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Changes to Florida's PIP Law Explained

By Saunders Law Group on July 08, 2014


Insurance companies lauded the changes to Florida’s PIP law (that took effect January 1, 2013), and as well they should. The law was very much a pro-insurance company piece of legislation that benefitted the insurance companies to the detriment of the consumer – Florida policyholders. The relatively new PIP law places limits on litigation, PIP benefits and the amount of recoverable money.

This law was passed under the facade of preventing insurance fraud. Florida is a no-fault state, which means that, if any person suffers injuries as a result of a car crash, each driver’s insurance coverage will cover said injuries regardless of fault. Florida’s prior PIP law required all drivers to carry basic PIP insurance with limits of $10,000.00 in coverage, but did not specify parameters for attorney’s fees or medical treatments. Insurers claimed the system was in need of reform due to numerous loopholes and flaws. Florida’s old PIP law, insurers claimed, allowed for and unwarranted vexatious litigation and excessive medical treatments.

And so the law passed. Florida Statute Sec. 627.736 now governs PIP. Specifically, this law redefines what constitutes medical treatments and covered injuries, and requires accident victims to seek medical treatment within 14 days from the date of the accident. Victims may only obtain initial treatment from certain medical professionals such as a Medical Doctor, Doctor of Osteopath, Dentist, or Chiropractic Physician, or treatment provided in a hospital or in a facility that owns or is wholly owned by a hospital. PIP only will pay for follow-up treatment if the initial treatment was obtained within 14 days of the accident and if the follow-up treatment is supervised, ordered, or prescribed by a Medical Doctor, chiropractor physician, Doctor of Osteopath, a Dentist, Physician Assistant or Advanced Registered Nurse Practitioner (or if it is to be provided by certain medical facilities). Massage therapists and acupuncturists are no longer allowed to treat patients under PIP.

If the above criteria are met, there are two levels of PIP medical benefits: 1) $10,000.00 for an emergency medical condition and 2) $2,500.00 for treatment that is not for any initially diagnosed emergency medical condition. Florida Statute sec. 627.732(16) defines an “emergency medical condition” as:

a medical condition 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: 1) Serious jeopardy to the patient health. 2) Serious impairment to bodily functions. 3) Serious dysfunction of any bodily organ or part.

While proponents of the law cite the fact that the law required insurance companies to reduce their PIP rates by at least 25% by 2014, it should be noted that the insurance companies may petition the government to be excluded from these requirements. Further, since PIP only accounts for a certain percentage of a total insurance bill, the 25% reduction does not seem to automatically equal lower premiums, and certainly not enough to compensate for the reductions experienced by the limitations of the law to policyholders. Have you noticed that your premiums are lower this year? This law has time-sensitive and strict provisions that may prevent those with injuries from recovering under PIP without following its dictates. The 14-day window within which injured policyholders must seek medical treatment alone renders it in one’s best interest to contact a legal professional immediately upon being in a car accident. The skilled, experienced attorneys at Saunders, P.A. will ensure your claim is properly considered and evaluated to determine what compensation to which you may be entitled.

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