Understanding the future of insurance in a world of autonomous vehicles is highly relevant for insurance carriers today. Auto insurance, like cyber insurance and new parametric products, will impact traditional lines of business with the rise of autonomous vehicle technology. Most carrier executives point to it as the industry’s key prospective destabilizer.
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Filed under Technology
Kissimmee elementary school teacher, Lanfranco Palman, is facing three felony charges for allegedly faking being hit by a car to defraud his insurance company. The staged accident occurred at a grocery store in 2016 where Palman claimed he was hit by a vehicle, but witnesses say he fell onto the hood after the car had stopped.
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Filed under Fraud
The Insurance Institute for Highway Safety (IIHS) has confirmed Tesla’s claim that its Autopilot and active safety features result in ‘fewer physical damage, injury liability claims.’ However, IIHS also found that the introduction of these features could increase other kinds of claims.
The combined driver assistance features on the 2014–16 Model S lowered the frequency of claims filed under property damage liability (PDL) and bodily injury (BI) liability coverage with the 2012–14 Model S without the technology. However, IIHS didn’t find that they lowered the frequency of collision claims. They also saw increases in MedPay and PIP claims.
Highway Loss Data Institute’s senior vice president, Matt Moore, admits that they would need more data to really understand the effect of Autopilot.
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Filed under Personal Injury Protection (PIP)
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 Fraud, Personal Injury Protection (PIP)
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 Uncategorized
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.
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Filed under Uncategorized
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.
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Filed under Legislation, Personal Injury Protection (PIP)
A new opinion was recently released by the Florida 9th Circuit Court in its appellate capacity interpreting Fla. Stat. § 627.736(6)(g) and the timely scheduling of Examinations Under Oath (EUOs). This case reaffirms that as a general rule, an insurer ought to schedule the initial EUO in any claim under investigation to occur within 30 days of receipt of the first bill to ensure that the investigation is being conducted well within the time limits set forth in the PIP statute without obliging the insurer to issue a payment of the subject bill prior to investigation.
In Geico Indemnity Co. v. Central Florida Chiropractic Care a/a/o David Cherry (2016-CV-000038-A-O), Central Florida Chiropractic sued Geico for breach of contract for failure to pay overdue PIP benefits. Geico asserted as an affirmative defense that coverage was appropriately denied because the assignor failed to appear for two EUOs.
Central Florida Chiropractic contested Geico’s above-described defense because the EUOs were scheduled to occur more than 30 days after the date on which Central Florida Chiropractic had submitted the bills for the alleged charges at issue and, thus, the EUOs were unreasonably set to occur beyond the 30-day statutory period for payment of said bills. In fact, the Court noted, the first EUO request was not even sent until after 30 days had lapsed. Further, Geico had not informed the claimant pursuant to Fla. Stat. § 627.736(4)(i) that his claim was pending investigation.
The 9th Circuit ruled that even though attendance at an EUO is a condition precedent to receiving PIP benefits under Fla. Stat. § 627.736(6)(g), this provision “cannot be read in a vacuum.” The Court specifically looked to section (4)(b), which requires provider bills to be processed within 30 days of receipt, and to section (4)(i), which states that the claimant should be notified in writing within 30 days of filing the claim that an investigation is under way. Geico argued that section (4)(i) permits a 60-day extension of time for investigation beyond 30 days, but the Court pointed out that Geico failed to send any letter notifying the claimant of the investigation in this case, so the 30-day window was not extended.
The Court also explained that timely payment of the provider bills does not foreclose the insurer from investigating the claim. Nonetheless, “nothing in the statute additionally excuses the insurer’s potential breach for failure to pay a PIP claim within 30 days as contemplated by section 627.736(4)(b).”
Therefore, Geico could not enforce the EUO as condition precedent to receiving PIP benefits because by the time it had scheduled the EUOs, it was already in breach of the policy as the provider’s bills were not timely paid within 30 days. “[B]ecause Geico was already in breach of the insurance contract before the EUOs were scheduled to take place, [the assignor] was not obliged to submit to them.”
The Geico case is the latest in a long line of opinions and trial court orders, starting with Amador v. United Auto. Ins. Co., 748 So. 2d 307 (Fla. 3d DCA 1999), which holds that an EUO does not toll or extend the 30-day period within which an insurer must pay otherwise timely, compensable charges pursuant to Fla. Stat. § 627.736(4)(b). Courts have also ruled that the insurer does not comply with the 30-day requirement if it coordinates the EUO within 30 days, but the EUO is nonetheless scheduled to occur beyond the 30-day window. (See Micro-Diagnostics & South Florida Inst. of Medicina a/a/o Luz Solarte v. United Auto. Ins. Co., 12 Fla. L. Weekly Supp. 248a (Fla. 11th Cir. Ct. App. 2004). In general, an insurer cannot defend claims on the basis of a claimant’s failure to attend an EUO if said EUO is scheduled to occur outside the 30-day period after submission of the medical bills. (See Humanitary Health Care, Inc. a/a/o Juan Esquivel v. United Auto. Ins. Co., 12 Fla. L. Weekly Supp. 531b (Fla. 11th Cir. Ct. 2005).
However, a Miami-Dade appellate court did find that an insurer may still benefit from the claimant’s failure to appear for an EUO if said EUO is initially scheduled to occur within 30 days, but then rescheduled for a later date at the claimant’s request. (See West Dixie Rehab. & Medical Ctr. v. State Farm Fire & Casualty Co., 10 Fla. L. Weekly Supp. 16a (Fla. 11th Cir. Ct. App. 2002)).
The above cases make clear that any communications regarding the re-scheduling of an EUO ought to be done in writing, with language that clearly communicates that the change in date was done to accommodate the request of the insured or insured’s attorney. When appropriate, the insurer may send a letter to the claimant or claimant’s attorney pursuant to section (4)(i) advising that a claim is under investigation within 30 days of the claim filing. This will extend the time period within which an investigation may be conducted up to 90days after the submission of the claim, and thus allows additional time before any provider bills must be processed.
If you have any questions or would like to discuss this issue in greater detail, please feel free to contact 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 7 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.
Filed under Legislation, Personal Injury Protection (PIP)
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.php73-37.phx1-1.websitetestlink.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.
Filed under Legislation
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.
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Filed under Uncategorized
