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On January 1, 2013, a highly debated new PIP statute went into effect which severely limits your rights to obtain your benefits under your own insurance. This new Florida PIP 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 Florida legislature’s changes in Personal Injury Protection (PIP) law were passed under the guise of preventing insurance fraud, but in reality hurt multiple non-insurance groups in Florida, including some medical providers and especially injured motorists.
Current Florida PIP Law
Current Florida law requires all drivers purchase Personal Injury Protection (PIP) Insurance. Florida requires each driver to carry at least $10,000 in PIP coverage, which allows a Florida motorist to receive medical benefits if involved in an accident, even if the accident is their fault. 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. As part of the changes, individuals injured in car accidents will have only 14 days to seek initial treatment.
Previous PIP policy placed no time limit on treatments. Under the new law, if treatment is sought after two weeks, nothing will be reimbursed by the insurance company.
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.
Massage therapists and acupuncturists will no longer be allowed to treat patients under PIP. These types of treatment will either have to be paid for out of pocket, under a letter of protection or by health insurance.
3. PIP will only pay for follow up services if there was initial medical 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.
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:
- $10,000 for an emergency medical condition and
- $2,500.00 for treatment not for any initially diagnosed emergency medical condition.
Only those with serious injuries are eligible for the higher limit, while those with less severe injuries will receive only up to $2,500.
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:
- Serious jeopardy to the patient health.
- Serious impairment to bodily functions.
- Serious dysfunction of any bodily organ or part.
In summary, the changes to the Florida PIP statute will drastically reduce the insurance protection injured people will receive. It will also result in the denial of valid claims leaving consumers to pay their own medical bills and create extensive litigation between medical care providers and insurance companies over what is an “emergency medical condition.”
The 14-day limit sets an extremely small window for injured motorists to seek medical treatment, and thus many drivers who hesitate to seek help immediately will likely be shut out of PIP compensation. It is absolutely critical for those injured in auto accidents to contact a Canan Law attorney immediately following an accident to ensure their rights are protected.
Call us or stop by our offices at 43 Cincinnati Avenue in downtown St. Augustine if you have any questions about pedestrian accidents or personal injury cases.
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