Volume 3 Issue 1

January 1, 2013
DONOVAN INSURANCE SOLUTIONS
A li fe of Ri sk b y Pa u l Do n o v a n
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A Life of Risk 1
PIP Reform new Rules
1/1/2013
2
Insurance Law Up- 2
Encouragement
Chronicles
3
1960-1970 TV Trivia 3
Claim Handling for
Florida
4
DISHappy New Year 4
Inside this issue:
Regret for the things we did can be tempered by time; it is regret for the things we did not do that is
inconsolable. Sydney J. Harris
The book, 100 Things To Do Before you
Die, by Dave Freeman, launched an entire
genre of similar type titles. In the book he
exhorts the reader get out in the world and
create a fabulous memory or two. Besides
being a call to arms against complacency, his
hope is that people will take more risks in life
through the new experiences they seize. The
main takeaway is that life is not meant to be
lived free of risk. In my opinion, there are a few essentials that help our lives gain fulfillment.
That includes taking on new challenges, creating strong relationships, eliminating procrastination
living life like as an adventure, risking some things and not being paralyzed by fear.
As insurance professionals, we deal in risk everyday. We identify risks, assess vulnerabilities and threats to assets and
then we help prioritize risk resolution. We typically work in four basic risk categories. There are strategic risks, hazard
risks, operational risks, and financial risks. There are also four ways we can deal with risk. We can avoid them, reduce
their impact, share/transfer them (insurance) or accept and budget for them. However, thats not the type of risks were
talking about here. Our concern is for those that havent truly lived because they never
venture past the safety of the shoreline to experience the ocean. Put differently, those
people that view life as a series of dangers to be avoided, are creating a recipe for
disappointment.
Weve all known people like that and sometimes weve been that person. It takes a
healthy mixture of confidence, enthusiasm and faith to take a risk. Before you do, ask yourself, What would you do if
you knew in advance that you could not fail? Thats easy, we would all shoot for the moon. However, experience can
be a hard teacher because, it gives the test first, then the lesson. My twofold new years wish for everyone is of course to
be safe. Additionally, I would encourage you to take a new and measured risk. This could be done by taking a trip to a
foreign country, attempting Tae Kwon Do or learning a new language. Dont be afraid to fail, attempt something new,
you may just find a new talent that was dormant or a new passion that fuels your life.
P A G E 2
I N S U R A N C E NE WS Y O U C A N US E
2013 New PIP Regulations
Here are some of the highlights of the new Personal Injury Protection rule changes.
PIP is Primary against all forms of insurance (medical/disability) EXCEPT in cases involving workers compensation. In
those cases, excess Medical Payments Coverage-is issued on excess basis to coordinate with PIP coverage.
1. 80% Medical Benefits ( Medically Necessary) $2500 MAX ( Medical, physicians-Hospital& or chiropractor) With-
in 14 Days of the accident. It used to be with or without cause.
2. 60% Work Loss Benefits No change
3. 100% Replacement of Household Services No change
4. Up to $5,000 Death Benefits (Additional) It used to be included in the PIP limits
5. $10,000 Maximum Total Benefits-per person/ per accident Same
6. 80% Medical (Additional treatment for medical emergencies) Used to be patient choice who to see and where to go
7. Massage clinics not owned by physician, not covered Most massage and acupuncture used to be covered expense
under PIP

