Florida PIP; One Newspaper Call For Repairs - Not Replacement.

The Orlando Sentinel weighs in on the upcoming battle that will surely pit the big business auto insurers against your local doctor and, if you drive a car, against you.

Pointing out that if you "Remove the PIP requirement, motorists will pay substantially more for their health insurance, which increasingly would cover auto injuries. More deadbeats also will drive without insurance, forcing others to pay for their care after accidents".

The Orlando Sentinel is calling for repairs of the PIP system, not replacing the system with something else. "Where it looks like you'll save on auto insurance, you'll end up paying more for health insurance", points out the newspaper.

The auto insurers also would love to replace a diminished personal injury protection (PIP) system with one mandating more expensive — and more profitable — bodily-injury protection.  Let's remember, this is big business and it's all about big profits.  Under the current system, last year (2010) State Farm's profits surpassed the billion dollar mark, up from $900 million in 2009.

So, with profits so high why all the complaints? Well, quite frankly it's a chance to change the rules of the game to favor big insurance even greater than they do now.

The Orlando Sentinel has it right, don't scrap the current PIP program, rather have our legislators roll up their sleeves and fix what's broken in the current system.  And, quite frankly it's not much. No matter what business, industry or profession, you will find a few bad apples.  But to throw out an entire basket of good apples because there are a few bad ones seems like a waste of a lot of good apples.  It's time for our legislature to pick out the bad apples and find out how they got there, then fix that part of the system.

If you had one bad employee would you close your business? or would you retrain or even re-hire a new one?

For more on the Orlando Sentenal's sentiments, click here for their entire article.

FPIB

PIP Benefits Cannot Be Denied If Patient Doesn't Show for IME or EUO-Florida Supreme Court Denies United Auto Rehearing

Tuesday, May 24, 2011

Florida Supreme Court Denies Rehearing of its Opinion in Custer Medical Center v. UAIC - United Automobile Insurance Company

On May 18, 2011, the Supreme Court of Florida entered an order denying United Automobile Insurance Company's ("UAIC") motion for rehearing and request for oral argument in Custer Medical Center v. United Automobile Insurance Company, 2010 WL 4340809 (Fla. Nov. 4, 2010) (Case No. Sc08-2036). The Court contemporaneously entered additional orders relating to ancillary motions and amici briefs. One of the Court's orders struck all amici briefs filed in the case, including briefs filed by numerous industry trade associations, insurance companies, and even the NCIB. Other orders denied motions filed in the case which were rendered moot by the court's denial of UAIC's motion for rehearing.
The Custer opinion, issued on November 4, 2010, contained language ancillary to the case's holding, known as dicta, that frustrates the purpose of the anti-fraud provisions of the personal injury protection ("PIP") statutes. The dicta opined that:

• PIP policy provisions that do not directly mirror the PIP statutes may be unenforceable.

• Unless otherwise provided by statute, a PIP carrier may not deny payment of medical expenses incurred and submitted by the insured prior to the date of a scheduled independent medical exam ("IME"), even if an insured does not attend the IME.

• Unless otherwise provided by statute, a PIP carrier may only deny payment of an insured's medical expenses incurred and submitted after the date of the IME if the carrier can affirmatively prove the unreasonableness of an insured's failure to attend an IME. Thus, the burden of proving the unreasonableness of the insured's action/non-action rests with the insurer.

• Denial of benefits for an insured's failure to submit to an examination under oath without counsel ("EUO") may no longer be permissible, as the Court points out that EUOs are not expressly permitted under the PIP statutes.

Denial of UAIC's motion for rehearing cements the Custer decision into our lawbooks, creating uncertainty for PIP insurers in Florida. The full effects of the Supreme Court's decision today are yet to be determined, but the use of IMEs and EUOs may be significantly impaired due to litigation contesting the use of these fraud fighting tools.

PIP 'Reforms' Disguise Insurance Industry Profit Grab

Reprinted / reposted from: http://www.sunshinestatenews.com/story/pip-reforms-disguise-insurance-industry-profit-grab

 

 

Proposed legislation writes loopholes into the law to help insurers

Recently, I read a commentary on your site from yet another special-interest group funded by the powerful insurance industry, with a name that sounds as if they are looking out for the interests of Florida’s consumers.

