Category Archives: Insurance

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.

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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.

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Filed under Florida, Fraud, Insurance

Two Miami Medical Clinics Raided for Staged Accidents & Insurance Fraud

Florida’s Department of Investigative and Forensic Services Bureau of Insurance Fraud and the Miami Police Department raided two South Florida medical clinics accused of paying for patients and fraudulent billing. Both clinics have been under investigation since early 2017 for recruiting people for staged accidents and billing insurance companies for thousands of dollars in treatments that they were not providing.

According to Captain Emissael Díaz of Florida’s Bureau of Insurance Fraud “Just in South Florida alone, most of your rates are going to go up 20 to 25 percent just because of the insurance fraud.” The captain stated that schemes of this kind are the reason insurance rates are going in South Florida.

The suspects taken into custody are facing several charges, including patient brokering, insurance fraud and grand theft.

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Filed under Florida, Florida Division of Insurance Fraud, Insurance, Insurance Claims, Insurance Fraud, Miami-Dade County, Miami-Dade Fraud

Former Dade City Police Officer and Two Others Charged in Insurance Fraud Scheme

According to the Florida Department of Law Enforcement, former Dade City police officer Jonathan Lance Hobby and two others, Bruce Dewayne Wilson Jr. and Carl “Chuck” Roach Jr. were arrested for insurance fraud among other charges.

Hobby, Wilson and Roach were charged with combinations of conspiracy to commit insurance fraud, filing a false police report, conspiracy to deal in stolen property and operating a chop shop. According to detectives, Hobby filed a police report and auto theft claim in May 2017 claiming his 2015 Dodge Ram 1500 truck was stolen from Rancho Bonito in Lakeland. The insurance company paid a claim to Hobby in the amount of $24,712.72.

Hobby’s truck was located at Wilson’s business, After Hours Diesel Service. Investigators say Wilson and Hobby orchestrated a scheme to falsely report the truck as stolen and sell most of its parts, which Roach knew about and actually participated in dismantling the truck.

All three suspects were arrested and booked into the Pasco County Jail.

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Filed under Auto Insurance Fraud, Florida, Insurance, Insurance Claims, Insurance Fraud, Uncategorized

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

Palm Beach Post Receives National Recognition for Insurance Fraud Coverage

Washington-based policy and research group, Coalition Against Insurance Fraud, has awarded its inaugural journalism award for fraud reporting to The Palm Beach Post for its work on fraud in the sober-home industry. The award honored Post coverage dating back to 2015 when Post investigators Christine Stapleton and Pat Beall first wrote about how sober-home operators were defrauding insurers of millions of dollars for urine drug tests.

Sober homes were requiring residents to be tested every day, creating multimillion-dollar business empires. Palm Beach County treatment centers and affiliated labs were charging as much as $2,000 for urine tests that can be purchased for $25 at a drug store.

In 2016, a team of Post reporters and editors, including Stapleton, Beall, Lawrence Mower, Joe Capozzi, John Pacenti, Barbara Marshall and Mike Stuck produced “Heroin: Killer of a Generation,” a 12-page special section of stories about 216 men, women and teenagers who died of a heroin-related overdoses in Palm Beach County in 2015. One in 10 had died in a sober home.

The Post’s reporting played a role in the prosecution of sober-home operators Kenneth Chatman and Eric Snyder as well as the successful push to tighten state laws which have resulted in more than 40 people on charges related to brokering patients.

Congratulations to the Palm Beach Post on this national recognition for their work in fighting insurance fraud.

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Filed under Florida, Insurance, Insurance Fraud, Palm Beach County

Florida Man Arrested for False Insurance Claim

Insurance Journal has reported that a Florida man, Claude Milhomme, was arrested for attempting to file a false insurance claim for his vehicle. According to the Department of Financial Services’ Disaster Fraud Action Strike Team (DFAST), Milhomme filed a claim in September stating water damage to his vehicle caused by Hurricane Irma in the amount of $225 for a diagnosis, after hours fee and storage fee.

