Memo Seeking to Correct Florida PIP Eligibility Gap Issued

124811_medical_series_3%20sxchu.jpgThe Florida Agency for Health Care Administration recently issued a three-page memorandum that was designed to eliminate a flaw in House Bill 119, the state’s new personal injury protection (PIP) law that was signed by the Governor in early May. As written, the law created a six-month eligibility gap beginning July 1st for health care providers such as doctors, dentists, and chiropractors. Although eligibility would have automatically been restored on January 1, 2013, insurance companies could arguably have refused to pay health care professionals who treated accident victims as part of the PIP insurance program in the interim.

PIP insurance was adopted in Florida in 1972. During the recent legislative session, Governor Rick Scott lobbied for changes to the law which requires Florida vehicle owners to carry $10,000 in mandatory no-fault accident injury insurance. Proponents of the new law say the changes are aimed at combating staged accident fraud. The law now includes tightened restrictions regarding who constitutes a medical provider, requires the name of all passengers involved in an accident to be noted by police officers, and creates a 14-day medical treatment window following an accident. Insurers are also required to lower the cost of premiums so long as certain specified criteria are met.

Critics of the new law believe it does more for insurance companies than consumers. Bill Newton, Executive Director at the Consumer Action Network, said recent changes to the PIP law will result in more limited services without the benefit of lowered insurance premiums. He also stated the law has shifted the burden of injury accidents onto the victims.

It is currently unclear whether the Agency’s memo is sufficient to eliminate the purported eligibility gap. According to Mark Seidenfeld, a Florida State University administrative law expert, the document may be useful to influence a court regarding the intent of the law, but whether it would have an actual impact on a court’s decision following a challenge is not apparent. Seidenfeld believes it is only a matter of time before someone challenges the state’s new PIP law based on either the eligibility gap or the constitutionality of the measure.

If you were hurt in an auto collision, it is a good idea to consult with a skilled Florida car accident lawyer as soon as possible. You may be eligible to receive compensation for medical bills, suffering, pain, disability, lost wages, lost earning capacity, and loss of enjoyment of life. A knowledgeable car accident attorney can explain your options and help you preserve your rights under Florida law.
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Florida Lawmakers Reform Personal Injury Protection Insurance

1334532_ambulance.jpgLast week, the Florida Legislature passed reforms to the state’s mandatory no-fault personal injury protection (PIP) insurance requirement. House Bill 119 was passed after a 22-17 vote in the Senate just prior to midnight and immediately before state lawmakers adjourned. The reforms are designed to rein in insurance prices by making it more difficult for individuals to commit fraud or abuse PIP insurance.

PIP was adopted in Florida in 1972. The law allows those injured in a motor vehicle accident to receive up to $10,000 for medical expenses and lost earnings regardless of fault. The costs associated with PIP insurance have purportedly increased by approximately $1.4 billion over the last four years. Some believe the increase is due in large part to fraud and staged accidents. The State of Florida reportedly has the most staged accidents nationwide, and the problem is particularly pronounced in the Tampa and Miami metropolitan areas.

The measure passed by lawmakers requires anyone who is injured in a Florida car accident to seek treatment within 14 days from a hospital, ambulance, physician, dentist, or chiropractor. An accident victim will only be allowed to receive the full PIP insurance benefit of $10,000 if a treating medical provider determines he or she suffers from an emergency medical condition. If not, the victim’s PIP benefit will be limited to $2,500. Additionally, the new law requires an accident victim to receive a referral from a health care provider prior to obtaining any follow-up medical services and eliminates payment for massage or acupuncture treatment.

The new law almost didn’t make it to a vote. Florida Senators narrowly accepted House changes to the measure by a 21-19 vote. According to Senator Joe Negron, who sponsored a similar bill in the Senate and negotiated the compromise legislation, the new law will have a large impact on PIP insurance fraud. Senate President Mike Haridopolos admitted to collecting on IOUs in order to get the legislation approved.

Governor Rick Scott was in favor of the legislation, but some Florida lawmakers believe the new law will only serve to create larger profits for insurance companies. Although the initial bill would have guaranteed a PIP rate reduction of 25 percent, the bill that was passed only requires a 10 percent rate reduction with no guarantees. If insurance companies fail to reduce PIP rates by 10 percent, they must provide a detailed explanation regarding why the reduction was impossible. If PIP rates are not reduced by 25 percent by January 1, 2014, another explanation is required.

