Testimony by Gregory V. Serio, Superintendent of Insurance, before the New York State Assembly Standing Committee on Insurance and President of the Borough of Brooklyn on Auto Insurance Premiums in Brooklyn
November 12, 2003
Good afternoon. I would like to thank you, Assemblyman Grannis and Brooklyn Borough President Markowitz, and members of the Committee, for the opportunity to testify at this hearing.
I appear before you today to discuss automobile insurance issues in New York City and specifically the issues and challenges of the automobile insurance market in Kings County. The residents of this Borough are burdened with some of the highest automobile insurance premiums in the State. Today, I will provide you with information regarding the causes for the apparent disparity between insurance affordability and availability in Brooklyn and elsewhere in the State. I will also attempt to dispel some of the widely held and largely inaccurate perceptions concerning the differences in automobile insurance rate premiums between upstate and downstate insureds.
Automobile rates for any territory in the State are primarily based on the loss costs experienced by an insurer in that particular territory. Unfortunately, the data reported to the Insurance Department (Department) clearly shows that loss costs in Brooklyn for both the voluntary market and assigned risk insureds are the highest in the State (see, Charts A, B and C). Not surprisingly, honest hardworking Brooklyn residents are forced to pay higher automobile premiums as a result. The question then becomes what are the reasons for the higher loss costs in Brooklyn. As Brooklyn Borough President Markowitz acknowledged in a statement from April 2002, no-fault insurance fraud is one of the reasons for the higher automobile premiums in Brooklyn. The Department could not agree more and has been a leader in the fight against fraud. In the past few months, for example, the Department, working in conjunction with state and local law enforcement agencies, cracked down on three separate automobile insurance fraud rings resulting in hundreds of arrests and dozens of indictments. Most of these fraud rings were traced back to Brooklyn and a majority of those arrested were Brooklyn residents. In fact, a review of the Insurance Fraud Bureau Reports (IFBs) filed with the Departments Frauds Bureau shows that Brooklyn has the highest incidence of suspected automobile no-fault insurance fraud in the State. In 2003, as of October 31, Brooklyn far surpassed the rest of the boroughs with a total of 4,484 suspected cases involving no-fault fraud with Queens coming in second with a total of 3,409 cases. For comparison purposes, the Bronx had a total of 1,904 suspected cases involving no-fault fraud, Manhattan had 1,339 cases and Staten Island had 311 cases. And the figures in Brooklyn for 2003 are consistent with prior years. In 2002, there were 3,838 reported cases in Brooklyn (versus 2,548 in Queens) involving no-fault fraud and in 2001, there were 4,768 cases in Brooklyn (versus 2,269 in Queens).
The sophistication of the criminals involved in these fraud rings and the elaborate schemes they engage in prove that criminals are well aware of how to manipulate the current no-fault law and make a great deal of money in the process. The Department and law enforcement agencies are doing everything within their power, under current law, to take these criminals off the street. The Department revised Regulation 68 to reduce no-fault time frames and we were deeply gratified by the State Court of Appeals favorable and unanimous decision upholding the regulation just last month.
Together with an increase in staff resources in the Insurance Frauds Bureau and a better, smarter deployment of these assets to "task force" squads in Suffolk, greater Rockland, Albany, Onadaga and Niagara Counties, there has been a greater coordination of activities among investigative and prosecutorial agencies, and finally, an earnest commitment by the insurance industry to get serious about fraud and abuse. Regulation 68 provides our fraud and abuse prevention and detection activities with the full power necessary to match the creativity, guile and industriousness of the organized, sophisticated perpetrator of fraud schemes, scams and rings. It is not to overstate the case to say the upholding of Regulation 68 was a major victory for the fight against fraud.
The one missing piece to the fraud-fighting puzzle: the failure of the Legislature to enact the strongest possible measures to attack fraud, including the passage of a felony runners bill. Until the Legislature enacts meaningful automobile insurance reform, we will continue to see criminals steal tens of millions of dollars from the automobile insurance system and cause automobile insurance rates to increase for all New York drivers.