DFAST received a suspected fraud tip about one month later. After an inspection by state investigators, it was revealed that Milhomme’s vehicle was mechanically inoperable prior to Hurricane Irma’s landfall in September of 2017.

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Filed under auto insurance, Auto Insurance Fraud, Florida, Insurance, Insurance Claims, Insurance Fraud

UPDATE – Pilot Theodore R. Wright III Pleads Guilty to Insurance Fraud

UPDATE – Pilot Theodore R. Wright III Pleads Guilty to Insurance Fraud

According to KLTV 7 of Texas, Theodore R. Wright III, the well-known pilot who survived a 2012 Gulf of Mexico crash and used an iPad to record his time in the water, has pleaded guilty to conspiring to commit wire fraud and conspiring to commit arson. Wright and three others also pleaded guilty to buying, over-insuring and ultimately destroying planes, boats, and cars to collect cash.

In May 2017, the Wright and his co-conspirators, Shane Gordon, Raymond Fosdick, and Edward Delima were charged with using fire to commit a felony and aiding and abetting, arson of property used in interstate or foreign commerce or used in an activity affecting interstate or foreign commerce, conspiracy to commit wire fraud, and wire fraud.

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

Judge Dismisses Lawsuit of Injured NJ Driver Who Maintained FL Insurance Policy

A New Jersey judge has ruled that Jeffrey Scholes, a man living in New Jersey but driving a car registered and insured in Florida, may not sue another New Jersey driver for injuries he sustained in a car accident. Judge Patrick Bartels of Essex County Superior Court dismissed Scholes’ personal injury lawsuit against defendant Stephen Hausmann on Oct. 24 citing that it would be a violation of the state’s automobile insurance statutes as Scholes fraudulently maintained a Florida automobile insurance policy while living in New Jersey.

Bartels noted that Scholes had been living and working in New Jersey since 2009 but maintained a Florida insurance policy issued by GEICO, registered his car there and had a Florida driver’s license because it was more cost-effective.

According to the ruling, Scholes was “severely injured” when he was struck head-on by Haumann’s car on Oct. 23, 2014, in South Orange. Although Scholes sustained back injuries that required epidural injections and surgery, Hausmann moved to have Scholes’ lawsuit dismissed on the grounds that New Jersey law requires that people who live in the state and who have a car here must maintain New Jersey car insurance.

Bartels agreed. “[W]e agree that plaintiff’s automobile is not considered insured pursuant to New Jersey law,” he said.

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Filed under auto insurance, Auto Insurance Fraud, Florida, Insurance, Insurance Fraud, New Jersey, PIP

Attorney Fee Multipliers in PIP and the Search for a Guiding Lodestar

In October 2017, the Supreme Court again addressed the issue of contingency fee multipliers to awards of attorneys’ fees. Personal Injury Protection (PIP) Plaintiff attorneys felt a tinge of delight and perhaps delayed buying their lottery tickets in hopes that this new decision will help them win an attorney fee multiplier if they prevail in a PIP suit. While HB 119 in 2012 eliminated multipliers from newer PIP lawsuits, there are still many older cases that are now being resolved which face the possibility of large awards of attorney fees going to Plaintiff attorneys. Additionally, there is no penalty for a Plaintiff attorney to attempt to pursue a multiplier, thus the key question is how to best defend against this potential windfall.

To understand the new decision in Joyce v. Federated Nat’l Ins. Co., 2017 Fla. LEXIS 2070 (Fla. 2017), it is beneficial to look back at the Florida Supreme Court’s interpretation of how and when to award a multiplier. The seminal decision regarding the applicability of multipliers is still the Quanstrom decision from 1990. Specifically, the requirements under Quanstrom necessary to find a fee multiplier are:

  1. Whether the relevant market requires a contingency fee multiplier to obtain competent counsel.
  2. Whether the attorney was able to mitigate the risk of non-payment in any way.
  3. Whether any of the factors set forth in Rowe are applicable, especially, the amount involved, the results obtained, and the type of fee arrangement between the attorney and his client. Id. at 834.

