Florida's No-Fault Reform: Trending in the Right Direction

After Leading the Nation with Suspicious PIP Claims, Florida Sees a Decline

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Mar 27, 2014, 06:00 ET

DES PLAINES, Ill., March 27, 2014 /PRNewswire-USNewswire/ -- The National Insurance Crime Bureau has released a new report revealing a decline in Florida's personal injury protection (PIP) questionable claims (QCs). In 2013, Florida PIP QCs declined by 7.6 percent from 2012. Meanwhile, for the period 2010 through 2013, Florida staged accident QCs decreased by 61.82 percent.

Tighter legislation, enhanced public awareness and a coordinated law enforcement response appear to be having the intended effect on PIP fraud in Florida. "We are encouraged by the decline in questionable claims that we've seen recently, but by no means are we declaring victory in Florida," said NICB President and CEO Joe Wehrle. "Florida remains a hotbed for fraudulent activity and we can't afford to ease up for a moment in our fight against those who would abuse the system and burden Florida consumers."

A Brief History of Florida PIP Fraud

In 2009, Florida not only led the nation in PIP QCs reported to NICB, but had twice as many as the next highest state, New York. From 2008 through 2010, the total number of QCs in the state increased by 34 percent.

According to the Florida Department of Financial Services, Division of Insurance Fraud, for fiscal year 2010-2011, 49 percent of the referrals it received were related to PIP fraud.

When these statistics were brought to light, further research was conducted to determine potential abuses and fraudulent activity within Florida PIP. These findings showed that about 62 percent of total PIP costs and about 43 percent of PIP treatment costs came from soft tissue treatments. Twenty-two percent of soft tissue treatments were massage treatments. From 2005 through 2010, massage therapists showed the largest increase in charges per patient—51 percent—accounting for medical inflation.[1]

In the face of this trend, legislative changes to Florida's PIP system were enacted. First, the Hillsborough County Commission passed a county ordinance in September 2011, intended to license PIP clinics and decrease the number of suspicious vehicle collisions—staged accidents—in Hillsborough County. A similar ordinance requiring the registration of PIP clinics was passed the following February in Miami-Dade County. However, an injunction against the Hillsborough County law remains in effect.

At the state level, the Florida legislature passed House Bill 119 in May, 2012. The enactment of this law was a two-part process. The first part established stronger penalties for medical providers who commit PIP fraud, including a five-year license suspension and a ten-year restriction from PIP reimbursement. The second part of the law established a 14-day, post-accident window for accident victims to seek medical treatment and reduced specified PIP benefits and treatments. A lawsuit followed and an injunction stopped the law from being put into effect until it was lifted in late October 2013.

Changes within Florida's PIP fraud environment do not occur overnight. Even after policy changes were made on the legislative and regulatory fronts, it takes time for QC data to reflect the effects of those changes. Although NICB does not receive all QC data in Florida, the dataset used to produce this report comes from the same sources used in previous Florida QC reports. Combining these legislative and regulatory efforts with a robust public awareness campaign and aggressive law enforcement response, the modest improvement in 2013 PIP QC data does suggest the initial stages of a positive downward trend.

See the full report here. For a video report showing how NICB worked with authorities in Jacksonville to stop the influx of PIP clinics and staged accidents in that area, click here.

Anyone with information concerning insurance fraud or vehicle theft can report it anonymously by calling toll-free 800-TEL-NICB (800-835-6422), texting keyword "fraud" to TIP411 (847411) or submitting a form on our website. Or, download the NICB Fraud Tips app on your iPhone or Android device.

About the National Insurance Crime Bureau: headquartered in Des Plaines, Ill., the NICB is the nation's leading not-for-profit organization exclusively dedicated to preventing, detecting and defeating insurance fraud and vehicle theft through data analytics, investigations, training, legislative advocacy and public awareness. The NICB is supported by more than 1,100 property and casualty insurance companies and self-insured organizations. NICB member companies wrote $350 billion in insurance premiums in 2012, or more than 78 percent of the nation's property/casualty insurance. That includes more than 93 percent ($160 billion) of the nation's personal auto insurance. To learn more visit www.nicb.org.

[1] Florida Motor Vehicle No-Fault Insurance, Office of Insurance Consumer Advocate, December 2011

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SOURCE National Insurance Crime Bureau