In the waning days of the 2012 Legislative session, Florida lawmakers narrowly passed significant revisions to the Florida Personal Injury Protection (PIP) statutes. The clear intention of the revisions was to discourage the use of PIP insurance benefits to the detriment of the consumer and the benefit of the insurance companies.
Insurance companies and business advocates insisted that the PIP law was being abused by certain people who in some cases staged car accidents. The people in the car accident then sought medical treatment from medical providers who ran up large medical bills for which PIP was responsible. Insurance companies used these examples of fraudulent claims to justify sweeping changes to the PIP laws that now result in damage to the vast majority of Florida’s citizen motorists who are legitimately injured in a car accident. This demonstrates the typical Legislative overreaction to a small but publicized problem which now results in law abiding citizens potentially losing valuable medical services and a method of paying for those services.
The changes to the PIP law take effect on January 1st, 2013. Injured people who want to take advantage of the PIP benefits for which they have been paying premiums, now must seek approved medical treatment within the first fourteen (14) days of an accident or be forever barred from using PIP insurance for valid, accident related medical treatment. What happens to that person whose schedule will not permit medical treatment from an “approved” medical provider within the fourteen (14) treatment window? What about that person whose doctor cannot see them within the fourteen (14) day window?
“Approved” medical treatment providers include emergency services as determined by a licensed medical physician, osteopath, dentist, physician’s assistant or registered nurse practitioner. Chiropractic services are limited to no more than $2500.00 and then only if chiropractic services have been recommended by an “approved” medical treatment provider. No longer are massage therapists and acupuncturists “approved” treatment providers. Thus, those individuals who seek a more holistic approach to wellness are likely excluded from many treatment options. If those individuals have health insurance, such insurance may still be available to cover holistic treatment options. Those without health insurance will be forced to pay out of pocket for these services or go without treatment.
Finally, only “Emergency Medical Conditions” qualify for payments above $2500.00. Such a condition is defined as (a) serious jeopardy to patient’s health; (b) serious dysfunction of an organ or body part; and, (c) serious impairment to a bodily function. Obviously, these terms will generate much litigation as to exactly what types of treatment will qualify.
At the end of the day, the insurance companies are supposed to roll back their rates on that portion of the automobile insurance premium that represents PIP coverage. The roll back is up to 25% of PIP’s portion of the insurance dollar; however, the insurance companies can avoid even this modest reduction in premium if they can provide a “detailed explanation” of why the rates were not reduced. Wonder how difficult it will be for an insurance company to avoid reducing rates in this insurance friendly Legislature?
Hopefully, the Florida consumer will pay attention to the continuous erosion of individual rights in favor of insurance companies which seem intent on accepting premium dollars in exchange for smaller and more narrow coverages for the insurance consumer.