Author Archives: Patricia Preciado

Duval County Public Schools Principal Arrested for Insurance Fraud

Florida CFO Jimmy Patronis announced the arrest of Darrell Perry, a Jacksonville elementary school principal for allegedly trying to submit altered insurance claims and false invoices for over $16,000 in the wake of Hurricane Irma. Investigators found Perry submitted fraudulent and fabricated repair invoices requesting reimbursement from State Farm due to alleged damages from Hurricane Irma.  Perry has turned himself in and now faces up to five years in prison if convicted.

Click here to read the press release.

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Filed under Insurance Fraud

Three Unlicensed Contractors Banned for Post-Storm Fraud

According to the Florida CFO Jimmy Patronis, three unlicensed contractors in Leon, Gadsden and Gulf counties have been banned from soliciting and conducting any work in Florida pending a full investigation. The Disaster Fraud Action Strike Team is investigating additional reports of potential fraud in Bay, Gulf, Washington and Leon counties. CFO Patronis is stressing the importance of verifying professional license information and whether the company has workers’ comp insurance before you hire a contractor.

Here’s a list of Tips to Stop Post-Storm Fraud:

  • Beware of Crooked Contractors.
  • Don’t Sign Anything.
  • Too Good to Be True? It Probably Is.
  • Beware of Door-to-Door.
  • Check a License.

Click here to read the press release.

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Filed under Fraud

Lake Mary Man Arrested for Posing As Insurance Agent

Michael Hensley of Lake Mary has been arrested for falsely presenting himself as an insurance agent and providing general liability insurance for two Seminole County businesses. This isn’t the first time Hensley’s been accused of posing as an insurance agent and stealing money from local business owners.

While Hensley’s license expired in 2015, he’s pocketed $72,000 in insurance premiums over the years. The business owners would discover that they were not covered when attempting to file a claim.

Claims for damage due to Hurricane Irma uncovered Hensley’s alleged scheme causing one business over to pay $18,000 out of pocket to fix the roof of his business due to the storm.

Click here to read the article.

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Filed under Insurance Fraud

4th DCA Finds AOB Without All Insureds’ and Mortgagees Signatures Unenforceable

On Wednesday, September 5, 2018 the Florida Fourth District Court of Appeals ruled that assignment of benefits (AOB) without all insureds’ and mortgagees signatures are unenforceable. The appellate court found no problems with an insurer requiring consent from all insureds and mortgagees, which is good news at a time when AOB abuse is such a big issue in Florida.

Visit Law360 (subscription required) or Justia for more information on this ruling.

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Filed under Assignment of Benefits, Insurance, Property Insurance

Florida Insurance Leaders Hope to Rein In AOB Crisis

The Florida insurance industry is hoping to put an end to its AOB crisis with education. Barry Gilway, president, CEO and executive director of Citizens Property Insurance Corp. says the key to slowing Assignment of Benefits (AOB) abuse in Florida is for the insurance industry to link AOB to its impact on the consumer and the premiums they are paying.

Insurance carriers from across the state have seen an increase in litigation due to AOB lawsuits from homeowners who work with unlicensed contractors who file inflated and fake claims on their behalf. According to the Florida Department of Financial Services, AOB lawsuits in Florida have increased from 405 to 28,200 between 2006 and 2016 with South Florida being the worst region for this issue.

Florida insurance industry leaders are hoping for a legislative fix with the new Senate leadership coming in next year.

Click here to read the full article.

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Filed under AOB, Property Insurance

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

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

Overreaching Assignments & Their Impact on Your Claims Handling

Recently, there has been an uptick in changes to the language in the assignment of benefit contracts which emergency mitigation companies are having Insureds sign.

One of the changes in the contracts is that the Insured’s execution of the assignment of benefits authorizes the carrier to not only directly pay them for their services, but to also include them on all checks regardless of the coverage they are for. For example, if the carrier pays the insured under Coverage A for repair, Coverage C for contents, or Coverage D for additional living expenses, this contractual language may require that the AOB company be listed on these checks.

