Response to Editorial by Insurance Industry Executive Regarding Florida PIP Insurance

dollars.jpgAs the 2012 Florida legislative session is about to begin, Corporate Florida is rolling out its guns to prepare for its annual assault on the civil justice system. Although packaged as an effort to benefit consumers, make no mistake that the true goal is to maximize corporate profits at the expense of people. Profits over People.

PIP is one of the main targets in Corporate Florida’s high powered sights this session.

Associated Industries of Florida is one of Corporate Florida’s most aggressive players in the never ending war between profits and rights. It was in the forefront of the assault on Florida’s workers’ compensation system that has resulted in less support for injured workers today than 10 to 20 years ago. PIP is next.

On November 28, 2011, the Miami Herald published an editorial by a vice president for governmental affairs at Associated Industries, in which various proposals were made for revamping the PIP system. I will respond to each proposal.

Proposal: “Allow insurance companies adequate time to investigate suspicious claims.”
Response: Under current Florida law, PIP insurance companies have at least 65 days to investigate claims before a lawsuit for breach of contract can be filed. This alone is adequate time to investigate a claim, but in reality carriers have much more time to investigate because in everyday practice PIP lawsuits are rarely filed within six months of an accident. During this period of time, carriers have many ways to investigate claims, including examining insureds under oath and having medical exams performed by hand chosen doctors.

Carriers have the right to deny claims that they feel are suspicious. If a claim is denied, an insured may drop the claim or file suit. Through legal proceedings, each side has the chance to fairly present its case to a judge and jury. What’s unfair about that?

Proposal: “Cap attorney fees in no-fault cases to eliminate the incentive for frivolous litigation.”
Response: This is a shell-game proposal. Carrier’s know that fee caps will discourage lawyers from pursuing legitimate claims. It is a ploy the insurance industry has used with great success in gutting the rights of workers’ compensation claimants. Carriers also know that there is no such thing as a frivolous lawsuits crisis, only a successful propaganda campaign to make the public believe there is. As I have blogged here before – Debunking The Myth About Frivolous Lawsuits (Florida) – Installment #1; Debunking The Myth About Frivolous Lawsuits (Florida) – Installment #2 ; South Florida Trial Lawyer – Tort Reform (“Deform) & What It Means – the concept that lawyers can make money pursuing frivolous claims defies logic and reason. As every lay person who has battled with an insurance carrier knows, it is hard enough to succeed with legitimate claims much less bogus claims. The civil justice system has created numerous filters to weed out even weak cases, so the notion that baseless cases somehow make it through the filter system is nothing short of disingenuous. Quite simply, Corporate America does not like being answerable to individuals in courts of law. The frivolous lawsuits fallacy is nothing short of a concerted campaign to bar the courthouse doors against individuals seeking redress. Profits over People.

Proposal: “Require greater accountability from Florida medical providers that treat PIP claimants.”
Response: It is hard for me to respond to this proposal, because I am not sure what it means. However, my guess is that it is an idea founded on arbitrary and capricious rules designed to discourage and frighten the best doctors out of the PIP system. As it is, Florida PIP doctors must comply with onerous report and bill filing requirements that require costly staff members to administer.

Proposal: “Prevent alternative medical operations from providing unnecessary and excessive treatment.”
Response: Again, I am not quite sure what this proposal means. However, I know that there is nothing PIP carriers dislike more than treating doctors making referrals for diagnostic testing and specialized care regardless of patient needs. For sure, Associated Industries would rather have bean counters making medical decisions than real doctors.

I have heard floated the proposal that the PIP carriers be allowed to select the treating doctors, a proposal similar to what has been done in workers’ compensation since 2002 thanks in part to Jeb Bush and Associated Industries. This would create a stable of doctors beholden to the carriers, not a good recipe for obtaining fair and impartial opinions.

The Associated Industries executive fails to mention that the insurance industry gained a huge victory in 2008, when it was able to get the Republican-dominated legislature to approve a measure changing the reimbursement standard from 80% of a medical community’s “usual & customary” rate to 200% of the rate allowed under Medicare. Various medical providers have told me that this change alone has accounted for a significant reduction in reimbursement rates.

To be sure, there is some fraud within the PIP system. However, it is a far cry from the crisis trumpeted by Associated Industries. Moreover, the insurance industry already has at its disposal every tool necessary to stamp out what little fraud there is.

I encourage every effort to root out the few bad apples. However, a whole system need not be poisoned to accomplish the goal. The insurance industry knows this, but for the sake of Profits over People, they are ready, willing, and able to be excessive.

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Jeffrey P. Gale, P.A. is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.

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