Florida’s new Personal Injury Protection (PIP) law takes place effective January 1, 2013. The new law was pushed by the insurance industry, and passed with the assistance of Governor Rick Scott. The law was passed under the guise of curbing fraud, but in reality is a huge boom for the insurance industry. Interesting is that a guarantee to reduce insurance premiums was removed from the new law. In fact insurance companies are already on record as saying, it will take years before the impact of the new law is felt. Those of you who remember that medical malpractice reform was passed by scaring citizens into believing that doctors premiums must be reduced or doctors would leave the state. Well premiums never were reduced!
Everyone who drives a car knows PIP is a required in Florida. PIP covers 80% of any medical bills up to $10,000.00; 60% of loss wages and also provides a death benefit. Beginning January 1, 2013, I you are injured in a car accident you must obtain treatment within 14 days or you will be denied PIP coverage. That treatment can be with M.D., D.O., Dentist, Chiropractor or provided in a hospital or in a facility that owns or is wholly owned by a hospital. Follow up treatment must be supervised, ordered, or prescribed by a M.D., Chiropractor, D.O., Dentist, Physician Assistant or ARNP.
One of the big changes is in the benefit available. If you obtain treatment with the 14 day period there are 2 levels of PIP medical benefits available to you:
$10,000 for an emergency medical condition; or
$2,500.00 for non emergency medical condition.
The law defines “emergency medical condition" as follows: medical conditions manifesting itself by acute symptoms of sufficient severity, which may include sever pain, such that the absence of immediate medical attention would be reasonable expected to result in any of the following:
Serious jeopardy to the patient health;
Serious impairment to bodily functions; or
Serious dysfunction of any bodily organ or part.
So what does that mean? It means insurance companies want you to pay for $10,000.00 in coverage, but force you to only be able to use $2,500.00. Insurance companies have the ability to send you to a provider they select to challenge you diagnosis. Rest assured the provider they select will be one they use regularly.
The second major change to the law is that, massage therapy and acupuncture will not paid under the new PIP law regardless of the diagnosis, and regardless of whether a M.D., Chiropractor, D.O., Dentist, Physician Assistant or ARNP prescribes it. In other words, the insurance company is deciding the type of treatment you need.
Whether you retain a lawyer or not, you should at least consult with an attorney before talking to the insurance company, and/or giving a recorded statement.
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