A second change in the contracts is that the assignment of benefits may have a single sentence seeking to exceed any emergency services cap the carrier’s policy may have. Once the carrier receives this contract, the clock begins ticking on the time frame for the carrier to respond. If the carrier fails to respond within the timeframe detailed in the policy, this cap is waived.

With an influx of insurance claims due to recent natural disasters, being aware of these changes is key to how you handle these claims. Hopefully, this overreaching on behalf of the AOB companies will be the final push needed to have some laws passed to regulate this AOB realm.

If you have any questions on this issue, please feel free to contact our First Party Property Team at info@roiglawyers.com.

ROIG Lawyers attorneys have provided presentations on Assignment of Benefits as well as other areas that are beneficial to our clients in the Property Insurance industry. 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.

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Filed under AOB, Assignment of Benefits, Claims Handling, FL Legislation, Florida, Insurance, Insurance Claims, Property Insurance

Helping You Navigate the Choppy Waters of Hurricane Claims

Our thoughts continue to be with all those affected by Hurricane Irma. We recognize many of you will face challenges in the days and weeks ahead. In staying true to our values of loyalty and teamwork, we want to let you know that ROIG Lawyers is here to help.

With the upcoming influx of property and insurance claims to be filed, top-of-mind awareness among claim handling professionals is key in identifying fraudulent and inflated hurricane claims.

We have a close-knit group of statewide First Party Property attorneys dedicated to providing quality and proactive legal services to our clients in the area of property defense. We utilize a proactive approach in which we litigate to property claims and moreover, if the need arises, we have experienced trial attorneys on our team ready to take files through trial.

We are also available to provide complimentary in-house CE courses to our clients and colleagues as a value-added service. We do this to ensure that our clients and prospective clients are making informed decisions based on the most up to date and relevant information. These are a few of the courses that may be of most interest to you and your team.

  • Public Adjusters and SIU, 2 credit hours
    This course will inform and update insurance adjusters on the role of a public adjuster when investigating a homeowner’s claim. The course will educate adjusters on the statutory authority for public adjusters as well as ethical requirements. Adjusters will be educated on common tactics and provided with examples of ways adjusters can assist with a fraudulent claim. Finally, adjusters will be educated on the potential pitfalls associated with alleging insurance fraud.
  • Water Mitigation Claims, 1 or 2 credit hours
    This course will provide a basic overview of the various requirements of water mitigation services pursuant to the Institute of Inspection Cleaning and Restoration Certification (“IICRC”). Specifically, the course addresses the types of machines used, the categories and classes of losses, and various SIU issues to be aware of when adjusting these types of losses.
  • Examinations Under Oath and the Law, 2 credit hours
    This course will inform insurance adjusters about examinations under oath and how and why they are used in practice. Additionally, the course indicates the information insurance adjusters should gather in anticipation of an Examination Under Oath.

If you have any questions, concerns, or to schedule a complimentary CE course, please contact the Marketing Department of ROIG Lawyers at marketing@roiglawyers.com.

ROIG Lawyers will continue to stand with you and as always, we thank you for standing by us.

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 from seven offices throughout the state of Florida. 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. E-mail list/s from ROIG Lawyers are intended to provide information of general interest to the public and are 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.

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Filed under Florida, Hurricane Irma, Insurance, Insurance Claims, Insurance Defense, Property Insurance

Andrew v. Matthew: The Evolution of Investigative Tools in Insurance Investigations

I am sure right now many of our insurance carriers are out there running themselves ragged, trying to quickly and efficiently adjust the thousands of claims that are pouring in from Hurricane Matthew.

As the dust settles, I want to remind you of all the great resources and tools you have to investigate and adjust claims that were not available during the time of Hurricane Andrew. Although there are many, the most impactful are cellphones, portable computers and trade-specific tools of laser distance meters, moisture meters and thermal imaging devices.

