Auto Insurers Allege PIP Fraud After Florida Crashes, Highlighting Ongoing Battle to Scrap It

Florida’s no-fault auto insurance coverage – also known as personal injury protection (PIP) – is controversial and the subject of ongoing legislative debate. Earlier this year, as reported by FloridaPolitics.com, a bill to repeal Florida’s no-fault auto insurance died in committee. Lawmakers haven’t given up on the prospect of reintroducing a similar, if modified, measure in the future.

As it now stands, PIP coverage, as outlined in F.S. 627.727, is required of all motorists and extends a maximum of $10,000 in medical and disability benefits and $5,000 in death benefits – regardless of fault. It is only if one’s condition crosses the “serious injury” threshold that they may seek additional coverage from the at-fault driver’s insurer and/ or their own uninsured/ underinsured motorist (UM/UIM) carrier.

Recently, it was reported litigation filed earlier this month in the Southern District federal court alleges three separate medical clinics wrongly billed an auto insurer for services through PIP, ultimately cheating the insurer out of $4.7 million. Although the lawsuits don’t specifically allege fraud by crash victims, it’s incumbent on Floridians and car accident attorneys to be mindful of these developments, as they may impact the types of challenges auto insurers may raise to deny medically necessary treatment following a crash.

According to the lawsuit, the clinics, controlled by two siblings in Miami, engaged in fraud, deceptive and unfair trade practices and unjust enrichment by submitting false, materially misleading and/ or fraudulent bills supporting records to plaintiffs for services which weren’t medically necessary – and in some cases, weren’t even rendered. The insurer alleges these clinics meted out a predetermined treatment plan to all South Florida car accident victims, without first considering the patient’s injuries. Each patient was reportedly diagnosed with non-specific sprains, strains or pain of the cervical, thoracic and lumbar regions – even if this was not reflective of their true condition. Further, all patients were referred for “excessive therapy modalities, regardless of the unique circumstances and needs of each patient.” All received X-ray scans, even when those results weren’t used in the treatment plans.

The insurer maintains the car accident victims weren’t properly examined, diagnosed or treated for their individual conditions, which resulted in treatment that was either unnecessary or excessive, in each case resulting in PIP benefits that were either exhausted or depleted – in some instances depriving crash victims of treatments they actually needed. This had been going on as far back as 2007, according to the allegations in the complaint.

The judge in the case is considering whether the federal courts even have jurisdiction over this issue.

In the meantime, it’s probable we’ll see another bill for PIP repeal introduced to the Florida legislature again soon. The state House speaker said that may come in the form of a no-fault/fault hybrid bill, wherein drivers would be allowed to maintain their PIP coverage if they wanted, but those who wanted to move to a mandatory bodily injury liability policy (which Florida currently doesn’t have, unless you have a poor driving record) could do so and ditch their PIP. Lawmakers say this could result in sizable savings long-term for a large number of people. Only about 10 percent of drivers in Florida carry only PIP.

Call Fort Lauderdale Injury Attorney Richard Ansara at (954) 761-4011. Serving Broward, Miami-Dade and Palm Beach counties.

Additional Resources:

New lawsuit highlights legislative logjam over PIP reform, Aug. 6, 2018, By Michael Moline, FloridaPolitics.com

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