Representative Scott Randolph of Orlando expressed concern regarding whether lawmakers should take insurance companies at their word. A spokesperson for the Florida Consumer Action Network, Bill Newton, doesn’t believe the legislation will have an impact on PIP insurance fraud. Senator Miguel Diaz de la Portilla of Miami also expressed his concerns over the new measure and stated insurance companies were already in control the PIP formula.
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What You should Know about Auto Insurance Fraud in Florida


Florida’s recent legislative session was filled with victories and losses for both parties. Surprisingly, one issue that is costing Floridians every year received little reform.

Auto insurance fraud has risen dramatically in Florida and has driven up costs associated with auto accidents for policyholders around the country. A recent article by Fox Business noted that Florida is the leader in staged accidents. The article discussed some of the negative impacts of Florida’s no-fault insurance system – a system utilized by 11 other states and Puerto Rico – which, as the article contends, has created a pool of funds that offenders exploit by staging accidents and utilizing crooked medical professionals to operate clinics that file false claims. Consequently, over 2,700 Florida claims were referred to the National Insurance Crime Bureau last year and it is estimated that insurance fraud costs Florida about $1 billion a year.

In light of these problems, lawmakers made efforts to tackle the issue. In April, the Miami Herald highlighted two bills, SB 1930 and SB 1694, aimed at combatting insurance fraud. SB 1930 would provide insurance carriers 90 days to investigate a claim before making payment medical payments (as opposed to Florida’s 30-day requirement) and SB 1694 attempted to limit fees for attorneys in PIP lawsuits. Critics feared that the bills would discourage injured parties with legitimate claims. Ultimately, the bills died in the judiciary.

Whether we see reform or stricter enforcement in the future, the numbers don’t lie: everyone pays for auto insurance fraud. As attorneys, we believe that it is our responsibility to protect the rights of auto accident victims and to represent their interests in a moral and ethical manner.

Florida Residents Get a Break from Fed on Insurance Premium Hikes


A federal award of $1 million will help the state of Florida fight unreasonable insurance premium hikes, officials announced today. The Department of Health and Human Services, along with the Affordable Care Act, is providing the funding so that Florida can review insurance rate hikes before they are enacted to ensure their fairness.

Further, the state intends to use the money to take action against companies who gouge policyholders and/or unreasonably deny their legitimate claims. The award is designed to fund a review process of insurance companies that will require them to provide more information about their individual and small group health insurance plants before approving a rate increase.

Basically, the funding will give the state the power to call into question arbitrary rate hikes, hopefully preventing them across the board. Additionally, the money gives the state the ability to seek legislative authority in 2011 to really crack down on companies who are just out to make a buck.

Another key component of the award is that it will add transparency by creating a search tool on the state website that allows visitors to see rate increases easily. HHS Secretary Kathleen Sebelius estimates that this will help drop premium costs 14 to 20 percent by 2014 by spurring competition and creating better risk pooling.

If you’re being denied coverage or aren’t getting the amount of money you should from an insurance company, call an attorney today. You have rights and should not have to suffer at the hands of a big insurance company.

Insurance Fraud Suspected in Intentional Accidents in Florida

According to Bloomberg News (June 28, 2010), insurance fraud in Florida has reached new levels as more and more policyholders are intentionally causing auto accidents to generate medical claims. The National Insurance Crime Bureau reports that “staged” accidents in the state of Florida climbed 58 percent to nearly 2,000 in 2009. Tampa is one of the cities where many reports of fraud have been filed recently, with the number of intentional accidents quadrupling in this city alone last year.

Throughout the state, insurance companies are taking a hard look at crashes that may show signs of fraud. In addition to pursuing drivers, a conglomerate insurance board called U.S. Car Insurers is also on the lookout for doctors who engage in these schemes and who are suspected of medical claim fraud. According to the USCI, auto insurance fraud for coverage of bodily injury totaled between $4.8 billion and $6.8 billion in 2007, and they are looking to reduce that amount drastically by cracking down on guilty parties. In the process, some people who have legitimate claims are being refused adequate coverage or are being made to jump through hoops just to receive compensation for their injuries.

Experts believe the economic hard times since 2007 may be to blame for the recent surge in deliberate car accidents in Florida. The insurance industry is now looking to raise insurance rates across the board in order to cover the costs of fraud. In addition, other drivers on the road have to be extra cautious of people willing to cause accidents to receive payments for medical care they don’t need.