Joyce re-iterates that a market inquiry as to whether a multiplier was necessary to obtain competent counsel is the primary factor under the Quanstrom[1] requirements. This is important to PIP litigation since there are few, if any, potential PIP lawsuits that cannot find a warm and welcoming PIP attorney eager and willing to take the case.

Interestingly, the Florida Supreme Court in Joyce noted that the United States Supreme Court in 1992 revisited the issue of contingency fee multipliers in Burlington v. Dague, 505 U.S. 557 (1992), concluding that “enhancements for contingency [was] not permitted under the fee-shifting statutes at issue…[and] Justice Scalia, writing for the majority, reasoned that enhancement for contingency would likely duplicate in substantial part factors already subsumed in the lodestar.” Joyce. at 17, citing Dague at 567.

Under Joyce, the Florida Supreme Court separated itself from this federal precedent and continued to allow the use of multipliers under Florida law. The fear was that without the possibility of contingency multipliers some individuals with meritorious claims would fail to obtain competent counsel and the Florida Supreme Court noted “their usefulness in helping parties secure legal representation and their importance in ensuring access to Courts.” Id. at 17-18 citing Bell v. U.S.B. Acquisition Co., Inc., 734 So.2d 403, 411 (Fla. 1999). In other words, the Florida Supreme Court was concerned that Justice Scalia failed to consider that without a potential multiplier there is a danger of never obtaining competent counsel. Id. at 25. But with the thousands of PIP lawsuits being filed every year, can a Plaintiff truly make an argument that finding a PIP attorney is difficult?

Under Joyce, it appears that contingency fee multipliers are alive and well under Florida Law, and there are some circumstances where they are certainly warranted. Paradoxically, the best argument against the applicability of multipliers to the majority of PIP lawsuits comes from the Joyce opinion itself. The majority opinion which intentionally diverged from federal precedent on multipliers in order to preserve access to courts appears to have absolutely no concern about whether prohibiting multipliers in PIP lawsuits somehow prevents individuals from obtaining fair access to courts or diminishes one’s ability to obtain competent counsel. The dissent also argues that PIP litigation suffered no decrease in volume after HB 119 and that there was no negative impact on an insured’s ability to obtain counsel in PIP cases. Id. at 40-41. The dissent even cites the Plaintiff’s own expert testimony that there is no lack of attorneys willing and able to take PIP cases and “that same fee expert begrudgingly ‘hate[d]’ to admit that plaintiffs’ attorneys throughout the entire State of Florida are abundantly motivated to take PIP cases (even though PIP cases contain no possibility of a multiplier).” Id. at 42.

The majority opinion in Joyce actually agreed with the dissent that PIP litigation is different because of the number of attorneys willing to take PIP lawsuits. The majority opinion notes that PIP should not be compared to other types of first-party litigation since, “the fact that there are attorneys who specialize in PIP claims, which can be handled with relative ease in a volume practice, does not correlate with the availability of competent attorneys who are willing to litigate other types of insurance coverage cases, where generally more complex issues are raised.” Id. at 25. Clearly, the majority opinion is willing to differentiate PIP lawsuits from other types of first-party litigation due to the ease of obtaining a competent attorney.

Ultimately, none of the Quanstrom factors changed with the recent Joyce decision. However, the new opinion does provide an excellent analysis and justification as to how multipliers developed under Florida law and why the Supreme Court continues to think multipliers are necessary to ensure fair and equal access to the courts. It is important to keep in mind that Joyce does not mean a PIP lawsuit can never justify a multiplier. In fact, the Quanstrom decision is a PIP lawsuit[2]. Understanding the best way to contest aggressive attempts to collect fee multipliers and create an appropriate record at the trial court level remains important in PIP litigation.

[1] Standard Guaranty Insurance Co. v. Quanstrom,555 So.2d 828 (Fla. 1990)
[2] Other notable PIP lawsuits have been awarded multipliers after there was substantial and competent evidence to justify that a multiplier was necessary.  See  State Farm Fire & Casualty Co. v. Palma, 555 So.2d 836 (Fla. 1990)

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

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 auto insurance, Florida, Insurance, Insurance Claims, Insurance Defense, Personal Injury Protection, PIP, PIP/No Fault, Uncategorized