Gov. Scott, as promised at the beginning of his term, made rising insurance costs a top priority. So, when the auto insurance reform laws were passed on the last day of the 2012 legislative session, he didn't hesitate signing them into law. The goal, crack down on the select few committing auto accident fraud and thereby lower insurance rates. The result however may be that innocent Florida residents involved in automobile accidents may be denied their $10,000.00 PIP benefit. Whether you know it as HB-119, the PIP Reform Laws or the Auto Accident Reform law, Florida Statute 627.736 is bound to be the subject of litigation when the changes take effect in just under a month.
A little background will help make sense of these changes to the No-Fault benefits, commonly known as PIP or Personal Injury Protection. In 1971, Florida became the second state in the U.S. to enact No-Fault insurance laws as a consumer protection. The law eliminated the need for establishing fault after an accident so the injured party could receive immediate financial or medical assistance from their own insurance. Before PIP insurance, an injured party with or without health insurance faced mounting medical bills, calls from debt collectors, damaged credit and more importantly untreated pain and injuries.
As it stands today all Florida residents must carry a minimum of $10,000 Property Damage insurance (to cover damage to someone else's property) and $10,000.00 of PIP or No-Fault insurance (to immediately help you). There is no mandate to carry Uninsured Motorist coverage or even Bodily Injury coverage. PIP Insurance covers up to $10,000 for medical treatment, partial wage loss and certain other out of pocket expenses you may incur immediately following an automobile accident.
As a Florida Resident there are five things you must know about the Jan. 1, 2013 changes;
If you are injured in an accident, you must seek medical treatment in 14 days or lose all of the $10,000 coverage you paid for and are required to carry. That means if you are injured and you either procrastinate or are unable to pursue treatment in that timeframe because of work, kids, doctor's schedule or any other reason, you will have to pay out of your own pocket.
Even if you do get treatment within the 14 days, that medical provider must diagnose you with an "Emergency Medical Condition" or else you are only able to use $2,500.00 of the $10,000 PIP coverage. An Emergency Medical Condition is defined as : (a) Serious Jeopardy to patient health (b) Serious impairment to bodily functions (c) Serious dysfunction of any bodily organ or part.
Chiropractors may not make an "Emergency Medical Condition" determination for their patients. Instead, only specified types of medical providers listed in the statute can designate "EMC" status.
Payment owed by the insurance company for injuries from an accident is limited to the initial diagnosis. If you didn't recognize the severity of an injury until a week after your medical visit the insurance companies may not have to pay for that treatment, even if the doctor attributes the injury to the accident.
Massage therapy is no longer covered by PIP insurance, even if it is prescribed by your doctor. The legislators have also created a new definition of "massage" which does not coincide with the current medical coding of "massage."
Florida's PIP laws have been reformed in 1998, 2001, 2003, sunsetted in 2006, then revived in 2007 and now "reformed" again in 2011. Each time, unfortunately, the results have been no reduction to auto insurance costs and more insurance companies being legally able to deny coverage to their insured's either directly or by refusing to pay for medical treatments provided by our local doctors and hospitals.
Parts of the law may be found unconstitutional in the near future, but until then you need to know the new responsibilities you have as a Florida resident. You can go to Florida Senate Web site to read the full HB- 119 or a summary of the changes at www.flsenate.gov
- Michael C. McQuagge is a Board Certified Civil Trial Attorney based in Fort Myers