How Legislators provide protection against insurance fraud | Searcy Law

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John Hopkins

Personal Injury Protection (PIP) and Legislators Looking Out For Consumers?

» Written by // May 22, 2013 // ,


When insurance fraud was on the rise in the 1970’s, insurance companies, law enforcement and state governments got together and did things like launched joint task forces to investigate fraud and formed insurance exchanges to help manage the problem. Their first reactions were not to; in effect, legally defraud the consumer.

Fast forward to the 21st century and the Florida legislators have approached similar fraud a different way: punish consumers. I suggest that the below conversation never took place, but you can certainly imagine it could, given informed consumers who were active in supervising the people we send to Tallahassee “on our behalf”

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Florida Legislators: Wow, we have a really big problem with all this fraud going on in the Personal Injury Protection insurance (PIP). We need to do something.

Consumers: How do you know there is a big problem?

Florida Legislators: Extensive studies have been conducted by really, really smart people and they told us.

Consumers: Who are these people developing and providing the statistics.

Florida Legislators: The best experts in the land and we know this because they all had badges that had “insurance company paid fraud expert” on them.

Consumers: Okay, so what should we do about it? Shouldn’t we involve law enforcement?

Florida Legislators: Now, don’t you bother your little head about it, we will take care of you; don’t worry.

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Florida Legislators to Consumers: Okay, so we have a really, really great solution to the fraud problem. Let’s see if we can explain it in terms you might understand, because it’s real complicated:

First, we pass a law that allows consumers to keep $10,000 in PIP coverage and allows insurance companies to charge for $10,000 in PIP coverage. But, we are really only going to force insurance companies to provide $2,500 in PIP coverage; unless consumers can comply with some tricky statutes and contract provisions – you know, to prove they are not committing fraud.

Consumers: Well, but, how is that fair? We pay for $10,000, but only get $2,500…

Florida Legislators: Now don’t you worry, we have you covered. If you go to an emergency room within 14 days of your accident and an emergency/trauma doctor diagnoses you with an “emergency medical condition”, you are golden! You get the full amount of coverage you paid for; but, well, you can not go to massage therapists, chiropractors, acupuncturists or maybe some other treatments.

Consumers: What about injuries that do not develop until after 14 days? Everyone has some bumps and bruises from an auto accident, but you would not go to an emergency room for that. What about a bad back injury, for example a herniated disc that does not really begin showing symptoms for a few weeks.

Florida Legislators: Never happens. All the best studies given to us clearly show that 14 days is the magic number. Any injuries you claim to have developed after 14 days are just fraud – pure and simple.

Consumers: But, if the injuries are actually proved to be real and from the accident, we get the full coverage, right?

Florida Legislators: Hmmm, probably not, because you are faking. So, you can sue the insurance company and 3 or 4 years later you may win because some “activist judge” decides he thinks you should get $10,000 in coverage simply because you paid for that amount.

Consumers: How is this law in our best interest?

Florida Legislators: Our insurance company backers, er, friends, er “expert advisors” have told us that insurance companies are going to leave Florida if we do not do something about all this fraud in PIP insurance.

Consumers: Well, rather than punish us, why doesn’t the insurance industry and law enforcement get together and fight the fraud?

Florida Legislators: But, they said they would leave and stuff; and they mentioned political contributions; and then they told us this was the way to go.

Consumers: Do you think you acted in our best interests when you cut the deal with insurance companies and passed this law?

Florida Legislators: See, we knew you would get all emotional about it. This is business and it’s in your best interests. Our friends told us so. Besides, you need to look at it in the “bigger picture”. Plus, Governor Scott signed the law, so it must be about creating jobs and lofty things like that.


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