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

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.

Click here to read the full article.

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

Minor ADA Violations Cost Florida Businesses Thousands in Attorneys Fees

Central Florida businesses being sued by a Daytona Beach attorney for potential violations of the Americans with Disabilities Act are awaiting a federal ruling to determine whether they’ll have to pay settlements in the form of attorney fees. The law forbids plaintiffs from receiving money for “relief” regardless of a court’s decision.

The alleged violations are often quick fixes, but they can cost businesses thousands in legal fees and settlement costs that could be passed on to customers.

More than three dozen Central Florida businesses have recently been hit with almost identical lawsuits filed by attorney Joe Quick. Quick represents the same four clients, often referred to as “testers” by some critics, in each lawsuit filed in the U.S. District Court for the Middle District of Florida.

Last legislative session, State Rep. Tom Leek introduced and passed legislation that allows business owners to hire ADA experts to inspect their businesses. Businesses are able to apply for a grace period to fix violations, but so far, only two businesses in the state have done so. Click here for more information on the Florida Department of Business and Professional Regulation’s ADA Title III Registry.

Click here for the full article.

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Filed under ADA, FL Legislation, Florida, Lawsuits