Your readers need to understand, however, that these so-called “consumer groups” are part of the insurance industry’s public relations engine, which is using the seemingly admirable mantra of reducing PIP fraud to disguise their real intentions of making it easier to delay or deny payments on legitimate PIP claims.

The statistics that often are cited are misleading at best. Let’s be clear: PIP fraud is wrong and must be stopped; but Florida consumers are being blatantly misled by these various consumer groups proclaiming that PIP fraud is rampant and is costing all Floridians significantly in what they pay for PIP.
Insurance companies are continuing to earn record profits, and they are continuing to look for ways to reduce what they pay for legitimate PIP claims. And, contrary to representations made by the various consumer groups, PIP premiums have not gone up in years. Clearly, there is no shortage of insurers fighting for your business – just take notice of all the advertisements and solicitations consumers see every day.

To fuel the uproar, consumer groups keep telling us that PIP fraud is rampant because “questionable claims” in Florida are on the rise. But, has anyone ever stopped to ask what a questionable claim really is?

The term most frequently used is in conjunction with data from the National Insurance Crime Bureau (NICB). As the NICB would confirm, questionable claims are simply initial claims referred to them from their member insurance companies based on what those companies believe to be "questionable" or "suspicious." Such claims are not yet determined to be definitive acts of fraud.

In addition, it is significant to point out that when the number of PIP questionable claims in Florida, according to a March 22 NICB report, is compared to the total number of crashes in Florida (as compiled by the Florida Department of Highway Safety and Motor Vehicles), PIP questionable claims represent less than 1 percent of all crashes (2009: NICB – 2,347 PIP QCs/FLHSMV – 235,778 crashes). And, it is important to keep in mind that data from the Florida Division of Insurance Fraud show that only 4 percent of all reported possible PIP fraud claims it receives (about 5,500) result in prosecution.

So, is PIP fraud really as rampant as insurance companies want all of us to believe? No, it is not.

Some provisions in the proposed PIP legislation have nothing to do with fighting fraud and will instead create a potentially unreasonable burden for medical providers and policyholders to get legitimate bills paid and could lead to fewer medical providers willing to treat PIP patients.

One outrageous provision in the proposed legislation would require medical providers and policyholders to submit to deposition-like questioning, examinations under oath, before claims will be paid. Another provision would allow an insurance company to deny a claim if there is a simple typographical error on a bill or in the policyholder’s medical records. And, the law would limit the amount of legal fees the insurance company would have to pay if it is determined to have wrongly denied a claim. How do any of these provisions stop PIP fraud? They don’t.

If the proposed legislation becomes law, many insurance companies will take advantage of loopholes that will be created in order to make it expensive, time-consuming and frustrating for medical providers to treat PIP patients. That is not fair to consumers. Legitimately fighting fraud must be the real target. Please do not fall for the insurance industry rhetoric.
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Cris Boyar is president of Floridians for Fair Insurance. FFI seeks to reform policies in Florida known as “bad faith” insurance laws and to protect Florida’s small-business owners and consumers from the threat of lawsuit abuse.

PIP fraud claims aren’t all they’re cracked up to be

From the Ft. Lauderdale Sun Sentinel

Uncategorized — posted by aaron deslatte on April, 7 2011 6:55 AM

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By Julie Patel, Sun Sentinel

Florida legislators are at work on laws, backed by major insurers and some consumer advocates, to combat what they say is “rampant” fraud by policyholders and health care providers filing PIP claims. The proposed legislation would, among other things, make it more difficult for people to file claims and for lawyers to collect huge fees.

Personal injury protection, or PIP, pays medical bills for policyholders injured in auto accidents, regardless of which driver is at fault. It’s intended to protect Floridians who don’t have health insurance and to avoid lawsuits and their costs for minor injuries. Florida drivers are required to carry $10,000 worth of coverage.

Lawmakers drafting legislation say there’s a “mountain of evidence” on PIP fraud, but most of the key data come from insurance industry groups, with some from the Department of Financial Service’s Division of Insurance Fraud.

Consider these points:

• The average payout for a personal injury protection claim increased over the past seven years — but not enough to keep up with the inflation rate for health care.
• The conviction rate for suspicious personal injury claims has dropped since mid-2007, even though the state beefed up its fight against fraud.
• Each Florida driver’s premiums were about $50 higher last year, the insurance industry says, to cover the cost of fraudulent claims, what insurers call the “fraud tax.”

 Keep reading.

