Florida's New Personal Injury Protection (PIP) Law Goes Into Effect January 2013

On January 1, 2013 a highly debated new PIP Statute, which severely limits your rights to obtain your benefits under your own insurance went into effect.  This new law, which will create extensive additional litigation between insurance companies and medical care providers, is much more favorable for insurance companies than the people who are injured in automobile accidents. The following will highlight the new law.  As you will note, the new law adds numerous additional hurdles to obtain the full $10,000 in coverage.  The new law significantly reduces insurance coverage for Floridians in a number of ways. It caps payment for chiropractic treatment at $2,500 and increases the amount of time in which an insurance company can pay a valid claim. It also allows for the use of EUOs by insurance company lawyers. An EUO is an Examination Under Oath which is a formal statement usually given with a court reporter present. Failure to attend an EUO can result in a denial of your benefits.

This significant reduction in coverage did not bring any savings to Florida drivers. The new PIP statute does not require insurers to charge any less for PIP coverage. There is mention of a 10% reduction in the law but it is not guaranteed. Insurers can skip the rate cut if they give a 'detailed explanation' as to why price reduction is not possible.  Have you seen a reduction in our insurance premiums?  I doubt it.

Current PIP Law

Current Florida Law requires that everyone purchase Personal Injury Protection (PIP) Insurance.   The idea when this law was originally enacted in the early 70’s was that all individuals would have a guarantee that their medical bills would be paid whether or not they were at fault for the accident.  PIP coverage pays for 80% of any medical bills, and 60% of lost wages, up to $10,000, and also provides a death benefit. 

New Law In Effect January 1, 2013

1. The initial medical treatment must be obtained within fourteen (14) days from the accident.  So, if you don’t see a medical provider within 2 weeks of the accident, no PIP benefits.
2. The initial medical treatment must be lawfully provided, supervised, ordered, or prescribed by a licensed physician (M.D.), D.O. (Doctor of Osteopath), Dentist or Chiropractic Physician, or provided in a hospital or in a facility that owns or is wholly owned by a hospital.
3. Follow up treatment: PIP will only pay for follow up services if there was initial medical treatment within fourteen (14) days and the following occurs:
   1. the follow up services are on the referral from an M.D., D.O., D.C and;
   2. the follow up services are consistent with the underlying medical diagnosis rendered on the initial visit.
4. This follow up treatment must be supervised, ordered, or prescribed by a medical doctor, chiropractor physician, doctor of osteopath, a dentist, physician assistant or ARNP (advanced registered nurse practitioner).
5. If the above referenced criteria are met, there are two (2) levels of PIP medical benefits:
   1. $10,000 for an emergency medical condition and
   2. $2,500.00 for treatment that is not for any initially diagnosed emergency medical condition.
6. The Statute defines “emergency medical condition” as: medical conditions manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention would be reasonably expected to result in any of the following:
   1. Serious jeopardy to the patient health.
   2. Serious impairment to bodily functions.
   3. Serious dysfunction of any bodily organ or part.

Massage therapy and Acupuncture are not reimbursable under the new PIP Statute.  So, these types of treatment will either have to paid for out of pocket, under a letter of protection, or by health insurance.  Doctors will generally treat injured people under a letter of protection for services not covered by PIP.  A letter of protection is basically an agreement by the medical provider to forego collection of the medical bill until the lawsuit is resolved.  In return for that, the attorney is agreeing that the medical care provider will get paid out of the proceeds of the recovery.

In summary, the changes to the Florida PIP statute does not save consumers any money and instead, drastically reduces the insurance protection injured people receive. It  also results in the denial of valid claims leaving consumers to pay their own medical bills and creates extensive litigation between medical care providers and insurance companies over what is an “emergency medical condition.”

By Zachary Leacox