II. Current Statewide Marketplace
We have in New York today a healthy and vibrant automobile insurance market with 271 insurers currently writing private passenger automobile insurance coverage. Of these insurers, 144 are writing coverage in Brooklyn. It has been, and continues to be, the goal of the Department to maintain this healthy market and to encourage competition among insurers. In order to encourage competition, we must continue to steadily depopulate New Yorks residual market by enabling insureds to obtain coverage in the voluntary market. The Departments efforts in depopulating the New York Assigned Risk Plan (AIP) have been extremely successful and the current population in AIP remains near a historic low. There were approximately 400,000 policies in force in the AIP as of September 30, 2003, down from roughly 1 million in 1994, representing less than 6% of the total number of automobiles in the State (see, Chart D). Applications for assignments have declined by 12% year-to-date compared with 2002.
Brooklyn, in particular, has seen a dramatic decrease in the number of insureds enrolled in the AIP and a corresponding increase in writing by voluntary market insurers. From 1990 to 2003, the number of private passenger automobiles in the AIP in Brooklyn has fallen dramatically from 163,360 or 46% of the total drivers in Brooklyn to only 27,367 or 7.3% as of September 30, 2003 (see, Chart E, F and G). From 1990 to 2003, the number of private passenger automobiles in Brooklyn in the voluntary market increased from 191,438 to an estimated 347,000; more than 50,000 automobiles were added to the rolls of the voluntary market since 1999 (see, Charts F and H). Clearly, in Brooklyn there has been a significant depopulation of automobiles in the AIP and a dramatic increase in the number of automobiles in the voluntary market.
It is important to note also that during this 13-year period, there were only modest changes (+ 20,000) in the total number of private passenger automobiles in Brooklyn year-to-year. In 1990, the total number of voluntary and AIP private passenger automobiles in Brooklyn was 354,798 (see, Chart F). Needles to say, it has become a "factualized fiction," through repeated speculation and conjecture, that the voluntary market has abandoned the borough. Many of the vehicles that were once insured in the AIP are now insured in the voluntary market.
Interestingly, Brooklyn actually has a higher percentage of insureds in the voluntary market when compared to the boroughs of Queens and the Bronx. Based on 2001 data, Brooklyn accounted for only about 9% of the private passenger automobiles in the AIP while Queens represented 18% and the Bronx made up 13% of the AIP (see, Chart I). And the Department is taking the necessary steps to depopulate the AIP in these boroughs as well.
While these figures represent positive developments in the Brooklyn automobile insurance market, losses continue to drive premium rates in Brooklyn both in the AIP and in the voluntary market. Currently, a 35-year-old male in Brooklyn with a clean driving record pays $4,381 for required insurance coverage in the AIP. In the voluntary market this same Brooklyn driver pays between $1,227 - $1,715 for the same required insurance coverage. But when compared to the other boroughs of New York City and territories throughout the State, this Brooklyn rate is significantly higher. For example, in Manhattan, a 35-year-old male with a clean driving record pays $2,495 for insurance coverage in the AIP and between $639 - $1,048 in the voluntary market. In Queens, the premium is $3,149 for the required insurance coverage in the AIP and between $734 - $1,293 for coverage in the voluntary market. In the Bronx, the premium rate is $2,394 for the required insurance coverage in the AIP and between $785 - $1,091 for coverage in the voluntary market. In Staten Island, the premium rate is $2,065 for the required insurance coverage in the AIP and between $732 - $1,075 for coverage in the voluntary market (see, Chart J). In Rochester, a 35-year-old male with a clean driving record pays only $722 for required insurance coverage in the AIP and between $219 - $497 in the voluntary market (see, Chart K).