Claims Of Personal Injury PIP Fraud Are Grossly Exaggerated

Brilliance in just a few words. As in all professions, those that commit fraud are an extreme minority.   They are the proverbial "squeaky  wheel" that gets the oil. That being said, the author of this article points out that PIP fraud accounts for less than 1% of all the insurance fraud relating to automobile accidents.  Yest companies like United Automobile & State Farm continue to pound the legislature with ridiculous claims that fraud is the industry standard rather than the exception to the rule. 

Let's not forget that with all the alleged growing fraud, State Farm still posted record profits of $800 Million in 2009 and $1.8 Billion in 2010.  Wow, who knew that fraud would increase their year to year profits so much ? I wonder how that happened. 

Anyway, here's a link to a fresh little article about the often hidden truths - Click here, read & enjoy

Proposed Florida Legislation Calls For "Fraud Tax"???

Here in Florida, a House subcommittee this morning approved a controversial bill that would limit fees for attorneys who sue insurance companies in disputes about so-called PIP claims...and here we go again.

Insurance companies cry foul when it comes to fraud because they say they are losing so much money due to fraudulent claims.  This year not only were they promoting their agenda regarding PIP fraud and staged accidents, but suddenly sink holes too. 

Please realize that an insurance company is a business like any other. So they try to wield their political influence in such a manor as to gain any business advantage in their market. Remember, they are in business to make a profit. And, there's nothing wrong with that. But when you run a company like State Farm and constantly tell people you're losing money to fraud when in 2009 you made a paltry $800,000,000.00 profit (yes, that's 800 million) and then in 2010 you increase your profits to $1,800,000,000.00 profit (that's 1.8 Billion in profit)...yet you continue to cry to your legislatures that fraud is continuing to harm your business, who do you think you're fooling?


No doubt that fraud should be stopped for no other reason than it's fraud and it's wrong. But if the stated statistics are true, then it seem that with the increase in fraud comes an increase in insurance company profits. I'm not sure how that works, but it seems to be the case.

But with all of the efforts that have taken place, one of the biggest reasons for a change in legislation is because fraud costs the consumers just way too much money...AND it's taking money out of the consumer's pockets. Yet, with all the legislation, with all the hoopla, with all the incredible profits posted by these insurance companies, I have yet to see one of them lower their premiums.  None!

When do the consumers get to save money? How much does someone like State Farm or the others have to profit by to get them to stop raising rates?  Maybe $1.9 Billion and we get a discount?  Excuse me but I won't hold my breath.

The real fraud is that this is a game to the insurance companies. They cry fraud, they get their PR companies to get article after article in the newspapers and stories on TV all to justify their raising your rates...  Good luck to them, let's see if you can make a $2-Billion Dollar profit in 2011. 

Seems like in a down economy, being an insurance company would have been the best bet.  People pay you for insurance and you get to deny their claims until an attorney calls you on it. Now, they want to limit an attorney's ability to protect the rights of citizens. Assuring their ability to increase their profits and rake you over the coals on their way to the bank to deposit their profits.

Here's the link to the original story... Enjoy

http://www.healthnewsflorida.org/top_story/read/state_officials_target_fraud_tax

State Farm Profits Double in 2010; Yet Says Losing Money Due To Fraud

Each year insurance companies for whatever section of the insurance market cry foul when it comes to fraud. They wine & dine our legislators, contribute large amounts of money to their re-election campaigns, give donations to they favorite charities all to get them to introduce legislation to curtail "fraud".  Yet, time and time again, it seems as if the insurance companies continue to win big with their profits. 

According to ChicagoBusiness.com, & The Chicago Tribune; State Farm has doubled its profits last year.  They hide these facts yet throw up smoke screens of fraud and every turn.  Why? Because it enables them to justify raising your rates for insurance.   For details, click here to read the full story.

Just remember, there's a difference between losing money and not making as much profit. And as we now see, in spite of alleged fraud claims, State Farm (and I'm sure others) are profiting nicely.  Especially in an economic environment where half of their policy holders are probably having difficulty paying their premiums, holding a job and keeping a roof over their families head.

I hope someone in the state legislature sees this before trying to introduce more crazy legislation to stem insurance fraud that is but a minor blip on the screen.  You see last year, State Farm only made $800 million profit.  This year, State Farm made $1.8 BILLION in profit.

You think now maybe you can pay my doctor and fix that dent in my car?