Tag Archives: GEICO

Third DCA Rules for Insurer in GEICO v. Gables Insurance Recovery

In an opinion issued December 10, 2014 in the case of GEICO v. Gables Insurance Recovery (a/a/o Rita M. Lauzan), the Third District Court of Appeal quashed a Circuit Court Appellate Division’s decision affirming final judgment in favor of Gables Insurance.

Lauzan, who was insured by GEICO, was injured in an automobile accident in 2008. After obtaining medical treatment, she assigned her GEICO policy benefits to All X-Ray Diagnostic Services, which subsequently assigned the benefits to Gables Insurance.

GEICO paid less than the amount it had been billed, and Gables Insurance filed a breach of contract action against GEICO. GEICO argued that Lauzan’s $10,000 PIP benefits had been exhausted and that it therefore had no further liability to Gables.

Deciding in GEICO’s favor, the Third District Court of Appeal held that the PIP statute does not require an insurer to pay more than the $10,000 limit in PIP coverage. Further, it does not require an insurer to “set aside” funds in anticipation of litigation. The Court noted that two other District Courts of Appeal have addressed the issue, holding that a showing of bad faith or impropriety on the part of the insurer is required before it can be held liable for benefits above the statutory limit.

Quoting a recent Fourth District Court of Appeal case, Northwoods v. State Farm, the Court concluded that once PIP benefits are exhausted, “an insurer has no further liability on unresolved, pending claims, absent bad faith in the handling of the claim by the insurance company.”

The case is GEICO Indemnity Co. v. Gables Insurance Recovery (a/a/o Rita M. Lauzan), Case No. 3D13-2264 (Fla. 3rd DCA, December 10, 2014). Click on the link to read the court opinion.

The case cited is Northwoods Sports Medicine v. State Farm, 137 So. 3d 1049 (Fla. 4th DCA 2014).

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Broward Staged Accident Results in Five PIP Fraud Arrests

Five individuals were recently arrested for their involvement in an alleged staged accident that took place in Broward in July 2012, according to an announcement by Florida Chief Financial Officer Jeff Atwater.

The five, who were arrested on grand theft and insurance fraud charges, carried out the alleged scam which resulted in fraudulent Personal Injury Protection (PIP) claims costing almost $40,000. Officials say a sixth individual is associated with the crime as well but has yet to be apprehended.

Investigators with the Department of Financial Services’ Division of Insurance Fraud (DIF) said that the five participated in the alleged crash as vehicle passengers. Shortly after the accident, they sought medical treatment at several South Florida clinics for bogus injuries. GEICO, Ocean Harbor and Gainsco insurance companies received fraudulent PIP claims as a result of the scam.

Those arrested include: Alfredo Romero, 66, of Hollywood; Alice Martinez, 27, of Pembroke Pines; and Jose Rodas, 33, Whitney Lopez, 25, and Mirna Madrid, 37, all of Fort Lauderdale. Alfredo Romero was also arrested in July 2014 for his role in another Broward County staged accident.

The cases will be prosecuted by the Broward State Attorney’s Office.

Mario Ruiz, 32, of Fort Lauderdale is the sixth individual currently wanted in connection with this crime. Anyone with information regarding his whereabouts is asked to contact DIF at 1-800-378-0445 or the Broward County Sheriff’s Office. Citizens may remain anonymous.

The Department of Financial Services to date has awarded almost $349,000 to nearly 60 citizens as part of its Anti-Fraud Reward Program. The program rewards individuals up to $25,000 for information that directly leads to an arrest and conviction in an insurance fraud scheme.

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Hollywood Couple Arrested for Filing a Fraudulent Stolen Vehicle Insurance Claim

Miguel and Francheska Quintero were recently arrested when it was found they allegedly arranged to have their vehicle removed from their home while they were away, in order to report it missing and subsequently make an insurance claim on the supposed stolen vehicle.

CFO Jeff Atwater announced the arrest of the Hollywood couple after an investigation by the Department of Financial Services’ Division on Insurance Fraud uncovered the plot.

On the day of the alleged theft, reports show that Miguel Quintero told Hollywood police that his 2011 Chevrolet Tahoe was locked and parked outside his home before it was stolen. The following day, Francheska Quintero filed a stolen vehicle report with GEICO insurance.

However, Quintero’s neighbor made a statement disclosing that he called Quintero on the phone to alert him about ‘two men’ who were attempting to start the Tahoe on the day of the theft.  According to the neighbor, Quintero told him that he was aware of the activity and tried to dissuade him from calling police by saying, “you don’t know anything about this.” The neighbor confirmed that he saw the two men successfully jumpstart the vehicle and drive it away.

Prior to Quintero filing the police report, a Doral police officer noted an abandoned vehicle parked off the road, and later research revealed that the vehicle was owned by Quintero.

At the time of the theft last July, the couple supposedly owed $35,173 on the vehicle loan and was three months behind on car payments.

Francheska and Miguel Quintero were arrested and transported to the Broward County Jail.

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Woman Busted for Insurance Fraud After Collecting Claim Money on a Stolen Car that She Pawned

A Greenacres woman was arrested for insurance fraud involving her car that she reported stolen in 2012.

Palm Beach County court records show that Lindela Edmonds faces charges of insurance fraud and making a false report of a non-existent crime.  She was arrested on January 15.

According to West Palm Beach police, the 44-year old Edmonds pawned her 2007 Toyota Camry at the pawn shop, Queen of Pawns, on February 17, 2012 and received $5,500 for the transaction. The next day, she went to the police and reported her car stolen from a parking lot in the 3100 block of N. Jog Road.

After filing the police report, she filed a loss of vehicle claim with GEICO and collected $12,326 from the insurance company.  But that isn’t the end of the story.

The Queen of Pawns wanted to sell the car because Edmonds had not returned for it a year later.  It was then that police discovered the vehicle was listed as stolen. The pawn transaction receipt is dated the day before Edmonds reported her car stolen, along with a copy of her driver’s license and thumb print.

In addition, the notarized insurance claim is signed by Edmonds. Ironically, her signature appears beneath a warning: “anybody who knowingly defrauds an insurer by using false information is guilty of a felony in the third degree,” the Sun-Sentinel reported.

Edmonds was booked at the Palm Beach County Jail on January 16 and released on $3,000 bond.

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