Florida AOB Abuse Update: ‘Alarming Trend’ Reaches Crisis Point

Assignment of benefits abuse has escalated over the last five years to the point where it is now a serious disruption to Florida’s insurance market.

The abuse, which is especially rampant in South Florida, stems from unscrupulous contractors and attorneys cashing in on homeowners dealing with a water loss, such as a burst pipe or roof leak. The “bad actors,” as they have been dubbed by the industry, use an AOB to acquire the homeowners’ insurance benefits, file inflated claims, and then pursue lawsuits against insurers when those claims are disputed or denied.

Because of Florida’s one-way attorney fee statute, insurers are left footing the bill for the inflated claim and the attorney fees.

“We believe the [one-way attorney fee statute] provides an extraordinary incentive for people to get into a dispute with the insurance company and inflate the claim so the company has to pay attorney fees,” said Florida Insurance Commissioner David Altmaier at the Feb. 7 Florida Cabinet meeting.

The industry hopes this will be the year that the Florida Legislature addresses the problem.

AOB is such a hot topic in Florida right now that it dominated discussions on almost every panel and between attendees of the Florida Chamber of Commerce’s Florida Insurance Summit held Feb. 1-3 in Miami. A glance at the numbers from various Florida sources tells the story of why:

Non-cat water loss claims accompanied by an AOB are increasingly coming to insurance companies in the form of a lawsuit before the insurer has even seen the claim. Data from Citizens found that 76 percent of water loss claims in 2016 were submitted to the company in the form of a lawsuit, up from the 2.5 percent of litigated water claims in 2012.

Citizens CEO and Executive Director Barry Gilway said the average water damage claim is received 50 days after the loss.

“We are not getting these lawsuits from the insured,” he said. “In many of those cases we have never even seen the claim, we’ve never had an opportunity to adjust it or received a statement of loss… it’s just ‘here is a lawsuit and a bill for $30,000.'”

Industry Response

As the situation continues to deteriorate, insurers say they can no longer afford to just watch the trend and are instead taking action to ensure that the increasing frequency and severity of claims won’t deplete their surplus and ability to pay claims.

According to the Florida Office of Insurance Regulation, nearly 73 percent of the rate filings received by insurance companies and approved by OIR were for a rate increase, largely because of AOB claims.

Insurers are responding in ways other than raising rates, as well, including pulling out of certain areas of the state, filing for policy wording changes, and accepting fewer take-out offers from Citizens. The company has reached its lowest policyholder count in its history, but there are concerns those efforts will be reversed if the AOB problem continues.

Citizens’ Gilway has been one of the loudest voices in Florida on the AOB problem, first calling attention to the issue at Citizens OIR rate hearing in August 2015.

Gilway says as a non-profit insurer, Citizens is in a unique position to bring attention to how the problem is really hurting the consumer and not just a way for insurance companies to raise rates so they can make more money.

“I don’t have any axe to grind here. My bottom line is I feel very, very sorry for the insureds. They are getting ripped off by signing one of these things. Most of the time when they sign them, they are under duress,” Gilway said.

Florida insurance companies are just starting to quantify the AOB abuse and its impact on their bottom lines. The industry has seen increased water loss claims and litigation, but hasn’t necessarily been tracking the frequency of AOB with those claims. In OIR’s 2015 Data Call, only four companies were able to provide consistent indicators of AOB for the analysis.

Because private companies have not put forth concrete data like Citizens has, some have questioned if the abuse is as great as the industry has claimed.

Belinda Miller, chief of staff for OIR, said regulators have closely examined if the problem is an abuse of the system or if insurance companies are somehow complicit in the increased litigation. To reach that determination, OIR evaluated consumer complaints over the last five years and if they had increased at the same rate as lawsuits. Miller said that wasn’t the case.

“The argument that maybe it’s just the companies aren’t doing a very good job and aren’t paying when they should, we don’t see any evidence of that,” Miller said.

And as AOB costs insurers more money in claims, they can raise rates in response.

“Insurance companies pass through these costs,” said Miller. “The insurance company can raise rates and keep paying. It doesn’t necessarily mean they are going to make more money — they are going to pass these costs on to their policyholder.”