Category Archives: Florida

Florida Man Caught Staging Crash on Dashcam

According to the Sun Sentinel, a Florida man was arrested on Friday, October 6th in connection with an alleged staged crash that occurred in December of 2016. 65-year-old Mauril Aldophe of Delray Beach plotted to force a tow truck to rear-end him. Unfortunately for Mr. Aldophe, the tow truck was equipped with a dashcam capturing footage of him abruptly stopping for no apparent reason and then driving forward for several feet, throwing his car into reverse, and then slamming back into the tow truck.

According to investigators, Mr. Aldophe went to a medical clinic three days after the incident and filed a personal injury claim stating a truck had rear-ended him while he was stopped at a red light.

Mr. Aldophe now faces charges for insurance fraud and participation in an intentional crash.

Click here for full article.

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

New Statute To Help Deflect Frivolous ADA Lawsuits

As reported in the Miami Herald, Florida lawmakers have implemented a new law aimed at ADA public accommodation compliance lawsuits often pressuring small businesses and property owners into quick settlements in order to avoid lengthy and costly court battles. In an analysis published in March by The News-Press (Fort Myers), of all the lawsuits filed under the ADA’s public accommodations law in Florida during the past five years, more than half of the approximately 6,000 suits were filed by just 12 plaintiffs. In addition, many of the plaintiffs are represented by the same law firms. The bill, receiving unanimous approval in both the Florida House and Senate during the 2017 legislative session, was recently signed into law by Gov. Rick Scott and is now in effect.

The new statute enables businesses and property owners to take substantive, preventative measures to help insulate themselves from the most frivolous claims. Under the law, a business or property owner may retain a qualified expert to conduct an inspection of their property to ensure compliance with building codes satisfying the ADA’s requirements. If the property is found to be in compliance with the ADA, the expert may issue a certificate of conformity that includes the date of inspection, proof of the expert’s qualifications, and a statement confirming that the property is in conformity. For properties that are not found to be in compliance, the owner may develop and submit a remediation plan approved by a qualified expert indicating that the property will be brought into conformity within a specified time period.

The compliance certifications or remediation plans may be filed with the state’s Department of Business and Professional Regulation, which will now maintain a publicly accessible website to serve as a registry for all of the certifications and remediation plans that it receives. Importantly, a remediation plan in existence before an ADA lawsuit is filed could serve to moot such a lawsuit.

The new law does not prohibit disabled plaintiffs from filing ADA public accommodations lawsuits, nor does it prohibit plaintiffs’ attorneys from seeking fees. It does, however, provide Florida businesses and property owners with a means to potentially defeat or limit frivolous ADA barrier-to-access lawsuits and greatly minimize their exposure to related attorney fees and costs.

Click here for the full article.

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Filed under ADA, FL Legislation, Florida, Lawsuits

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

Insurance Agent Allegedly Sold Fraudulent Insurance Policy

According to the Palm Beach Post, Fred Thomas Jr., 39, is facing charges of fraud and embezzlement between $300 and $2,000 after he allegedly sold a Palm Beach County woman fraudulent/fake car insurance during a three-year period. Thomas was arrested by the Florida Highway Patrol on Interstate 95 for driving with a suspended license when the trooper found an active warrant for Thomas in the insurance fraud case.

Click here for the full article.

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Filed under auto insurance, Auto Insurance Fraud, Florida, Insurance, Insurance Fraud, Palm Beach County

Florida Insurance Rates Rise Thanks to Windshield-Replacement Schemes

According to Insurance Business America, your auto insurance premiums are going up, all because of ongoing windshield-replacement schemes.  As reported by Ryan Smith of Insurance Business America, these windshield schemes involve drivers with cracked windshields signing over insurance benefits to windshield repair and replacement shops.  These shops, through an “assignment of benefits”, will then submit an inflated invoice for the work allegedly rendered.

The Tampa Bay area has become the hub of the fraud and abuse involving these schemes.  More often then not, the fraudulent schemes are no fault of the insureds.   Florida law states that a deductible cannot be applied to windshield replacement and repair services.  This allows these shops to advertise that the work being done is “free” to the insureds.  The result of these “free” services has led to over 1900 windshield-claim lawsuits in Florida in 2016 alone; increasing litigation costs and ultimately hitting everyone’s pocket.

Click here for full article.

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Filed under auto insurance, Auto Insurance Fraud, Florida, Florida Division of Insurance Fraud, Insurance, Insurance Defense, Insurance Fraud, Windshield, Windshield Damage Scam

ROIG Attorneys Publish Ridesharing Article in Daily Business Review

ROIG Lawyers Attorneys Cecile S. Mendizabal and Lissette M. Alvarez published the article, “Ridesharing Legislation May Trigger New Wave of Litigation” in the Daily Business Review.

