Florida auto insurers seek more power to fight fraud

Let's agree that we need to fight auto insurance fraud in Florida.

Does that mean your car insurance company should be able to:

• Require you, your doctors or anybody who treats you for an injury to be examined under oath?

• Have its own doctor examine you, and deny your claim sooner if you don't cooperate?

• Send your claim to a panel of outside arbitrators instead of paying it?

• Cut back on the fees that lawyers can make to reduce their incentive to take insurance cases?

These are some of the ideas being considered by our state Legislature this spring, with a big push coming from the insurance industry.

They deal with a kind of insurance coverage that every Florida driver is supposed to carry, called "personal injury protection," usually known as PIP.

This is "no-fault" coverage, and in theory it is a great idea. You get hurt, your costs are covered, regardless of what or who caused the accident.

On the other hand, it also is a seemingly automatic pot of money. Every driver has to have at least $10,000 in coverage.

According to the insurance industry, Florida now has the fourth-highest average PIP claim in the nation, about $8,100 per injury.

And the frequency of claims has spiked by nearly half, 47 percent, since only 2008.

That means either we Floridians suddenly have become even lousier drivers (which is hard to imagine), or something else is going on.

That "something else," the industry says, is fraud and overuse — sometimes fake accidents that are staged outright, and sometimes just a network of clinics, pill mills and other providers who have become very good at using up that $10,000 in coverage.

Because this drives up premiums on the rest of us, every Florida vehicle is paying a "fraud tax" that averages $84 this year, and soon will be over $100, the industry claims.

Some of the proposed changes are not entirely new. Insurance companies have used examinations under oath and outside medical exams in the past. But court rulings have undercut the companies' ability to enforce them.

Not everybody is enthusiastic, and some warn that insurers could abuse their power.

"It seems more like the insurance companies are using the cover of real fraud in the form of staged accidents, etc., to change the law so they have an easier time of denying typical and legitimate PIP claims," contends Cory Tilley, a representative for some health care provider groups.

And indeed, the one bill filed so far (House Bill 967 by Rep. Mike Horner, R-Kissimmee) doesn't especially target suspicious claims. It simply gives insurance companies these powers, period.

The bill even gives insurers the power to change their rules and procedures no matter what a written policy says, specifically declaring that "an insurer is not required to amend its policy form."

There is plenty of evidence that Florida is a hotbed of auto insurance fraud. It also seems obvious that our state's exploding number of pill mills, pain clinics and such are thriving on that $10,000 PIP coverage.

However, the first draft of the bill seems a little broad-brushed. If the industry really isn't seeking the power to hassle everybody, then surely the Legislature can strike the right balance here. Surely.

Florida auto insurers seek more power to fight fraud 03/02/11 [Last modified: Wednesday, March 2, 2011 6:38pm]

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