Citizens Insurance in Florida using RICO Act to Fight Fraud

21 Jan

Citizens Property Insurance Corp and Heritage Property and Casualty in Florida have started going after alleged fraudsters who submit fraudulent claims with a legal tool that was developed to help prosecutors convict organized crime members. 

In recent lawsuits, Citizens Property Insurance Corp. and Heritage Property & Casualty have claimed that certain repair contractors and their legal partners are operating as criminal enterprises as defined by the Racketeer Influenced and Corrupt Organizations Act, also known as the RICO Act according to a recent Sun Sentinel article. 

This can be a difficult route but insurers in Florida feel they have no other recourse to stop less than honest contractors from filing frivolous lawsuits. The RICO act is used by private companies when they are hoping to stop organized crime that is not being prosecuted by the government. 

RICO suits can be complicated and difficult to prove according to legal experts. They are often dismissed by the court because they do not meet the exact criteria spelled out in state or federal law. Heritage jumped into the RICO world on January 13th in Miami when they filed a suit in federal court.

Heritage accused brother and sister Angelica and Albert Sigler of using their companies, Moisture Rid and Water Dryout to submit multiple claims. The suit claims that they duplicated documents signed by homeowners to create multiple claims despite the fact that the homeowners believed they were just giving one of the companies the right to bill their insurers on their behalf. The Heritage lawsuit documents 12 examples where the two companies duplicated a signature onto a document assigning a claim to the other company.

The suit claims that the two were a “deceiving Heritage into believing that the insured had in fact, assigned its rights in two separate claims,” according to the Sun Sentinel article. 

Citizens Property filed a suit in a state circuit court in June, that is targeting South Florida attorney Scot Strems, the public adjusting firm Contender Claims Consultants Inc. as well as the repair company, All Insurance Restoration Services Inc. Citizens Property is Florida’s insurer of last resort. The lawsuit accuses the companies named in the suit of “working together to inflate or manufacture insurance claims and submitting them through false and fictitious invoices.”

Scot Strems, the lawyer named in the suit, is currently the subject of three Florida Bar complaints to the state Supreme Court according to the Sun Sentinel article. One of the complaints accuses his firm of misleading elderly and immigrant homeowners. Strems is currently suspended and cannot legally practice law. He has denied all charges in that case as well as all charges leveled against him in Citizens’ RICO suit. The Citizens case was originally filed in Leon County, but has been transferred to Miami-Dade County.

RICO suits can be very difficult to win

Both the Citizens Property and Heritage lawsuit claim that the activities of the defendants violate RICO laws. In order to be successful, the lawsuit must prove the following according to the Sun Sentinel article:

  • the existence of an ongoing enterprise
  • a business association between the various defendants with a common purpose
  • an operation that has been sustained over a period of time, not a one-time scam
  • the enterprise is engaging in criminal misconduct that’s likely to continue and that the plaintiffs have suffered damage as a result of the misconduct

All of these components can be complicated to prove, and these cases tend to be more difficult to prove than just a single case of fraud. “You need (at least) two predicate criminal acts by the defendant,” said Barry Zalma, an insurance claims consultant based in Culver City, California in the Sun Sentinel article. “It takes money and time to investigate. And it’s harder to prove then a single claim of fraud.”

Citizens released the following statement after filing the lawsuit in June. “This lawsuit is about what we contend are concerted actions by the defendants to abuse the claims process for their own gain, and to the detriment of both Citizens and our policyholders. These abuses have made it virtually impossible for Citizens to handle claims efficiently and effectively. We believe we had no choice but to file this suit to address the costs of these abuses that are shouldered by all Citizens policyholders through higher premiums.”

RICO Suits can be very effective, but are hard to win

RICO suits often fail as they are so difficult to prove the numerous components required by law. 

“The plaintiff must show that the enterprise has an ongoing organization and functions as a continuing unit with the common purpose of engaging in certain conduct,” said attorney Michael Pike, who specializes in RICO litigation at the South Florida law firm Pike & Lustig LLP in the Sun Sentinel article.  “An enterprise is not the same as a pattern of criminal activity.”

 “You cannot allege bald assertions and conclusions of law that are vague and lacking specificity. If you do, the case will be dismissed. If your claims are not precise, you will not get past a motion to dismiss, much less a trial,” warned Pike in the Sun Sentinel article.

In RICO cases, if the plaintiff is unsuccessful, they may be required to pay the defendants legal fees. On the other hand, if the case is successful, the defendants may be required to pay triple the amount of the damages they caused. 

Regardless of whether or not they are successful, these RICO lawsuits let contractors and lawyers know that insurance companies are ready to fight back, which may help deter future scammers. 

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