The premium disparity between Kings County and all other areas of the State can be summed up in one word: losses. As material as the premium differences may be, even more significant are the losses in Brooklyn. According to statistics from the Department of Motor Vehicles, Kings County has one of the highest percentages of accidents involving personal injury relative to the number of registered vehicles. For example, in 2000 there were 486,987 vehicles registered in Kings County and a total of 27,191 reported personal injury automobile accidents (total reported accidents of 38,152). Compare this to Queens County, where there were almost 300,000 more vehicles registered in 2000, at 784,848, and yet there were almost 3,000 fewer accidents involving personal injury (24,459 personal injury accidents and a total of 36,578 reported accidents). The figures for 2001 are comparable. Moreover, in the AIP alone, Brooklyn drivers accounted for only about 9% of the population but 20% of the losses in the entire AIP (see, Chart I). In terms of actual dollars and required coverages, the average loss for a Brooklyn driver in the AIP was $5,043, while in Queens the average loss was almost half as much at $2,986, and in Manhattan it was $2,744. The average statewide AIP loss equaled $2,204 and in Rochester, it was as low as $791 (see, Chart A). In the AIP, Brooklyn had 23 no-fault claims per 100 insured automobiles. Compare this to 15 per 100 in the Bronx, 14 per 100 in Queens, 13 per 100 in Manhattan, and 9 per 100 in Staten Island. Again, the statewide number was significantly lower at 11 per 100 (see, Chart L). And the average no-fault claim in Brooklyn in the AIP is again highest in the State equaling approximately $12,279 per claim. The average claim statewide is $10,641. Brooklyn outranks Queens by over $1,100 per claim, the Bronx by over $1,300 per claim, Manhattan by over $1,500 per claim, and Staten Island by approximately $3,100 per claim (see, Chart M).
It is no wonder that the increased average loss size coupled with more than twice the statewide frequency of claims in Brooklyn results in higher loss costs for Brooklyn drivers and their insurers.
An examination of Brooklyns voluntary market also demonstrates that losses are driving the premium rates upwards. In terms of actual dollars, the average loss for a Brooklyn driver in the voluntary market was $1,529 per automobile, roughly 30% greater than the average loss in the Bronx ($1,195 per automobile) and in Queens ($1,156 per automobile). Compare these figures to Albany and Rochester where the average losses in the voluntary market were only $341 and $284, respectively (see, Chart B).
III. AIP Changes
Over the past five years, the Department has urged the AIP Governing Committee to pay closer attention to issues that directly and indirectly affect AIP business, such as fraud and abuse in both the claims and underwriting disciplines, improvement to AIPs systems, and enhancement in AIPs openness and responsiveness to its constituency. We directed AIP to expand the Governing Committee to increase participation by agents and consumers. There are now 10 public members in addition to the 11 insurer subscriber members, and at least one seat is designated for a consumer representative as well. We have encouraged the Committee to "think out of the box" in exploring solutions to promote depopulation and to help AIP meet its appropriate statutory obligations more efficiently. The Committee has responded with an array of initiatives and suggestions, including the allowing of territorial credits upstate.
Based on the latest figures reported to the Department, approximately 43,800 (12.5%) of AIPs insureds received a Careful Driver Credit which is worth approximately $25 million statewide. This $25 million represents about 2.5% of the AIP statewide premiums or about 3/10 of 1% of the total statewide voluntary premiums. In Brooklyn, 4,700 (16%) AIP insureds receive the Careful Driver Credit and on average, a Brooklyn driver in the AIP receiving the Careful Driver Credit pays approximately $900 less than he or she would have paid had the Careful Driver Credit not been offered (in Brooklyn, the total credit is worth approximately $4 million). But we must keep in mind that this $900 savings is in addition to the subsidy the AIP driver is already receiving from the voluntary market. At its November 2002 monthly meeting, the AIPs Governing Committee authorized the Automobile Insurance Plans Service Office (AIPSO) to develop an amendment to the AIP rules that would phase out the Careful Driver Credit over a period of three years.
Under the original proposal that was developed by AIPSO, no new AIP policyholder would be eligible for the Careful Driver Credit after the rule goes into effect. However, any policyholder in AIP at least one year prior to the effective date of the rule would receive a Careful Driver Credit that gradually diminished by approximately one-third each year. For example, an insured currently eligible for a 30% credit in 2003 would receive a 20% credit the first year the new rule is in effect, 13% the second year, 9% the third year, and then no credit thereafter. At a subsequent meeting, the Governing Committee voted 17-3 (with one abstention) to effectively ratify the proposal developed by AIPSO. In view of the overwhelming support the Governing Committee afforded the proposal, the Department has given careful consideration to all aspects of the proposal.
