On June 12, 2012, Managing Partner, Frank S. Goldstein was a featured panelist at the prestigious Mid-Year Meeting of the Coalition Against Insurance Fraud, about the potential impact of the Legislature’s amendments to the Florida No-Fault Statute.
Specifically, addressed were the key anti-fraud provisions, requiring tougher licensing standards for clinics and the “Custer Fix,” confirming the insurer’s right to conduct Examinations Under Oath and Independent Medical Examinations. While general consensus was that these anti-fraud provisions were a step in the right direction, caution was urged to all attendees.There’s still a question about whether the provision giving insurers 90 days to investigate before paying a claim — up from 30 days — will work in practice, cautioned Goldstein.
It’s potentially a huge plus, but insurers must factually document their “reasonable belief” that a possibly bogus claim has been filed, Goldstein warned.
Also discussed at length were the more stringent clinic licensing requirements and the efforts which will be undertaken by fraudulent providers to “skirt” these requirements, including but not limited to the installation of “straw” medical directors. Lastly, the panel discussed the new statutory provision permitting an insurer to require Examinations Under Oath and establishing a clear prohibition against payment for failure to satisfy the statutory condition precedent. While the requirement itself is a plus, the drawbacks to the provision are the possible limitations upon the scope of the inquiry and the prohibitions against “fishing expeditions” as well as the complete lack of any requirement that third-party medical providers submit to similar inquiry.
All in all, the amendments were viewed as a “mixed bag of potential plusses and minuses”, which will provide an interesting backdrop for future litigation. Mr. Goldstein would like to thank the Coalition Against Insurance Fraud for inviting him to speak at their Mid-Year Conference and looks forward to speaking at future Coalition events.
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