This is the final edition of Advocate for 2017. It’s also the final flourish for the Coalition’s director of government affairs since our earliest days. Howard Goldblatt retires at the end of this year, and noted insurance attorney Matthew Smith assumes the government leadership mantle in 2018 (See our Four Questions conversation with Matthew below).

Howard recently posted a farewell blog detailing his 24-plus years with the Coalition. The Coalition was unknown in the early days. Howard had to introduce himself to every legislator and regulator, plus explain who he was and what the Coalition does. That gradually changed. Howard and the Coalition became sought-after for advice on crafting ground-breaking anti-fraud legislation. These efforts have helped build a large network of state fraud laws. They’ve greatly strengthened consumer and insurer protections against predatory scam artists.

The baton of government affairs director will remain in good hands with Matthew. We expect a seamless hand-over in the Coalition’s government affairs programs for 2018.

The Coalition, often in partnerships, is a leader in filing amicus curiae briefs on key court cases across the nation. Well-crafted “friend-of-the-court” briefs can influence positive court precedents that strengthen anti-fraud efforts around the U.S. — while protecting consumer rights.

A Kentucky case that threatened insurer EUOs shows why alertness is needed. A plaintiff attacked EUOs in court. A negative decision could’ve set a precedent that opened EUOs to attack in other states. We had to win this one.

Fortunately, the state Supreme Court correctly upheld an insurer’s right to conduct all-important Examinations Under Oath. The Coalition and NICB filed a joint amicus brief defending insurer rights to EUOs. It helped carry the day — with the highest court even mirroring our EUO defense. Here’s how the whole threat played out:

Court challenge: Whether auto insurers have the right to take EUO testimony under Kentucky’s mandatory PIP coverage. Most insurers believe they have an absolute right under the policy contract. Yet that argument failed in Kentucky lower courts. EUOs came under direct threat, and we had to navigate tricky waters.

EUO opponents argued: The legislature didn’t specifically include EUO rights in the state’s PIP statute. So insurers couldn’t take an EUO, even though the policy explicitly required it. The EUO policy provision thus was void. The legislature possesses sole decision-making power over the PIP statute. Only the statute controls PIP claims, including EUO rights.

Near-bedlam reigned in the state’s largest county (Jefferson County) while this case wound through the courts. Questionable PIP claims have exploded. Insurers found EUOs were crucial tools for gaining intelligence that could help dismantle staged-crash rings.

A lower court upheld EUOs: Another court denied the right unless it was specifically referenced in the state’s PIP law. Insurers must petition the court every time they want an EUO, a third court ruled. Insurers and claimants had no clear direction.

Court defends EUOs: The justices should consider the importance of EUOs as a fraud-fighting tool, the Coalition and NICB urged in our joint amicus brief. The majority agreed and upheld EUOs, specifically referencing our key amicus point.

We invite you to let us know about other cases that are important to fraud fighters. We can monitor them, and file an amicus brief if the issue meets Coalition criteria. Just contact Howard or Matthew.

Efforts to reform the state’s no-fault PIP laws and create a much-needed state automobile anti-fraud authority are linked — and likely stalling for this year.

The legislature is sliding into the final days of the 2017 session. A new bill would overhaul the state’s cost-soaked auto insurance system — and create an automobile fraud prevention authority. The large re-do is backed by the House leadership, Detroit mayor, plus the state’s NAACP chapter and chamber of commerce.

The bill’s future still is uncertain. Every special-interest group will find a reason to oppose it: rate rollbacks … linking medical fees to the Medicare’s low rates … letting consumers choose their level of PIP coverage, including the lifetime fee cap … and letting seniors opt for Medicare coverage instead of auto insurance to cover crash injuries. Only the auto-fraud agency seems to have universal support. So it’s unclear if this huge bill has traction to go anywhere this year. This leaves the anti-fraud authority in limbo as well.

You can bet insurance fraud is on the floor whenever Florida’s legislature meets. That will be especially true when the Sunshine State’s session opens in January. Largescale PIP reform likely will be on tap, with significant anti-fraud provisions. Enactment of such a bulky and controversial bill is doubtful, however, in an election year. Legislators will carefully avoid offending any of the powerful special-interest groups with a large stake in reform’s outcome.

Most assuredly, efforts to reign in fraud-soaked assignments of insurance benefits also will be debated. Larcenous contractors are luring homeowners into giving the contractors control of home-damage claims. The contractors use that legal power to inflate claims and frivolously sue insurers. Steady fraud losses to AOB scams are driving up homeowner premiums in many areas of Florida.

A reform bill fizzled this year, and already has been introduced for the 2018 session. As always, the Coalition will watch Florida closely to see what direction legislation takes in the year ahead.

Interestingly, another AOB bill already sits in the hopper for 2018 — for windshield-replacement scams. It would grant insurers the right to inspect a windshield before replacement in claims involving AOBs. The Coalition has contacted the sponsor to express our interest in making certain that Florida protects consumers and insurers from dishonest windshield claims.

The State Police gained two dedicated fraud prosecutors this year. The legislature freed up existing budget funds to make the welcome move possible. The Coalition and NICB supported the funding effort.

The State Police already are working to add yet two more fraud prosecutors to cover the populous areas of Northern Virginia and the Southwestern region. Once again, the budget funds exist. They just need to be freed up for action.

The 2018 statehouse sessions already are taking shape. From thwarting larcenous contractors … to crackdowns on auto schemes … to increasing funding for state fraud bureaus … the year ahead will be quite busy.