Following additional discussions at the Committee level, the Governing Committee recently voted to amend the proposal. The amended proposal, currently under review at the Department, provides that those insureds currently receiving the Careful Driver Credit will continue to receive the credit at the current level until the insured either leaves AIP or no longer qualifies for the credit, but those AIP insureds not presently receiving a credit, and any new insureds, would no longer be eligible to receive the Careful Driver Credit.
While no final action on the modified proposal will be taken without a complete review of all pertinent aspects of the subject, including how to protect against "temporary" take-outs of drivers who are then recommitted to the AIP a short time later, it should be noted that, by statute, AIPs proper role is as an insurer of last resort. The only way to permanently achieve a sustained moderation of all New Yorkers automobile insurance costs is through the fostering of an innovative and competitive voluntary market. A residual market that effectively competes with voluntary insurers for superior risks is an anomaly that needs to be avoided. Our efforts have focused on ensuring that AIP accomplishes and maintains its proper statutory role. Vigorous promotion of the PASS program, which requires electronic filing of applications to AIP, enhancement of the Take-Out Credit programs to encourage insurers to take business out of AIP, and improvements in AIPs various information processing activities, are some of the innovative initiatives that we have encouraged and developed not merely to improve AIPs operations, but to ultimately improve New Yorks automobile insurance market as a whole.
Automation of AIP's processing of applications via the PASS program has allowed the Department to better understand trends in the makeup of the AIP. Insurance producers have indicated on almost half of the applications submitted through PASS for coverage in the AIP that they have no voluntary market in which to place their clients. We have contacted insurers with which many of those producers are affiliated. The responses received from the insurers confirm that in some cases insurers have indeed been more selective in underwriting prospective risks. However, a substantial percentage of the insurers surveyed indicated that they could not explain why some of the agents having contracts with them stated in the applications that they have no market available other than the AIP. To be sure, it takes some effort to locate the best coverage on behalf of a client. But that is a producer's job. Clearly, insurance producers -- especially the many storefront brokers who operate in Brooklyn -- need to do more to reduce the population of the AIP. Consumers too need to shop around for availability because 45 out of the 144 insurers currently writing private passenger automobile insurance in Brooklyn write business directly or use exclusive agents.
IV. Anti-fraud Initiatives
The Department has been at the forefront in trying to increase the availability and affordability of automobile insurance in New York. Toward this end, the Department has adopted a zero tolerance policy for insurance fraud. It is now estimated that up to $177 of every auto insurance bill is due to insurance fraud. For this reason Governor Pataki has made fighting no-fault insurance fraud a priority. While the Department has taken every step available within its regulatory authority to combat fraud, tougher laws for the crime of insurance fraud and for the criminals who commit this fraud are required.
All measures and all available resources are being utilized to detect, prevent and deter insurance fraud. The Department has pursued a multi-pronged approach to tackle the elaborate organized crime rings that involve "runners," recruiters who arrange staged accidents and then direct "victims" to seek treatment from medical mills for their feigned injuries, often reaching the statutory no-fault cap of $50,000 for each passenger involved in the accident.
These fraud rings manipulated the timeframes under the former Regulation 68 to maximize their profit, typically waiting until the 90th day after the staged accident (the last day to file a notice of claim) to notify the insurer of the claim and withholding all the medical bills generated from the medical mills until just before the expiration of the 180-day period for submitting proof of loss (the last day to submit proof of loss for medical treatment). These lengthy time periods prevented an insurer from performing any meaningful independent investigation to determine the validity of the medical services rendered. Coupled with the fact that an insurer had only 30 days to either pay or deny the claim, many insurers would pay the claims in order to avoid any penalties for failure to pay on a timely basis.
In order to reduce opportunities for this rampant fraud and abuse, the Department amended Regulation 68 in September 2001. After a series of hard fought court battles in defense of the amendment, the Court of Appeals recently upheld the regulation. The revised regulation reduces the time limit for filing a notice of claim from 90 to 30 days, for submitting proof of loss due to medical treatment from 180 to 45 days, and provides that proof of work loss must be submitted within 90 days. The revised regulation also provides for a more flexible standard for accepting late filings, replacing the previous rule that late filings were permitted only when written proof showed that compliance with a deadline was "impossible." The new standard allows for a late filing when there is a "clear and reasonable justification" for the delay.