Clearly, we have come a long way from the time of paper files, pay phones and disposable cameras. During Hurricane Andrew, if you wanted to review a prior claim file, you would need to retrieve it from storage or an archive. If you wanted to make an appointment to inspect the property, you would need to leave messages for the insured at their home or office, and wait for them to call you back at the office. Finally, if you wanted to take pictures of the damage, you would have needed to use a disposable camera (which date back to 1986) and hoped you captured the images you needed.

The most significant technological advancement we have at our fingertips is our cell phones. Cell phones give us the ability to take photographs, take videos, record audio and otherwise document an event. As an example, the first cameras on cell phones arrived in 2000. Since then, cellphones quickly evolved into what we know today. With that in mind, ensure that the insured is asked whether they have any photographs of the property taken prior to your inspection as well as any photographs of the damaged areas prior to them being damaged.

Ask for this information early on in the claim handling, so that if it exists, it can be secured prior to a coverage decision. A photograph is worth a thousand words, and you do not want a few of those words to be “if I’d seen that …. ”

Also, be aware that pursuant to Florida Statute 626.854 (15)(c), which states in pertinent part that an insurer shall not be prevented from “timely conducting an inspection of any part of the insured property for which there is a claim for loss or damage,” you are entitled to inspect all areas claimed as damaged. As such, make sure you are asking to see just that — all damaged areas.

Tools Of The Trade
Advancements specific to the trade have been measuring tools, moisture meters and thermal cameras, to name a few. Although the spring-click tape measure was invented in 1868, it was not until the early 1990s that laser distance measures began to circulate. These electronic tape measures not only provide precise measurements, they also assist in obtaining measurements of hard to reach or unsafe areas, common in many homes after the passing of a major hurricane.

Moisture meters and thermal-imaging devices in their current form are fairly recent concepts that have significantly impacted the trade. These two items, when used together, are very effective in locating sources of leaks, water patterns and extent of moisture. The thermal-imaging device will depict a pattern of temperature differences through contrasting colors, while the moisture meter will indicate whether an item is wet or not and can even provide the percentage of wetness depending on the device.

However, please keep in mind that thermal-imaging devices only measure differences in temperature, and the manufacturers of those devices strongly suggest verifying the thermal readings with moisture meters for that very reason. A change in temperature does not equate to moisture in and of itself.

Finally, the best technological advancement for claims handling has been the portability of the computer, i.e. tablets and laptops. These portable computers were invented in 1981 and provide the ability to retain and organize the information obtained by all of the other advancements mentioned. They also allow you to carry large amounts of information regarding weather conditions, aerial photographs of insured properties and claims history.

Knowledge Base
Ultimately, the one thing that has not changed since Hurricane Andrew is that the insured continues to be your best source of knowledge. Remember that Florida Statute 626.854(15)(b) states in pertinent part that a “person acting on behalf of the insurer” should have “reasonable access at reasonable times to any insured or claimant.”

Use that reasonable access to chat with your insured about the loss while it is still fresh in their mind. Topics of interest should include the specific details of the loss, when the loss was first discovered, efforts at mitigation, and any individuals and companies that have helped with the claim. As to efforts at mitigation, make sure to ask what was done, who did it and how they did. This information will be essential to your handling of the claim to ensure all of the insured’s proceeds are used as efficiently as possible to put the home back to its pre loss condition.

Coupling your best source of knowledge with the information you secure during your claims handling and your grasp of the relevant law will be your recipe for success during the aftermath of Hurricane Matthew.

If you are in need of a quick refresher on the rights and duties included in the applicable statutes, get in touch with registered continuing education instructors who may already have this information in a course approved by the state.

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Filed under Claims Handling, Florida Statute 626.854 (15)(c), Hurricane Andrew, Hurricane Matthew, Insurance, Insurance Claims