The Coalition plans active involvement wherever action is warranted. We’ll diligently consider the full-range of insurance-fraud concerns. We’ve developed a list of target states and legislation needed for the year ahead. We’ll defend the best interests of fraud fighters and consumers alike. Two added action points:

Compound creams. We’re tackling the thorny issue of overpriced and often worthless compound creams. They’re increasingly prescribed for bodily-injury and workers compensation claims — posing a volatile threat of growing losses. Often the creams are grossly overpriced and have questionable medical value. Their main purpose is to soak insurers.

We’ll seek member input, and from elected officials and consumer advocates. The Philadelphia Inquirer recently published a major story exposing illicit use of compound creams. This scam is imposing large losses on auto and workers-comp insurers. The time is ripe for major reforms around the U.S.

Amicus briefs. The Coalition plans to grow our amicus curiae legal-brief program in 2018 as well. Coming on the heals of our major EUO win in Kentucky, the Coalition is willing and able to assist members who identify key cases involving important insurance-fraud issues. All cases will be reviewed by our Amicus Committee. Cases must cover substantive issues impacting consumers and insurers. They can arise in federal or state courts. Contact Matthew for more information.

Whether in the halls of Congress, the state legislatures or courts, the year ahead will be filled with many opportunities for action by the Coalition, its members and partners.

This is a happy and sad time for the Coalition. Happy because we’re welcoming longtime insurance attorney Matthew Smith to the Coalition staff as government affairs chief, starting in 2018. It’s also a sad time. Our longtime government director Howard Goldblatt retires at the end of this year. Howard spent 24-plus years of building the Coalition into a respected voice at all levels of government. We talked with Matthew about the challenges he faces in filling Howard’s oversized government shoes — and Matthew’s vision for the Coalition’s next directions.

The Coalition celebrates its 25th Anniversary in 2018. What are the Coalition’s core strengths as it moves into its next quarter of a century?

I’m sure there were many discussions back in 1993 about whether the Coalition would make it off the ground, let alone celebrate a 25-year anniversary. The Coalition steadily grew to become the sole fraud organization speaking for consumers, insurers and government agencies — and a major force respected throughout the fraud-fighting community.

Anniversaries are a great time to look back and celebrate the road you’ve traveled; and we will do that throughout 2018. Looking backward, though, isn’t what built the Coalition. Looking forward is. We stand at the cusp of the most exciting era ever for fighting insurance fraud. The technology is the equivalent of “Star Wars” to most of us non-Millennials in the world of insurance fraud. The Coalition is uniquely suited to help guide our members about the importance of fighting insurance fraud. And just as important, we’ll help guide regulators, legislators and courts. Whether it’s new legislation, filing amicus curiae briefs with courts or working to set best practices for protecting consumers and insurers, we will serve as a strong voice.

How will you your extensive legal experience apply to your new role with the Coalition?

We have a first-row seat to seeing how our personal and professional lives are becoming more interconnected through technology. This same phenomenon also is occurring in our government. The federal government operates as three separate but equal branches — executive, legislative and judicial. Yet those branches are becoming more connected. The reality of our becoming a more interconnected society is equally clear.

My strong hope is my legal background will allow us to grow and expand our governmental affairs influence. Several years ago, the Coalition renewed its commitment to impacting all three branches of government through our program of amicus curiae legal briefs. We’ve filed three briefs with state Supreme Courts in Kentucky, Texas and Massachusetts. We’ll encourage our members to involve the Coalition in more key court cases — state or federal — that present unique and important issues impacting the fraud fight.

The Coalition is the only organization that can be a voice to the courts while speaking equally for consumers and insurers. That’s a strong message that judges will consider. When we pair with our partners to file a joint amicus brief, we’re also truly a strong voice to America’s judiciary. But we can only assert our voice when our members involve us in their cases. Our message? Let us know about cases we should consider for amicus briefs.

Equally, it’s common knowledge that most state and federal legislators come from a legal background. I hope my training as a lawyer — combined with more than 30 years of handling insurance legal matters — will strengthen the Coalition’s voice with legislators in meetings and at hearings.

Where do you see the legislative, legal and regulatory anti-fraud efforts moving in the coming years?

Like almost every other aspect of our society, it comes down to one word: technology. From the right of privacy, to drones, to the Internet of Things, the vast majority of legislative and judicial energy is gearing toward the proper use of new technologies. The impact on fraud-fighting will be undeniably huge. For that reason, we must have a seat and voice at the table. How the courts, legislatures and regulators decide the best legal use of these new technologies will define how we investigate fraud for the next generation, or longer. Our success with influencing those directions will take great joint cooperation, knowledge and commitment.

Of course the Coalition will direct our efforts in many other important areas. Whether it’s consumers and insurers being bilked by storm-chasing contractors, tamping down staged-crash rings or abuse of insurer-paid opioids, the Coalition will help lead the battle against insurance fraud.

The Coalition has worked hard to be a respected and trusted ally to organizations such as NCOIL, NAIC and NCSL. We’ll work hard to strengthen those relationships. Our 25th anniversary year also provides an opportunity to yet again consider our roots and reinforce what makes the Coalition unique.

Online resources
Links to legislative and regulatory resources at InsuranceFraud.org


* Current legislation
* Fraud bills enacted this year
* Latest legislative news
* Model insurance fraud act
* State anti-fraud requirements
* State insurance fraud laws