These new timeframes allow insurers to receive notice of an accident sooner and permit insurers to better investigate the claim closer to the time medical services were rendered without compromising the claimants legitimate right to benefits.
In addition to closing the opportunities for fraud and abuse through regulatory action, the Department has also taken an extremely proactive role on the law enforcement side. The Department has partnered with all law enforcement agencies to combat insurance fraud and abuse. In addition to working with the Attorney General, who was appointed Special Prosecutor in fraud cases by the Governors Executive Order No. 109, the Department works closely with the Federal Bureau of Investigation, the State Police, the New York City Police Department (NYPD) - Auto-Crime Unit and Fraudulent Accident Investigation Squad, local police departments, the Division of Criminal Justice Services, and the Department of Motor Vehicles. Working with the Department of Motor Vehicles, the Insurance Information and Enforcement System (IIES) initiative was successfully implemented providing New Yorks law enforcement agencies and the insurance community with a state-of-the-art insurance data program, and other states with the standards by which they will be measured.
The Department is also a member of automobile insurance task forces such as the DCJS working group/task force and the New York State Auto/Arson Task Force between the Bureau of Fire Investigation and the Departments Arson Unit. In addition, we have also assigned fraud investigators to District Attorney's offices and the Departments Frauds Bureau works closely with the Special Investigations Units (SIU's) of insurance companies on IFBs submitted, open cases and resources for sting operations, such as pretext policies and undercover vehicles.
The Frauds Bureau has also hired additional investigators and has supplemented its personnel in the No-Fault Unit. The Bureau is in the final stages of relocating it's No-Fault Unit to Brooklyn where they will share office space with the AIP. The AIP has recently created an SIU to investigate insurance fraud and is already entrenched in uncovering a major no-fault insurance fraud case in cooperation with the Frauds Bureau and the Queens District Attorney.
Every investigator assigned to the Frauds Bureau has and will continue to reach out to community groups throughout the state to educate them on insurance fraud, including ways to identify and prevent fraud, and advertising the Departments hotline number to report insurance fraud. Education and the support of the community in reporting suspected fraud is paramount. No law enforcement effort can be sustained without the support of the community. Everyone has to participate in this fight.
The NYPD and local police departments across the state are continuing to expand resources into this area, creating new units, such as the NYPD's Fraudulent Accident Investigation Squad and the No-Fault Task Force of the Attorney General's Office. An enormous effort is underway to address insurance fraud and the result of this effort is evident in the increased arrests and convictions for insurance fraud. It looks as though we are finally getting an upper hand in our fight against fraud.
This past September, the Department, together with the NYPD and the Brooklyn District Attorneys office, participated in a sting operation that resulted in the arrest of 51 individuals as part of the takedown of a no-fault insurance fraud ring. These arrests were the first phase of "Operation Gateway," an investigation into a criminal organization that is taking advantage of New Yorks no-fault laws by falsifying auto accidents. Based on the evidence in this case, runners were paid up to $2,500 for every victim they could link to a fictitious accident and the resultant losses are in the tens of millions of dollars. The Department participated in this takedown where NYPD detectives posed as insurance company representatives, called the perpetrators at home to inform them they had been awarded an insurance claim of up to $11,000 and to pick it up in person in Queens. When they arrived to pick up their claim money, they were arrested and charged with fraud. Of the 51 persons arrested, 34 resided in Brooklyn. This operation involved 44 automobiles, of which 25 automobiles were registered in Brooklyn.
