Filed Under:Claims, Claims Technology

A Solution to PIP Fraud in Florida

The Answer Lies Not in the Legislature, But in the Streets and Courts

PIP fraud has a lot of people complaining but not enough of them doing anything about it. Slick plaintiff lawyers and so-called consumer groups have so demonized auto insurance companies that it has become difficult to convince voters and legislators that action is needed now.

The advertising and public relations assault has hidden the truth about PIP fraud in Florida:

  • Tampa Bay, Orlando, and South Florida are among the worst markets in the nation for staged accidents and PIP fraud.
  • The fraud tax was $50 per driver last year. For United Auto Insurance Co. customers in Miami-Dade County, the figure is closer to $500 because non-standard drivers bear the brunt of fraud costs.
  • Insurance companies settled almost 20,000 PIP-related lawsuits in 2010 and had another 10,000 pending at year-end. Each of those figures totaled 5,000 or less in 2007.
  • Since 2004, the average claim paid out for PIP claims has gone up 22 percent.
  • Florida drivers pay higher premiums than those in other states, about $1,055 annually here versus $789 nationally. Remove the large rural areas of the state from the equation, and Florida is probably the most expensive state in the country.

Sadly, the Florida Legislature did nothing to address PIP fraud in the 2011 session. Representatives and senators went before the media to declare that PIP and accident fraud were major issues and that they were committed to eliminating abuses. Yet for all their talk, they passed none of the legislation important to the Florida insurance industry. Most bills died in committee, and the few that made it to the floor were either watered down or voted down.

Trial lawyers, doctors, chiropractors, medical clinics, and others who benefit the most from PIP locked arms to blockade every reform that would hurt their pocketbooks. Rather than acknowledge there is a fraud problem and work honorably toward a solution, they lobbied against all bills.

Trying Again in 2012
PIP legislation will be introduced in  2012 by Rep. Jim Boyd, R-Bradenton, and Rep. Mike Horner, R-Kissimmee. Their bill provides, among other things, that insurers have the right to conduct reasonable investigations, revise discovery provisions, and deny payment to claimants who violate certain provisions. This is a good bill but must be revised to include attorney fee reform if it is to have any hope of curbing PIP fraud.

Sen. Gwen Margolis, D-Miami, has filed a bill that would require medical or lawyer referral services to conform to The Florida Bar rules regarding advertising and solicitations. Clearly, that racket has gotten out of hand. The company behind the 411-PAIN campaign spends upwards of $10 million annually on advertising.

In the Margolis bill, The Florida Bar would review and possibly prohibit the television ads and billboards that drive accident victims to a toll-free number that routes the calls to lawyers’ offices. The measure would close a loophole that currently enables lawyers to get around Bar rules by using a middleman to chase potential clients. The law would also stop a medical referral service from sending patients only to clinics in which the service has a financial stake.

Will the measures pass? I’m not optimistic. The same lobbying forces that shot down every meaningful attempt to clean up PIP fraud will fight those bills and any others that threaten their livelihood. And they will probably succeed again even though the public, the media and local governments are squarely in favor of reform.

Even if a bill regulating lawyer-marketing companies passed both chambers and was signed into law, it would face a severe and probably successful First Amendment test from well-heeled companies and their attorneys. Given a federal court ruling in October that stripped The Florida Bar of some of its control over lawyer advertising, the outlook is not promising.

A Different Solution
I see a different solution to PIP fraud, one that depends less on legislators and more on the insurance industry and consumers. As insurers, we need to direct our time and money to cleaning up the streets and the courts.

In his first nine months in office, CFO Jeff Atwater has done more to fight PIP and accident fraud than any of his recent predecessors. In May, Atwater said, “I am committed to cracking down on PIP fraud, putting these thieves behind bars and finding new ways to combat this pervasive crime.”

He has backed up those words with actions. Under his direction, state law enforcement has conducted raids and crackdowns across the state. Atwater also has worked with local law enforcement officers and private investigators to find and arrest those who stage accidents and then file phony medical claims.

The CFO is not alone. Law enforcement officials in hard-hit counties have formed task forces and assigned undercover officers to break up criminal rings. Local police officers have taken the time to educate the public on how to spot and report accident and PIP fraud.

The good news: The efforts are working. Accident organizers are being chased out of hotspots such as Hillsborough County; clinics are being shut down.

To effect change, insurance companies and their customers should support efforts to increase public funding (no, not raise taxes) for state and local investigators. The more detectives we have on the job, the sooner we can drive criminal rings and shady medical center operators out of the state. That’s a first step.

Second, we need to close local loopholes on medical clinics. The Hillsborough County Board of Commissioners led the way in September when it tightened regulations on medical clinics that primarily treat people involved in automobile accidents and earn the majority of their income through PIP claims. The same rules should be adopted in Florida’s other 66 counties.

Third, we need to hold the courts accountable. There are enough laws currently on the books to put a noticeable dent in PIP fraud; the issue now is enforcement of the rules when a lawsuit is filed in county court.

Fix the Fees
Most important, we have to fix the fee system. State Farm paid $8,000 on one claim to the plaintiff and $550,000 in fees to the plaintiff’s attorney. I am sure that every insurer in the state has a similar horror story.

Through our investigation of court records, we found attorneys who were collecting more than $500 an hour to file and litigate PIP lawsuits. Forget fair. Is that figure reasonable? No, but county courts routinely approve outrageous billable hours and rates, even if they bear no relation to the magnitude of the case.

Only in a PIP lawsuit will a plaintiff attorney send an insurer 20 written discovery requests that bear no relation to the case or defenses raised, and demand depositions on top of it. Why?  Because the lawyer knows that the paperwork and hours of meaningless interviews will boost his fees.

Florida had a big problem with workers’ compensation cases until the amounts paid to attorneys were reduced. Within a few years, the number of lawsuits filed dropped dramatically and premiums went down.

Why? Lawyers who advertised, “Were you injured on the job?” could no longer command outrageously high fees for their very ordinary services. As a result, workers’ compensation insurance premiums dropped and those obnoxious ads disappeared from television and billboards.

Florida can learn from that lesson and the fee schedule instituted in New York, where auto accident-related lawsuits have also been a problem. The system no longer allows attorneys to take home big paychecks for routine PIP work. Our state also should adopt a fee schedule that is either a flat fee or a percentage figure in cases where the claims are minimal.

PIP fraud is a cancer in our industry. While we can never cure the problem, we can treat it in such an aggressive fashion that we drive it into remission and make Florida a better place to do business and, not so coincidentally, a better place to be a driver.

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