If you have been injured in an auto accident in Fort Lauderdale, Miami, Orlando or any other Florida community, it is vital that you contact a reliable auto accident attorney to fight for your case. A lawyer can help you defend your rights against an insurance company or another driver who isn’t willing to pay what you’re owed.

The Law offices of Lazarus and Lazarus, P.A. frowns upon fraud of any kind, especially insurance fraud, which makes it more difficult for our clients who have legitmate claims. If you know of anyone engaging in Insurance fraud, please contact the Florida Dept. Of Law Enforcement immediately.

Medical Malpractice and Uninsured Florida Doctors

Were you aware that pursuant to Florida law doctors are allowed to treat patients in our state without any insurance coverage? Not only are they allowed to do so but they have been allowed to go without malpractice coverage for decades. As a result, the following percentage of doctors opt out of medical malpractice coverage:

• 1/4 of the doctors in Broward and Palm Beach Counties;
• 1/3 of the doctors in Miami; and
• 1/8 of the doctors statewide.

Florida law states that doctors can go uninsured if they post signs in their offices and promise to pay up to $250,000 per malpractice award, with a maximum of $750,000 per year. Their penalty for not paying pursuant to statute is revocation of their medical license.

Ultimately, the victim’s desire is twofold; to ensure that what happened to them doesn’t happen to someone else in the future and to be compensated for the severe injuries that they have sustained at the hands of a doctor who rendered care that substantially deviated from the professional standards. Although revocation of the at fault doctor’s license is a remedy that is warranted in some instances; the amount of compensation mandated by the Florida legislature doesn’t begin to cover the damages of a catastrophic injury caused by medical malpractice.

This practice has left patients with valid malpractice claims unable to retain counsel to represent them in claims against these uninsured doctors and obtain financial compensation for their injuries. As a result, malpractice victims are less likely to sue doctors who don’t carry insurance and are paying the highest price of all…loss of their health, loss of their ability to earn a living, loss of their quality of life…all due to the malpractice of a doctor who is uninsured.

It’s amazing to believe, but despite the fact that medical doctors are allowed to practice without insurance coverage, Florida does require the following medical professions to obtain malpractice insurance: chiropractors, podiatrists, midwives, some nurses, acupuncturists and optometrists. Where is the logic in this?

South Florida Citizens To Be Charged Fees For Automobile Accidents

In a misguided attempt to find other sources of revenue, cities throughout South Florida are actually considering charging a fee to those citizens who are involved in auto accidents within their city limits. This month, the town of Davie will likely vote whether to bill non-residents who are involved in automobile accidents in their city.

The Florida Sun Sentinel reports that Davie is defending the fee as “a way of recouping tax dollars that are spent on non-residents”, town spokesman Braulio Rosa said. Davie is considering an average charge of $840.00. Miramar, Plantation and Southwest Ranches are still undecided as to what to charge, if anything, and under what circumstances.

There are those that are worried that this will start a fee war between the cities. The city of Weston has already threatened to respond by passing a similar ordinance if their residents are charged. The American Civil Liberties Union may challenge these ordinances on constitutional grounds. Brandon Herslan, a spokesman for the ACLU of Florida, stated that by singling out non-residents, proposals being considered in Davie and Miramar “raise questions about equal and fair treatment of citizens” and could spur lawsuits.

The cities are responding by saying they will bill the driver’s insurance companies. Michael Connolly, a spokesman for State Farm Insurance, the state’s largest private insurer, responded by saying automobile insurance premiums will rise.

This issue represents a microcosm of the problems that have been caused by the cuts in our state’s budget. These cuts have left local governments in a desperate search to make up the lost funds that they were once receiving from the state. Compounding this problem is the decrease in the local tax base caused by the pop of the real estate bubble and the significant increase in foreclosures.

However, by creating these quasi tax schemes, the citizens of all cities are the ones that are harmed. With the state and national economy causing widespread problems for everyone, it is time for the cities to slash even more fat out of their budgets.

Cities should retain independent companies to analyze their budgets and recommend reasonable cuts that will force the cities to operate more efficiently. Disparate tax schemes, like the one discussed in this article, are not the answer and may in fact be unconstitutional depending on how they are framed.

South Florida Hit and Run and Drunk Drivers

Within the past few weeks the police in the Fort Lauderale area have been investigating two instances of pedestrians being injured in vehicular accidents. In the first instance, law enforcement is attempting to locate a car that a surveillance camera caught hitting a pedestrian, Marshall Clinton, 51,and then driving away. The crash happened about 11 p.m. Friday, May 23, 2008 as Mr. Chilton crossed the street. Marshall Chilton, 51, was admitted in the hospital with broken bones and is expected to recover.

