The New PIP Statute: What it is. What it is not.

For more than 40 years Florida law has required every insurance policy providing coverage in the state of Florida to provide personal injury protection to the named insured, the insured’s resident relatives, persons operating the insured vehicle, passengers in the vehicle, and pedestrians struck and injured by the vehicle. The intent of the statute was to ensure that every injured person had the access to immediate emergency and short-term medical care when injured in a motor vehicle collision.

Until recently the benefits set forth within the statute, Florida Statute 627.736, included that the insurer was responsible to pay 80% of all reasonable medical expenses as well as 60% of wage loss and specified death benefits caused by the operation of a motor vehicle.

In 2011 Legislature began a process to modify F.S. 627.736 in an effort to reduce or eliminate perceived fraudulent conduct on the part of certain persons and entities, including but not limited to 1-800 marketing entities who advertise to be lawyer and/or medical referral agencies but are frequently in business to simply send referrals to their own associated physicians and attorneys.

Although the language proposed in the original House Bill 119 appeared to be a large step toward eliminating fraudulent conduct, the final legislation passed by the Senate and House was watered down by vested interest groups.

The new statute does, however,  include significant changes that all Florida citizens should be aware of. Some of the more significant changes are as follows:

  1. 14 Days or Lose Benefits: The new statute requires the victim of an auto accident to obtain medical treatment within 14 days or forfeit his or her rights to seek coverage for medical care caused by the collision.
  2. Medical care immediately following an automobile accident must be initiated by a hospital facility or medical, dental, or chiropractic doctor.
  3. Unless the hospital or doctor reports that the patient’s condition qualifies as an “Emergency Medical Condition” the medical benefits are limited to a total of $2500.  If the condition is reported as an Emergency Medical Condition the medical benefits limit are set at $10,000.
  4. The definition of an “Emergency Medical Condition” is “a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following (a) serious jeopardy to patient health, (b) serious impairment to bodily functions, or (c) serious dysfunction of any bodily organ or part.”  Only a hospital or a medical or dental physician is allowed to make the determination of whether a patient has suffered an emergency medical condition. A chiropractic physician is not allowed to make this determination.
  5. Under the revised statute insurers are not required to pay for care for injuries not found and reported during the course of initial treatment.  For example if an accident victim suffers both head and back injuries in an auto accident but because of the severity of the head injury overlooks the back injury when talking with the emergency room doctor, under the revised statute subsequent care for the back injury may not be covered.
  6. Also under the new PIP statute insurance companies are not required to pay for massage or acupuncture care and the carrier may require its insured to submit to an examination under of regarding the insureds claim for benefits as a condition to the insurers responsibility to pay for medical bills and wage loss.  The insurer may refuse to pay the benefits if the insured fails to appear twice for said examination.

Word to the wise. If you unfortunately are injured in an automobile collision, in order to make sure that you preserve all of your  PIP benefits be sure to seek medical care within 14 days and be certain to tell the initial treating physician of each and every injury and pain you are experiencing as a result of the collision. Always better safe than sorry.

Call me if you have questions…
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Dan Dannheisser

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