as primary counsel for numerous national and regional carriers and corporations related to all aspects of insurance litigation. ROIG Lawyers does not intend to create an attorney-client relationship by offering this information, and anyone’s review of the information shall not be deemed to create such a relationship. You should consult a lawyer with regard to specific law issues that requires attention.

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Filed under Uncategorized

Geico Claims Fraud By Plaintiff Seeking Class Action Lawsuit In Florida

As reported by Law360, in its efforts to have class certification denied, GEICO has asserted that VIP Auto Glass Inc. may lack standing to bring any claims against GEICO and maintain its lawsuit.  “Since VIP actually has no valid assignment, it has no standing to bring any claims, much less any class claims. Class certification must be denied on this ground alone,” GEICO added, also noting that it reserves the right to seek sanctions or other appropriate remedies based on the alleged improper conduct.

According to the Complaint, VIP Auto Glass Inc. is seeking damages on behalf of GEICO policyholders, alleging that GEICO’s prices violate Florida laws and “have absolutely nothing to do” with the amount most shops charge for a windshield replacement.  VIP Auto Glass has asked a federal court in Tampa to certify a class of similarly situated windshield repair facilities in the state that were hired to perform repairs by Florida GEICO policyholders, obtained an assignment of benefits and submitted bills for reimbursement, but did not receive full payment from the insurer.  However, in its response opposing that motion, GEICO has advised the court that it has recently discovered that VIP’s repeated assertions that Mr. Jones assigned it his benefits have been false.  GEICO says that Jones recently confirmed the forgery during a deposition and in a sworn affidavit, testifying that the signature and initials on the filed assignment of benefits are not his. In his affidavit, Jones also says that his first name is spelled Derryl, with two “Rs.”

GEICO has stated that the court’s analysis should end with a finding that VIP lacks standing, but also argues that class certification should be denied because class members cannot be easily ascertained since each proposed member’s assignment of benefits would have to be verified through individual factual inquiries.

Click here for full article. (Subscription Required)

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Filed under Class Action, Florida, Insurance, Insurance Defense, Windshield

Four North Carolina Men Charged in Insurance Scam

As reported by The-Dispatch.com, four North Carolina men have been charged by the N.C. Department of Insurance with charges including insurance fraud, felony conspiracy, injury to real property and attempting to obtain property by false pretense. Phillip Brandon Edwards, Mark William Madison, Joel Jayson Smith and Brandon Richard Turner are being accused of deliberately damaging roofs in at least two homes to obtain insurance payment from United Services Automobile Association under false pretense.

The National Insurance Crime Bureau, Thomasville Police Department, Davidson County Sheriff’s Office and Concord Police Department are the agencies that assisted with the investigation.

“According to the FBI, insurance fraud costs the average family between $400 and $700 per year in the form of increased premiums,” North Carolina Insurance Commissioner Mike Causey said in a news release. National Insurance Crime Bureau has seen a rise in potential fraudulent roofing claims and complaints with over 150 referral complaints in 2014 and 2015.

Click here to read full article.

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Filed under Insurance, Insurance Claims, Insurance Defense, Insurance Fraud

UPDATE: Naples Man in Florida Crash Ring Sentenced to 3 Years in Jail

On May 2, 2017, the Coalition Against Insurance Fraud reported that Wisler Cyrius of Naples was sentenced to three years in federal prison after pleading guilty of conspiracy to commit mail fraud and money laundering.

Cyrius and five other individuals conspired to solicit people to participate in staged motor vehicle accidents in exchange for compensation. According to the Justice Department, Cyrius was also ordered by the court to pay restitution to automobile insurance companies and to forfeit property in the amount of the proceeds traceable to the offense.

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

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Filed under Auto Insurance Fraud, Florida, Insurance, Insurance Fraud

Florida’s Third District Court of Appeal Retroactively Applies Allstate PIP Decision

According to Law360, on Wednesday, April 19th Florida’s Third District Court of Appeal retroactively applied a state Supreme Court decision involving Allstate Insurance Co.’s personal injury protection policy language regarding the use of the Medicare fee schedules, overriding a lower court’s ruling and handing Allstate the win. After denying the insurer’s request for review of a circuit court appellate division’s ruling in favor of medical provider Hallandale Open MRI LLC last September, the court reversed course, applying the Supreme Court’s January decision in Allstate v. Orthopedic Specialists.

Click here to read the full article (subscription required).

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Filed under auto insurance, Case Law, FL Legislation, Florida, Insurance, PIP, PIP/No Fault

Geico Sues Florida Health Clinic for ‘Unnecessary’ Massage Claims

As reported by Law360, Geico sued Medical Wellness Services Inc. of Miami, FL for allegedly making $1.2 million in claims for providing medically unnecessary treatments for automobile accident victims who were eligible for coverage under their no-fault insurance policies. According to Geico, some of the claims were for services that were not actually provided and contained billing codes that misrepresented and exaggerated the services.

“The defendants do not now have — and never had — any right to be compensated for the fraudulent services that were billed to Geico through Medical Wellness,” Geico said. Geico claims Medical Wellness Services Inc. submitted claims for massage therapist services which are not reimbursable because Florida law prohibits no-fault insurance reimbursement for massages or other similar services.

According to the suit, the scheme began no later than 2013 and continues to this day. In addition to the request for $1.2 million in damages, Geico is also requesting a declaration from the court saying it will not have to pay any pending fraudulent claims by the health clinic which totals more than $75,000.

Click here for the full story (subscription required).

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Filed under Auto Insurance Fraud, Florida, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, Miami-Dade County, Miami-Dade Fraud, Personal Injury Protection, PIP/No Fault