For many years, Florida's auto insurance market has enjoyed stability in terms of availability and affordability of coverage with any number of solid insurers competing for business, including nonstandard risks. Florida's relatively stable market for auto insurance could be in jeopardy due to personal injury protection (PIP) insurance fraud that has grown at an alarming rate over the past three years. Although PIP fraud has been a problem in the Miami area for many years, the problem is no longer localized to that part of the state. Organized fraud rings that employ such tactics as staged auto accidents and fraud and abuse in medical billing have moved into other areas of the state, causing many carriers to tighten their underwriting standards and raise their rates to cover the increasing costs of battling PIP fraud.
Legislation that would have addressed this problem failed to gain traction in the 2010 legislative session, but there was momentum heading into the 2011 legislative session for meaningful PIP fraud reform due to reports coming from the National Insurance Crime Bureau (NICB), Florida's Office of Insurance Consumer Advocate, and Agency for Health Care Administration (AHCA) that corroborated the anecdotal evidence that carriers had previously relied upon for support of PIP fraud reform. Unfortunately, PIP fraud reform once again was not prioritized, and the 2011 legislative session ended with only a few discrete measures adopted that are unlikely to resolve the problem.
The latest NICB report on vehicle collision questionable claims (VC QCs), issued April 11, 2011,1 shows that between 2009 and 2010, there was a 15-percent increase nationwide in the total number of BI/PIP claims and a 17-percent increase in the number of VC QCs. The most common reason reported for VC QCs was “Staged/Caused Accident,” followed by “Suspicious Hit While Parked,” “Paper/Phantom Accident,” “Jump In,” and “Solicitation (Chasers and Cappers).” Florida led the nation with the highest number of VC QCs in 2009 and 2010. The cities with the most VC QCs were New York, Tampa, Orlando, Los Angeles, and Houston. The report notes that each of these cities already has an NICB Major Medical Fraud Task Force comprised of investigators and analysts from NICB, the insurance industry and law enforcement. These task forces were established to target the growing fraud associated with auto policies and illegitimate bodily injury claims. So the number of questionable claims has increased in these cities despite the stepped up anti-fraud efforts by the auto insurance industry and law enforcement.
The insurance industry is not alone in sounding the alarm bell. On April 11, 2011, the Florida Office of Insurance Regulation (OIR) issued a report on the results of a PIP data call to auto insurers licensed in Florida.2 The results of the data call revealed that in 2010, the pure direct loss ratio for PIP was 97.4 percent, which means for every dollar of premium that the insurer collects, more than 97 cents was used to pay losses. The OIR report also found that the frequency of PIP claims in Florida had generally decreased from the fourth quarter of 2005 to the fourth quarter of 2008. Since 2008, however, there has been a sharp increase in the frequency of paid claims. The OIR's report states that, if the frequency of claims continues to increase at the same rate over the next year, OIR expects a 19-percent increase in the frequency of paid claims in the next year. The OIR report further revealed that the severity of PIP claims in Florida has generally increased since the fourth quarter of 2005. If the severity continues to increase at that same rate as it has from the fourth quarter of 2008, OIR expects a nine-percent increase in the severity of paid claims in the next year. Over the next year, OIR expects to see a 29-percent increase in pure premium, which is the average premium per exposure needed to cover expected losses for that exposure.
It is important to note that the latest NICB report and the results of OIR's PIP data call were not released until after the 2011 session of the Florida Legislature was already underway, which may have limited the usefulness of that information for advocates of PIP fraud reform. However, prior to the beginning of the 2011 session, on November 3, 2010, Florida's Office of Insurance Consumer Advocate issued a report and recommendations to Florida House and Senate leadership on the results of a PIP roundtable conducted earlier that year.3 This report confirmed that Florida's auto insurance fraud problem is not limited to questionable accidents, but also extends to fraud and abuse in billing for medical services. The Consumer Advocate's recommendations incorporated a number of measures directed at tightening regulation of health care clinics and providing more tools and resources for law enforcement to combat staged accidents.
A number of the recommendations in the Consumer Advocate's report are similar to those that had been included in the Comprehensive Insurance Fraud Investigation and Prevention Act of 2010 (HB 1447), a PIP fraud reform package that failed to garner much attention during the 2010 legislative session. The core provisions of HB 1447 were directed at cracking down on health care clinic licensure and exemption fraud; fixing glitches and loopholes that limit the ability of the Division of Insurance Fraud and insurance investigators to investigate fraudulent acts; and providing additional economic sanctions to deter insurance fraud.
Heading into Florida's 2011 legislative session, the insurance industry identified a number of issues targeted at reining in PIP fraud, including:
- Reducing attorneys' fees by eliminating application of a contingency risk multiplier
- Requiring insureds to submit to a medical examination prior to receiving PIP benefits
- Requiring medical providers to submit to examinations under oath
- Expanding the use of the long form crash reports by law enforcement and requiring the collection of the names of all parties involved in an accident
- Creating a Direct Support Organization to support the Department of Financial Services in prosecuting PIP fraud
- Creating enhanced financial penalties for PIP fraud
- Authorizing insurers to offer discounts to policyholders who choose a preferred provider network for PIP benefits
The issues that were pursued in 2011 were split into two sets of bills — one aimed at attorneys' fees and medical provider examinations (House Bill 967 and Senate Bill 1694), and the other that dealt more broadly with PIP fraud (House Bill 1411 and Senate Bill 1930). All of these measures were strongly opposed in the House and Senate by trial attorneys and medical provider interests and ultimately died in committee. Some members of the Legislature attempted to amend some of the anti-fraud measures onto other bills, including those directed at attorneys' fees, long form crash reports, enhanced fraud penalties, and the Direct Support Organization, but only two of them survived on bills that passed the Legislature. Senate Bill 2160 included language relating to expanded use of long form crash reports, and House Bill 1087 creates civil monetary penalties for motor vehicle insurance fraud. Both of these bills were signed by the Governor and enacted into law.4 However, there is a widespread view that neither of these measures will provide insurers and law enforcement with the tools necessary to stymie the growth of PIP fraud in Florida.
Preparations are already underway for the 2012 Florida legislative session, and PIP fraud reform is gaining attention once again. The recently appointed Florida Insurance Consumer Advocate has announced the creation of a working group to be comprised of legislators and various stakeholders to study the problem of auto insurance fraud.5 The Florida Senate Banking and Insurance Committee also has added auto insurance fraud as an issue to be studied in advance of the 2012 session.6 It is likely the Committee will issue a white paper or policy statement as a result of their study, before the 2012 Florida legislative session convenes. The governor has not yet developed any specific legislative proposals but has recognized there is an ongoing problem with PIP and even has publicly questioned whether PIP should be made optional.7