Big Changes: What You Need to Know About FL PIP Law

Florida is set to enact its new PIP laws on January 1, 2013. The Florida Legislature has enacted a new PIP Statute which severely limits your right to obtain benefits under your PIP insurance. Additionally, it gives insurance companies numerous ways of not lowering their rates. In effect, this is a huge boom for the insurance industry and a gift from the Florida Legislature and Governor Rick Scott. The following are the changes to Florida’s PIP Law that will take place on January 1, 2013. But first, a quick definition of what PIP or Personal Injury Protection is in the State of Florida.

Personal Injury Protection (PIP) is a type of insurance that is required under all car insurance policies in Florida. This covers 80% of any medical bills up to $10,000.00; 60% of lost wages and also provides a $10,000.00 death benefit. Florida first enacted what is known as the PIP Statute in 1971 as a way of guarantying individuals that their medical bills, whether they are at fault for the crash or not, have a large number of their medical bills paid. In exchange for that guaranteed payment, the Legislature enacted a restriction on lawsuits that would only allow individuals to seek non-economic damages (pain and suffering) if they received a permanent injury. This Law did not and has not affected somebody’s ability to recover economic damages, which are lost wages, medical bills, and loss of support and services. When this Law was first enacted, a number of the provisions were struck down as being unconstitutional by the Florida Supreme Court, but in effect, the system has been in place since the early 1970s and until recently has worked very well and helped a tremendous amount of individuals having medical bills paid during an auto accident.

NOTE: What I am about ready to outline does not go into effect until January 1, 2013, therefore up until that date, Florida’s current Personal Injury Protection (PIP) Laws do apply.

Starting January 1, 2013, the initial treatment must be obtained within fourteen (14) days from the accident.
That “initial services” and care must be lawfully provided, supervised, ordered, or prescribed by a licensed physician, D.O. (Doctor of Osteopath), Dentist, or Chiropractic Physicians or provided in a hospital or in a facility that owns or is wholly owned by a hospital.

Follow-up treatment: PIP will only pay for follow-up services if there were an initial treatment within fourteen (14) days and the following occurs:

the follow-up services are on the referral from an M.D., D.O., D.C and;
the follow-up services are consistent with the underlying medical diagnosis rendered on the initial visit.

This follow-up treatment must be supervised, ordered, or prescribed by a medical doctor, chiropractor physician, doctor of osteopath, dentist, physician assistant, or ARNP (advanced registered nurse practitioner)

if the thresholds 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.

The Statute defines “emergency medical condition” as: medical conditions manifesting 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:

Serious jeopardy to the patient health.
Serious impairment to bodily functions.
Serious dysfunction of any bodily organ or part.

Additionally, massage therapy and acupuncture are not reimbursable under the new PIP Statute.

The term “emergency” and “emergency medical condition” as it is defined in the Statute could leave enough room to allow for more than the $2,500.00 of treatment. However, this issue needs to be heavily litigated and defined and the Courts are going to have to make the final determination on that matter.

Please note: that doctors’ offices will generally take what is known as a “Letter of Protection” for any services that are not covered under PIP. Just because an item is not covered under PIP is only a way for these Laws to save the insurance companies money, and increase their profits and has nothing to do with whether the service is reasonable, necessary, and related to an injury someone received in an auto accident.

Related Articles