Other major cases include:
- In August of this year, under the auspices of the Insurance Crime Unit (ICU), which was created by the Department and the Suffolk County District Attorneys office, an eight-month investigation resulted in the arrest of 98 individuals, including physicians, psychologist, chiropractors, attorneys, medical clinic owners and others in the first stage of what may be the largest no-fault insurance fraud scheme ever prosecuted in New York State. With 85 indictments and up to 500 additional unsealed indictments, the sheer magnitude of this insurance ring should shock the conscience of every honest New Yorker. This case began with an investigation of one suspected instance of insurance fraud and evolved into a much larger sting operation that uncovered an intricate scheme to defraud the no-fault system. The evidence points to the operation of a complex, highly disciplined, staged collision ring whose members intentionally caused car accidents to spawn phony no-fault insurance claims. According to investigators, much of the crime uncovered in the initial stage of the probe involves insurance fraud by immigrant Russian ring members in Brooklyn. The ring members staged motor vehicle collisions in Suffolk and Nassau counties, and in the boroughs of Queens and Brooklyn. Physicians and other trained medical professionals who are Russian migrs have also been indicted. The alleged scheme involved owners and managers of medical clinics paying "runners," or recruiters, arranging automobile accidents and sending individuals supposedly injured in the accidents to clinics for treatment. Of the 98 persons arrested in this case, 38 resided in Brooklyn. This operation involved 106 automobiles, of which 100 were registered in Brooklyn.
- In September 2002, the Department, working with the Attorney Generals office, charged 25 people who operated two separate automobile insurance fraud rings in New York City. The defendants in the first ring, who operated out of Brooklyn, caused actual accidents to occur and sought treatment for feigned injuries. The second ring, which operated out of Brooklyn and Manhattan, created phony accident reports and then sought and obtained treatment for their fake injuries. Together, over $425,000 in phony bills were submitted to insurance companies, of which over $200,000 was paid.
- In one of the largest sting operations at the time, "Operation Whiplash," in December 2001, culminated with the arrests of 112 individuals, 70 of whom resided in Brooklyn. Operation Whiplash was jointly conducted by the Department, the Queens District Attorneys office, the NYPD and the New York State Police. This 14 month joint investigation uncovered an organized network of individuals and corporations including attorneys and medical professionals engaged in a systematic scheme to defraud insurance companies through the filing of false accident reports and fictitious claims of physical injury. In many instances, fraudulent accident reports, doctors records, prescriptions and affidavits were created as part of the scheme.
While there is tremendous effort underway to crack down on fraud and abuse in the no-fault system, there is a movement afoot to rollback the timeframes under Regulation 68, thereby undermining all that we have accomplished. And remarkably this proposal is coming straight out of Brooklyn where Regulation 68 has already had its greatest impact. Specifically, there is a bill pending in the Legislature to increase the time limit for filing a notice of claim from 30 to 90 days and to increase the time in which to submit proof of loss due to medical treatment from 45 to 60 days (Assembly Bill 269/Cohen). Most alarming about the proposed timeframe for medical bill submission is that in cases of continuous treatment the clock does not begin to run until completion of the treatment. This could potentially last years, costing insurers thousands of dollars without the insurer ever knowing about the treatment until years later, leaving the insurer without the ability to verify the medical condition of the claimant well after the treatment is rendered. As bad as the 180-day time period was for insurers to mount a meaningful investigation and defense, this legislation would, in essence, completely eliminate an insurers right to investigate and defend a claim on a timely basis, creating a cold case file right from the start.
In her memorandum in support of the bill, Assemblywoman Cohen states that the revised timeframes are unreasonable, yet she fails to acknowledge that the loopholes under the prior regulation were exploited as opportunities for fraud and abuse, particularly in Brooklyn. Increasing these timeframes as proposed in this bill will be an invitation to every organized crime ring that the no-fault system is again open for business. I urge you today to oppose this legislation.
We need to continue working together as the fight against no-fault fraud is far from over. You have asked what more needs to be done. I recommend the following measures:
- Similar to the Suffolk County ICU initiative and following on the great success of Judge Brown in Queens, every district attorney's office in New York City should create an insurance crimes unit.
- Forfeiture laws should be utilized to take the profit out of the crime.
- All SIUs should continue to train their claims and underwriting personnel in identifying insurance fraud. Insurers should follow the example of some insurance companies that have committed more resources to their SIUs and have created sub-units in their claims departments to identify no-fault fraud in the early stages. And, insurers must stop the plainly anti-insurance practice of bulk settling claims with providers.
- The passage of meaningful automobile insurance reform measures, such as making it a felony to act as a runner, getting tough on physicians who either lend their name to keep the medical mill in operation or who perform excessive and unnecessary medical treatment under the no-fault system, and making it a crime to commit fraud in the application process in personal lines. Such measures, which I will discuss further shortly, would be powerful tools in the arsenal to fight insurance fraud.