In a second incident in Fort Lauderdale, a man is accused of killing a woman, Ms.Kathleen Gosnell, 60, and injuring Mr. Raymond Haruben, 63, after striking them with his vehicle on Thursday, May 22, 2008. Toxicology reports confirmed that he was Driving Under the Influence of Alcohol (DUI). Steven Kopson, 53, of Fort Lauderdale, was charged with manslaughter while driving under the influence of alcohol, among several charges.

Both these incidents raise the question, “If I am a pedestrian in an accident who was struck by a hit and run driver- who will pay for the treatment and pain and suffering I have sustained through no fault of my own?” The answer is that even though you are a pedestrian, your own PIP and UIM insurance will ensure that you are fully protected and covered for your injuries even though you weren’t driving your vehicle at the time.

The importance of PIP coverage and UIM coverage on your automobile policies is especially important when you are a pedestrian and you you are struck by a hit and run driver. It is in that instance that your own insurance coverage is there to protect you. Your PIP Insurance or Personal Injury Protection Insurance will cover the first $10,000.00 of your medical bills and your UIM Insurance will afford you coverage for everything over and above the first $10,000.00 up to the limits you choose.

What if your injuries are serious and you need treatment well over and above $10,000.00 and what about pain and suffering, wrongful death and lost or diminished capacity to earn a living? UIM coverage is the only coverage that will protect you if the party at fault in an accident either is unknown, has no Bodily Injury coverage (which is not required in the State of Florida) or has a minimal amount of Bodily Insurance Coverage. In effect you can seek compensation for your injuries and damages from your own insurance company should any of these circumstances occur, but only if you have UIM Insurance coverage.

If you would like to read further about this issue, we have addressed the Florida UIM and PIP Insurance issue in a previous article on our blog entitled: “Florida No-Fault, Med Pay and UIM Insurance” dated May 12, 2008. It is our hope that all Florida drivers will contact their insurance agents and demand a quote for UIM coverage on their policies. That way, should the unfortunate happen and you are injured in an accident caused by an uninsured driver or underinsured driver, you won’t have to worry about your financial future being decimated by medical bills.

If you have any questions about these issues please feel free to call our offices. We want every Florida driver to be aware and informed about their right to protect themselves through proper and FULL automobile insurance coverage.

Florida No-Fault, Med Pay and UIM Insurance

Since 1972, Florida has been a “no-fault” state with regard to automobile accidents. That simply means irregardless of who causes an automobile accident, each party must submit the first 10,000.00 of their medical bills to their own insurance company for payment. (This is known as P.I.P.) The P.I.P. law (Personal Injury Protection) requires your insurance company to pay 80% of your medical bills up to the $10,000.00 limit.

This vitally important law provides a number of other benefits to Florida citizens who are involved in auto accidents, namely a $5,000.00 death benefit and a lost wage benefit. For those drivers who do not have health insurance, P.I.P. provides the only avenue to have one’s medial bills paid. (Medical debt is one of the leading causes of personal bankruptcy in the United States.)

What does this mean for you and what should you do? First, please call your auto insurance agent immediately to discuss the alternatives to P.I.P. Specifically, obtain a quote for “medical payments” coverage, which is separate and apart from P.I.P. Even if you have health insurance, consider the inconvenience associated with obtaining referrals to specialists and other red tape. Medical Payments coverage will allow you to choose any doctor you wish without the need for a referral. This becomes especially important when one requires treatment with a medical specialist.

Another potential problem that you may encounter in Florida is being struck and injured by an uninsured driver. There are far too many drivers on Florida roads without insurance. This creates a danger for all of us who incur medical bills for accident related injuries. However, there is a very simple solution to this problem. It’s called U.M. Insurance. Uninsured Motorists (U.M.) Coverage is perhaps the most important type of auto insurance you can have in Florida. In the event that you are struck and injured by someone without auto insurance, U.M. Insurance allows you to turn to your own insurance carrier and force them to “stand in the shoes” of the uninsured driver.

U.M. Insurance requires your own insurance carrier to compensate you for all of the damages that you would have been entitled to receive from the uninsured driver. Unfortunately, many insurance agents do not explain this essential layer of coverage properly and often advise their clients to reject U.M. insurance in writing.

Finally, it is extremely important to protect yourself and your family should they be injured in an accident. The purchase of “medical payments” coverage and “Uninsured Motorist” coverage will provide that protection.