Talking points for 1/26 House Committee Meeting
  • Walt Dartland - with the Consumer Federation of the Southeast. I am also a founding board member of the Coalition Against Insurance Fraud which is a national broad-based alliance of consumer groups, public organizations and insurance companies dedicated to combating all forms of insurance fraud through advocacy and education.
  • After the end of the 2010 legislative session, the Coalition reached out to the Florida Insurance Council to partner on efforts to strengthen Florida’s automobile fraud laws in the 2011 legislative session. This effort has led to the Sunshine Alliance to Erase Fraud.
  • The Sunshine Alliance has state insurers, including FIC, the state offices of PCI, AIA, NAMIC, Allstate, Nationwide, Direct General and the Florida Property & Casualty Association to name a few of the insurers. The Florida Consumer Action Network, which also is a board member of the Coalition Against Insurance Fraud, Florida PIRG and consultation with AARP are some of the Florida consumers within the Alliance.
  • The Alliance also has had the CFO’s office, the CFO’s office of insurance consumer advocate and the fraud division at our table to discuss issues and recommend how to target the PIP fraud facing Floridians.
  • The Alliance members came to the table with one thought in mind - what can we achieve together, consumers and insurers to help attack the auto fraud attacking our state. The Coalition has played the honest broker to keep us on track to offer recommendations to this committee that has the support of both consumers and insurers - two groups that are not usually seen in support of the same position; something that everyone in this room should take a note of.
  • We are in the final stages of drafting a focused fraud bill that addresses our concerns:
The key provisions are:
  • Requiring the names and addresses of all passengers involved in an automobile crash
  • Requiring a warning on clinic license applications that clearly state that submitting a false, misleading or fraudulent application is a crime
  • Requiring any entity or clinic that treats an injured crash victim to submit a form to the insurer that it meets the lawful requirements to treat a crash victims and to require the filing with the appropriate state agencies a form notifying of any change in ownership
  • Allowing an insurer to toll the 30-day deadline to pay a claim if the insurer is investigating a fraudulent insurance act. Also, the insurer will be required to notify the claimant in writing that an investigation is being held. The insurer is given a total of 120-days to investigate the claim.
  • Allowing an insurer to hold paying any part of a claim while the fraudulent element of the claim is fully investigated. The injured party also is protected from being required to pay any medical entity if the medical entity was deemed to have committed a fraudulent insurance act.
  • Insurers are given the right to request an examination to ascertain the facts of any claim that may be filed. The insurer also may request an independent medical exam to verify the medical diagnosis and treatment. And, the language also will require insurers to meet a clear test before requesting any examination. Because of a recent state supreme court decision, Florida is the only state that has put the ability of insurers to exam claimants into doubt.
  • And, adding to the existing law permitting insurers to offer a PPO option to insureds as a means to reduce insurance costs. The new language would require that an insurer offer a rebate to insureds when the PPO option is taken and a cost savings occurs.
Conclusion:

The Alliance came to the table from different perspectives with a single solution in mind: to help reduce the fraud that is harming the economic vitality of Florida. We stand together on these issues because we all believe that they are a viable step to reaching that solution. And, no matter what this committee is looking at achieving during this session, this anti-fraud package we believe is a benefit to Florida. In order to keep the Alliance together, we strongly recommend that the anti-fraud package be viewed as a stand-alone issue for this committee.