You might think that the person who cuts you off and forces you to rear-end them is just a jerk with bad luck. Once in a while, that may be true. But the Sunshine State has a huge problem with auto insurance fraud, particularly with PIP fraud, and Florida insurance investigations are often the only way to determine what’s legitimate and what’s really just someone trying to steal from every driver in the state.
To understand why PIP fraud is such a massive problem in Florida, first you have to understand what PIP actually is. Florida auto insurance is not like that found in most other states. Sure, many of the basic components are there, but PIP is what makes it special. PIP stands for personal injury protection, and the general idea behind it is that your insurance pays for your injuries, regardless of who is actually at fault for the accident. It was signed into law with the best of intentions, but in many ways it hasn’t worked out well.
One of those ways is that it’s a great opportunity for those who would like to commit insurance fraud. The way the scam works, in a nutshell, is something like this. A guy cuts you off, or otherwise causes an accident that’s generally not going to be considered to be their fault. They claim they’re injured in difficult to prove, non-specific ways like soft tissue injuries. Then they take their insurance and get treated at a clinic that’s in on the scam.
The clinic doesn’t actually render any treatment, they just bill the insurer. The driver and the clinic divide up the profits – and it’s all profit since no services were rendered – and the driver lives to scam another day. Some loopholes, especially with when treatment must start and what sorts of professionals are eligible for reimbursement, have been closed in recent years, but there are still options to bilking insurance companies and the Florida public. That’s where Torres Protection Group comes in.
Florida insurance investigations can be quite complicated. Torres Protection Group brings law enforcement and investigative experience to the table to make sure that your client gets the facts. If fraud is present, there are two goals. The first is to recover or prevent payout of the claim. The second is to ensure that the criminal doesn’t continue on to commit more fraud.
Often, PIP fraud investigations in Florida can hinge on the activities of the driver. Do they actually go to the clinic who billed the insurance company? Are they living like someone with a low back soft tissue injury, or are they touring every golf course in the state with their ill-gotten gains? Life has to move on, even when someone is injured, but there’s a marked difference between someone who drags themselves to work injured because they have no other options and someone who clearly is living the good life with no injuries.
Another element of PIP fraud investigations is the submission of claims. If a claim is denied by the insurance carrier, does the clinic correct it and resubmit it? Or do they forget about it and move on? Legitimate doctors want to get paid for their legitimate services, especially because they have employees to pay. Doctors who are fraudulently billing insurance companies tend to just move on when a claim is denied, because they don’t want to invite the scrutiny of the insurance company. That’s just one of the many red flags involved in investigating insurance fraud in Florida.
Recently in Jacksonville, Guillermo de la Vega pleaded guilty to being part of an intentional car accident and two insurance fraud-related counts. He’ll get six years. He organized and was involved in a series of staged car accidents which were then used to file fraudulent insurance claims through a clinic called the Arlington Rehabilitation Center. The clinic allegedly offered fake treatment for these fake accidents, collected the fraudulent PIP claim, and then split the money with de la Vega and the people involved in the fake accidents.
Dogged insurance fraud investigation can be long, difficult, and hinge on the smallest details. If you believe that you have a fraudulent claim on your hands, you should work with the best and most experienced insurance fraud investigation firm in the business, Torres Protection Group. You’ll get the right investigators assigned to your case, the right experience, the right attention to detail, and the right results. On top of that, proper handling of the PIP fraud investigation is crucial to your chances of recovering the money that was paid out fraudulently.
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