There is one other suggestion that merits consideration. We have spent some time here today describing insurance costs and the effects of insurance fraud on insurance premiums. But we must also consider some of the causes as well. To the extent that our culture has tolerated a degree of abusive claims behavior and fostered an adversarial posture, costs have spiraled upward and perpetrators of fraud have been able to flourish. Every New Yorker needs to understand that it is not OK to pad a claim to recover a deductible; it is not OK to state on your application that you only drive to church on Sundays when you really use your car for business purposes; it is not OK to register your car in another state and contending that it is principally garaged there when on most nights it can be found parked here on the streets of Brooklyn; it is not OK to stretch that yellow light even if you may be in a hurry; and it is never OK to act out your frustrations when you are behind the wheel. It is not just our pocketbooks that are at stake it is our lives as well. Zero tolerance for any such practices will not only reduce all of our insurance costs, but will also improve our quality of life.
V. Legislative Solutions
While the legislative effort to undermine Regulation 68 is the wrong approach for New York, the Legislature must come together to enact meaningful reform to ensure the continued stability of New Yorks automobile insurance market.
First and foremost, the Legislature needs to aggressively treat "runners" as the criminals they are and prosecute them as such. It is important that any person who acts as a runner -- recruiting individuals to participate in staged accidents -- be charged with a felony, rather than a misdemeanor. Making this crime a felony will give prosecutors the tools they need to get tough on runners and lessen the impact of the critical role the runner plays in the typical no-fault insurance fraud ring.
Similarly, healthcare providers play an integral role in the criminal enterprise through the establishment of medical mills that have bilked the no-fault system out of tens of millions of dollars each year. In fact, at the present time, the physician is a key to the whole no-fault criminal enterprise. Without physicians submitting fraudulent medical bills for reimbursement under the no-fault system, the criminal enterprise loses a major source of revenue. In addition, in a typical medical mill, a physician lends his or her name and license to the medical practice but that is the extent of his or her involvement. There must be serious consequences for these absentee doctors and for those that submit phony or excessive medical bills for unnecessary treatments. One proposal is to provide a mechanism that would permit the Department to certify and decertify those physicians who seek reimbursement under the no-fault system, similar to the certification process currently in place at the Workers Compensation Board.
Another proposal to reduce the amount of fraud and abuse is to provide for a revamped no-fault managed care program based upon the successful Preferred Provider Organization (PPO) concept, now in use in Workers Compensation. The PPO concept is an important one. The threat of escalating medical costs to automobile insurance premiums cannot be overstated.
There must also be criminal and monetary sanctions for those that commit fraud in the application process for private passenger automobile insurance. The criminalization of application fraud could help in efforts to prevent fraud rings from forming in the first place. An individual who lies on their application for insurance may intend to use that policy for purposes of a staged accident. Once the staged accident takes place, the insurer is then responsible for first and third party claims. While the insurer may use fraud as a defense in denying the claim, this defense must be raised within 30 days. Otherwise, the insurer must pay the claim. In addition, no matter whether fraud is raised or proven, the insurer is still responsible for any third party claims.
Each of us must do our part to promote a vigorous and efficient automobile insurance market for the benefit of all New Yorkers. While it is true that Brooklyn drivers pay the highest premium rates in the State, the loss costs in Brooklyn support the rates being charged. Without question, fraud is the primary cost driver for Brooklyn but it also has a significant impact for the other boroughs of New York City.
Members of this Committee, you have within your power the ability to enact meaningful no-fault reform which will help stabilize rates in New York City. However, until the Legislature acts, the Department, working with law enforcement agencies, will continue to crack down on the no-fault scams that occur each and every day, particularly in Brooklyn. Make no mistake, the Department will do its part to hand over the criminals to law enforcement, but until the Legislature gets serious about no-fault crime there will continue to be a revolving door process - the jail cell door will not remain closed because prosecutors do not have all the tools they need to keep the criminals behind bars.
Therefore, I stand ready to work with this Committee and Brooklyn Borough President Markowitz so that all New Yorkers, particularly those in Brooklyn, have access to affordable and comprehensive automobile insurance coverage.
Thank you and I will be happy to take any questions.