This reform for PIP coverage takes place in FL on January 1 2013. If you have any questions or concerns, please feel
free to call us.
"The minute you read something that you can't understand, you can almost be sure that it was drawn
up by a lawyer.
Will Rogers
2012 was a particularly active one for Several State Supreme Courts and Federal District Circuit
Courts addressing insurance law. The following is a brief listing of some of the more important
rulings:
1. Obamacare - in a landmark decision, healthcare reform was ruled constitutional, as the Feder-
al government has the ability to tax. (Even though its not a tax?)
2. Katrina Canal Breaches - 5th circuit courts tackled property claims against U.S. Army corps
of Engineers for claims arising from Hurricane Katrina. Rulingmost Federal agencies are immune from flood
damage projects where no violation of statute, regulation or code was made.
3. USAA Casualty v Permanent Mission of Republic of Nambia - applies to whether or not foreign governments are
immune under FSIA rules pertaining to building code violations in NY city. Ruling - everyone has a duty to comply
4. Royal Capital Development LLC v Maryland Casualty - concerning stigma damages. Disclosure laws and stig-
ma damages involve potential loss of market value of property even after full repair, due to the stigma associated
with the property damage. GA Supreme court ruling - stigma damages are compensatory to make insured whole.
5. Hennan v McGinty - concerning property damages in a Texas home. A popularly used estimation software was pre-
sented as evidence of repair costs. Courts held that repair bills, estimates and invoices are not sufficient evidence that
repair costs are reasonable and necessary. Unfortunately, the court did not provide instruction or clarification as to
what can be used as evidence to prove damages.
Lastly, in Frazier v WCAB (Bayada Nurses Inc.) the Supreme Court of PA held that a 1993 amendment to the states
workers compensation law provided complete immunity to the government. The workers compensation carrier has no
lien rights from a claimants settlement with a government agency. For claims professionals this means that work comp
carriers for private employers may not subrogate against state, county or municipal actors.
As the courts move forward interpreting the laws we will keep you posted (unless we forget).
Insurance Laws Update
P A G E 3
V O L U M E 3 I S S U E 1
1 960- 70 Televisi on trivi a v i a t he mi nd of P aul
Encouragement Chronicles B y P a u l D o no v a n
The happiest people don't have the best of everything. They just make the best of everything."
Unknown
A group of alumni, highly established in their careers, got together to visit their old university professor.
Conversation soon turned into complaints about stress in work and life. Offering his guests coffee, the
professor went to the kitchen and returned with a large pot of coffee and an assortment of cups - porcelain,
plastic, glass, crystal, some plain looking, some expensive, some exquisite - telling them to help them-
selves to the coffee. When all the students had a cup of coffee in hand, the professor said:
"If you noticed, all the nice looking expensive cups were taken up, leaving behind the plain and cheap
ones. While it is normal for you to want only the best for yourselves, that is the source of your problems
and stress. Be assured that the cup itself adds no quality to the coffee. In most cases it is just more
expensive and in some cases even hides what we drink. What all of you really wanted was coffee, not the
cup, but you consciously went for the best cups... And then you began eyeing each other's cups.
Now consider this: Life is the coffee; the jobs, money and position in society are the cups. They are just
tools to hold and contain Life, and the type of cup we have does not define, nor change the quality of Life
we live. Sometimes, by concentrating only on the cup, we fail to enjoy the coffee God has provided us."
God brews the coffee, not the cups.......... Enjoy your coffee!
1. What were the names of the main characters in the Munsters TV show?
2. What were the names of the main characters in the Addams Family TV show?
3. On the Andy Griffith Show what was the name of the town Barber?
4. What was the name of the ranch that Ben, Adam, Hoss, & Little Joe all lived on &
what was their family last name?
5. Name three German and three POW characters from Hogans Heroes.
6. Who played the two title roles on the hit show, The Odd Couple
7. Name Mr. Drysdales secretary on The Beverly Hillbillies.
8. When Timmy fell down the well his best friend went for help on this show?
9. A space colony family struggles to survive when a spy stowaway throws their ship hopelessly off course in what
show?
10. Sid & Marty Krofft brought two brothers together to discover this stranger from the sea in what Saturday morning
show?
11. Sid & Marty also brought this famous dragon to life on Living Island?
12. This long running show premiered live on NBC on Saturday, October 11, 1975 and still enjoys success today.
" Dont sweat the petty things and dont pet the sweaty things.
Steven Wright
For Property and Casualty risks in the state of FL there are guidelines and deadlines that must be met
by agents, brokers, insurance companies and claimants to ensure appropriate and timely claims
resolution. Naturally, if factors are beyond control these timelines are extended (ex: hurricane, etc.)

ACT TO BE PERFORMED COMPLIANCE TIMEFRAME REFERENCE_________

Pg. 4
Going to church doesn't make you a Christian any more than standing in a garage makes you a car.
Claims handling rules for Florida
Trivia Answers from Page 3:
1. Herman, Lily, Eddie, Grandpa & Marilyn, 2. Gomez, Morticia, Uncle Fester, Lurch, Grandmama, Wednesday, Pugsly & Thing, 3.
Floyd Lawson, 4. From Bonanza the Cartwrights lived on the Ponderosa, 5. Col. Hogan, Cpl. LeBeau, Cpl, Newkirk, Sgt. Carter, Sgt.
Kinch Kinchloe, Col. Klink, Sgt. Schultz, Maj. Hochstetter, & Gen. Burkhalter, 6. Jack Klugman & Tony Randall, 7. Jane Hathaway,
8. Lassie, 9. Lost in Space 10. Sigmund & the Sea Monsters, 11. H.R.Pufnstuf, 12. Saturday Night Live!
1. Review and give written
acknowledgement of communica-
tion of claim

2. Provide necessary claim forms,
instructions and telephone numbers
3. Begin investigations as is reasona-
bly necessary
4. Provide written statement that the
claim is being investigated upon
written request from insured
5. Affirm or deny full or partial cov-
erage of claims. For partial coverage,
the $ amount or extent of coverage
6. Furnish OIR with appropriate re-
sponses to any written or oral inquiry
1. Within 14 calendar days
Unless payment is made within that
time period or failure is caused by fac-
tors beyond insurers control
2. Upon notification of claim

3. Within 10 working days of receipt
of proof of loss statements.
4. Within 30 days after proof of loss
statements have been completed
5. Within 30 days after proof of loss
statements have been completed

6. Within 21 days of receipt of inquiry
1. FL Admin Code
Ann.r.690-166.024
(1)
2. (2)


3. (3)

4. Fla. Stat. 626.9541 (1)
(i) (3)
5. Fla Admin. Code
Anne.r. 69O-166.025

6. Fla.Admin.CodeAnn.r.
69O-166.031 (5) a)
While this is no means an exhaustive list of timelines, it should be clear that responsibility to report claims and pay
claims does have limitations that need to be adhered to by all parties.
We can be reached at
10 N. Pinellas Ave
Tarpon Springs, FL 34689
727-935-4858 (Office)
877-226-9304 (Fax)
727-656-5371 (cell)
Donovan Insurance Solutions is a full lines insurance
brokerage offering benefits insurance (personal and group), personal
lines (auto, home, boat, etc.) commercial P&C (general liability,
professional liability, property etc.) and workers compensation
coverage.
HaPPY new year be safe from all of us at DIS