Will Florida Legislators Stop Insurance Fraud

Florida Homeowners Insurance Claim Reform: February 9th starts off with Florida lawmakers taking a stab at enacting reforms to stop insurance claims abuse.

As the new year takes off, insurance companies do not seem confident that Florida lawmakers will be able to pass legislation that will help fight insurance fraud, which is currently the insurance industry’s most important issue.

So far a solution to the problem has eluded Florida lawmakers mainly because insurance companies and trial lawyer groups have fought so hard to get their own way that legislation has not been passed.

In a recent Sun Sentinel article, Paul Handerhan, senior vice president for public policy at the Florida Association for Insurance Reform said,” I would love to see both parties come up with a product that would pass the Legislature. Reforms are needed, and I’m hopeful but not overly optimistic.”

Insurance companies are warning consumers that they will be the ones to pay the price if legislation is not passed. As costs increase for insurance companies due to claim fraud, insurance companies pass those costs on to homeowners via higher premiums.

Experts predict that many homeowners in South Florida will see rate increases that range from 5 to 15% because state lawmakers have failed to address insurance fraud issues.

Insurance companies continue to blame higher costs due to claim abuse as they seek rate increases, unfortunately for homeowners, the Florida State Office of Insurance Regulation has improved the majority of the requested increases.

Assignment of Benefits Fraud

Insurers are looking for legislation that will help stop excessive lawsuits being brought by contractors who are working under an assignment of benefits (AOB) clause. When a homeowner signs an Assignment of Benefits contract, they sign over their insurance policy rights to the contractor, including the right to seek payment from the insurance company for the work they performed.

Insurers claim that contractors who have signed assignment of benefits forms submit inflated invoices for the repair work they have done. When the insurance company declines the claim or pays a partial amount, the contractor, working alongside less than honest law firms, file a lawsuit, which pushes up costs for everybody.

Each year thousands of lawsuits are filed because attorneys take advantage of a state law that allows customers to collect legal fees from insurance companies if the lawsuit results in an insurance company paying any amount of money that exceeds its initial settlement offer.

The same law states that customers do not have to pay the insurance company’s legal fees if they lose the lawsuit. This loophole allows contractors and law firms to file lawsuits with very little downside.

On the other hand, attorneys claim that lawsuits would be unnecessary if insurance companies would pay a fair price for repairs. Failing to pay the proper price for repairing a home leaves contractors and attorneys no choice but to take the insurance company to court.

Recent Legislation Attempts Have Failed

There have been a number of attempts over the years to find a solution to help fight assignment of benefits fraud but they have all failed or will were not even taken up for debate.

Last year insurance companies helped write a bill that would prohibit third-party assignees from collecting legal fees from insurance companies. Sen. Anitere Flores, R-Miami, who is the chair of the Senate Banking and Insurance Committee, killed the legislation by refusing to even bring the bill to the floor for debate.

It was also Flores who refused to debate a bill that passed the House. This bill would have made the formula for awarding legal fees much more complicated. The bill stated that contractors could only collect legal fees if they won a settlement that exceed a certain threshold but insurers could collect legal fees from contractors if the settlement is less than or just a small amount more than the insurance companies initial offer.

While both bills will be reintroduced this year, it is unlikely that Flores will allow either one to be debated or put on the committee’s agenda.

Flores is planning to bring a new bill to the floor for debate. While this new bill contains some of the reforms that the insurance companies have requested, it leaves out one component that insurance companies claim is a deal breaker.

Portions of the bill the insurance companies consider positive are a requirement that contractors provide a written scope of work and that consumers have the ability to rescind an assignment of benefits within seven days of signing it.

Contractors would also be required to notify insurance companies of assignment of benefits within seven days of it being signed or 48 hours after they have begun nonemergency repairs.

In addition, written estimates would have to be submitted by contractors and contractors who are working under an assignment of benefits would be forbidden from pursuing a claim against the homeowner except for the deductible amount or the cost of any work that had been performed before the assignment of benefit was revoked.

The sticking point is that the bill contains no restrictions on the contractor’s ability to collect attorney fees and would prohibit insurance companies from passing those attorney fees costs onto its customers.

While Flores knows that the bill will be unpopular with insurance companies, she hopes it will be a starting point for negotiations between insurance companies and trial lawyers so that a bill that is acceptable to both factions will eventually emerge.