ROIG Lawyers Summer Law Clerk Yasbel Perez also contributed to the article.

Subscription required for full article.

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Filed under auto insurance, Claims Handling, FL Legislation, Florida, Insurance, Insurance Claims, Insurance Defense, Personal Injury Protection, PIP, PIP/No Fault, Ridesharing, Transportation Network Companies

Florida Doctors With Multiple Malpractice Settlements Face Little Discipline

According to Health News Florida, there are 29 Florida doctors operating with clear medical licenses although they have at least six malpractice complaints against them that have resulted in insurance payments since 2000. These doctors are continuing to practice without discipline from the state system that oversees them, which means either insurers paid to settle the cases that had no merit or the state hasn’t always followed up.

Critics say Florida’s system is broken and it’s putting people’s lives at risk. Dr. Sidney Wolfe, founder of the Public Citizen Health Research Group, based in Washington D.C has studied medical discipline nationwide for decades and says Florida’s Board of Medicine must intervene.

Patients and their families can also file a complaint with the state’s regulatory agencies, although the odds are stacked against them. 6,713 complaints and reports were filed with the Department of Health from 2015-2016. Only about 15 percent or 1,018 of them were found “legally sufficient.” Of those, 762 were taken to a probable cause panel, and three-fourths were rejected. The 188 administrative complaints filed that year represent less than 3 percent of the number of complaints and reports that came in.

In some cases involving doctors with multiple claims, records show the Department of Health received early warnings, but took little or no action. One of those cases was that of Dr. Michael Rosin, a Sarasota dermatologist who was convicted in March 2006 of defrauding Medicare of more than $3 million in a scheme that dated back more than a decade. He was sentenced to 22 years in prison and ordered to pay millions of dollars in restitution. After his criminal conviction, the Department of Health revoked his license, according to state records. Federal records show that Rosin, now 66, is at Otisville Federal Correctional Institution in Otisville, N.Y. He is scheduled for release in 2025.

Click here to read the full article.

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Filed under Department of Health, DOH, Florida, Florida Healthcare, Health care, Insurance, Malpractice

Discount Plan Organization (DPO): What is it and why should we know?

A “Discount Medical Plan Organization” was created in 2004 and is now simply called a “Discount Plan Organization (DPO).”

What is it and why should we know?

It is like a concierge medical agreement where a patient pays a fee, for example, $1,500/year to get quick access to a specific doctor.  Usually, the DPO is the only way to access specific practitioners.  It does little more than grant access, some prophylactic treatment, and the practitioners are usually the patients’ primary care physician.  You may see these organizations providing post-accident services.

Let’s make sure we are not also paying for the DPO in disguise through administrative CPT’s. Click here for the Bill Analysis.

Summary:

Discount Medical Plan Organizations (DMPOs) offer discount medical plans, in exchange for fees, dues, charges, or other consideration, which provide access for plan members to providers of medical services and the right to receive medical services from those providers at a discount. The Legislature established the regulatory scheme for DMPOs in 2004, which includes licensure, forms and rate filings and approval, disclosure requirements, and penalties.

CS/HB 577 renames a “Discount Medical Plan” and a “Discount Medical Plan Organization” as a “Discount Plan” and a “Discount Plan Organization” (DPO), and makes extensive conforming changes to part II of ch. 636, F.S., to reflect the new names. The bill clarifies the definition of a “Discount Plan” to exclude any plan that does not charge a fee to members. The bill removes all rate and form filing and approval requirements for DPOs. To increase flexibility in marketing and reduce administrative barriers for DPOs, the bill:

  • Defines “first page”, upon which certain disclosures must appear, to mean the first page of any marketing material that first includes information describing benefits;
  • Allows DPOs to delegate functions to marketers and binds DPOs to the actions of those marketers within the scope of the delegation; and
  • Allows marketers and DPOs to commingle certain information on forms, advertisements, marketing materials, or brochures.

To maintain consumer protections for members and potential members of Discount Plans, the bill:

  • Changes the disclosure requirements by requiring acknowledgement and acceptance of the disclosures before enrollment and creating visibility and follow up requirements for disclosures made by electronic means or telephone;
  • Establishes new cancellation and reimbursement requirements for DPOs to disallow any charges beyond the effective cancellation date;
  • Requires pro rata reimbursement of charges paid by a member for the months beyond the effective cancellation date; and
  • Requires pro rata reimbursement for members who cancel during an open enrollment period, upon return of his or her discount card.

The bill does not have a fiscal impact on state or local government.

The bill became law on June 14, 2017, and is now Chapter 2017-112, Laws of Florida.

If you have any questions or would like to discuss this issue in greater detail, please feel free to contact Dennis LaRosa (dlarosa@roiglawyers.com/850-264-6389) or any ROIG Lawyers attorney of your choice.

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Filed under FL Legislation, Florida, Insurance, Insurance Defense

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