There are significant change to the Florida PIP (Personal Injury Protection) Law that will impact everyone’s medical costs and take effect in January 2013. The good news is that there is something you can do NOW to prepare for it.
New Florida PIP Law Reduces Insurance Coverage
In May 2012, Governor Scott signed into law significant changes in Florida’s personal injury protection laws. These are the laws that protect you when you’re in a car accident and help pay your medical bills.
Supposedly, the new law was passed to help reduce insurance fraud. However, as you will see, it doesn’t really do anything to curb insurance fraud. To make matters worse, it does not even help accident victims. In fact, most accident victims will see a 75% reduction in PIP benefits even though they will continue to pay the same premium for this state-mandated coverage.
Yes, you read that correctly, 75% less coverage for the same premium!!
Important Changes To Florida PIP Law
Here are some of the main and most important changes that will take effect after January 1, 2013:
You must seek treatment within 14 days of the accident.
You are allowed to seek the full $10,000.00 in PIP benefits only if you are diagnosed with an “Emergency Medical Condition (EMC)”.
EMC is defined as:
Acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in:
SERIOUS jeopardy to patient health.
SERIOUS impairment of bodily function.
SERIOUS dysfunction of any bodily organ or part.
Only an M.D., D.O., P.A or ARNP is authorized to make the diagnosis of EMC.
Massage therapy, even by a licensed massage therapist, as well as acupuncture treatment, is NOT reimbursable at all under the new PIP statute.
If you are not diagnosed with an EMC or if you want to seek treatment initially with a chiropractor, then you only get to use up to $2,500 of the PIP benefits that you have paid for.
You get $0 in PIP benefits if you seek treatment beyond the 14 days after the motor vehicle accident no matter how serious the injury.
And finally, probably most importantly, considering the reason for the new rules was the desire to reduce fraud and thus save customers money, the New Florida PIP bill failed to incorporate the 25% rate rollback for consumers.
In the end, the insurance companies got a guaranteed benefit while the citizens of Florida got no guarantees at all!
How The New Florida PIP Law Could Effect You
So let me try to summarize this in real life ways that are easy to understand.
Assume that you currently have $10,000 of insurance benefits, called Personal Injury Protection (PIP), to cover you and your family for medical bills as result of a car accident. This is state-mandated coverage and you must have it to drive on the roads of Florida.
Under the new law, you must still pay for $10,000 of benefits but in most cases you will only receive $2,500 if you are in a car accident. Even though in probably 95% or more of the cases an insurance company will never have to pay $10,000 of medical bills, you must still pay for that amount of coverage. Very unfair!
The only way to be covered for $10,000 the benefits is to have an emergency medical condition which was defined above. Many, many people, and all the patients I see in my practice, do indeed have significant injuries, pain and disability but they do not meet the definition of an emergency medical conditions.
To make matters worse, the new law has in it that you must see a doctor within 14 days or you have no benefits at all! This is terrible because I have personally seen so many thousands of car accident patients over the years and many of them wait a few weeks or so, sometimes even more than a month, before they actually seek treatment. This is common because with the types of injuries we see, many patients have soreness and spasm etc., and they wait a little while to see if it will go away on its own. Or they have their spouse rub their shoulders. Or they take a hot shower or use ice packs. Or they take over-the-counter medications like Advil or Tylenol. Then, after a few weeks when the pain is not going away or is in fact getting worse, they decide to seek medical attention. Under the new Florida PIP law, there would be absolutely no coverage. This is a shame!
If the patient does seek treatment within 14 days, for typical sprains, strains, herniated discs and so forth, they would only have $2,500 of coverage (but again paid for $10,000).
In our office, as in many, our patients benefit from massage therapy treatments. Since many of the injuries involve damage to the muscle structures in and around the spine, massage is of great therapeutic value and helps people tremendously. Unfortunately, under the new law massage therapy was completely cut out. There are no benefits at all for massage. This is truly a shame! (same for acupuncture).
There are more bad things in this law – like an insurance company doesn’t have to pay any bills for you until you undergo an Examination Under Oath (EUO), and this is basically a recorded statement by you in which they ask you a bunch of questions about your injury, and also seek to find out if there is any fraud associated with your claim. They have freedom to do this whenever they want and can even do it on all cases, holding up payments and so forth. It’s definitely not a good thing that insurance companies can do EUO’s for ANY reason, at ANY time, on EVERY case if they choose to.
Another bad thing is that insurance companies can delay paying claims for up to 60 days if they “suspect” any kind of fraud. The new law doesn’t define what “suspect” really is. Therefore, an insurance company can make up ANY reason they want and say they suspect fraud and keep delaying claims up to at least 60 days.
In summary, Governor Scott pushed this bill through, and as many out there have said, it’s basically an insurance company “wish list”. They basically got every wish they wanted. The consumer still has to pay full premium for $10,000 of coverage, but the insurance company in 95% or more cases, will only have to pay $2,500. This will result in billions of dollars of additional profits to the insurance companies. Insurance companies can delay and deny claims, almost at will, based on wanting to do “EUO’s” and having “suspicion” of fraud. And lastly, there is nothing in the new bill that guarantees any rate reduction for Floridians. It’s ironic because the purpose of the bill was supposed to curb fraud and stop the rising cost of personal injury protection coverage. It doesn’t do either!
How To Protect Yourself Against 2013 Florida PIP Changes? Get Med-Pay NOW.
To protect yourself and your family, I strongly urge you to get an optional coverage called “Medical Payments” coverage.
What is Medical Payments Coverage (Med-Pay)?
This is an optional coverage that is generally inexpensive and supplements Personal Injury Protection. Medical payments will pay the remaining 20% that is not covered by PIP as well as continue to pay medical bills at 100% (up to the limit) once PIP has exhausted (once all the $2,500 or even $10,000 has been paid out).
Quite often, PIP coverage exhausts quickly if emergency room or hospital services are used, with no coverage or little coverage left for treatment after release from the hospital. Medical payments coverage also extends coverage to passengers injured while in your vehicle.
What To Do Next
Summary: Make sure to get Med-Pay and get the maximum you can. Usually $20,000 in coverage.
If you have any questions about the New PIP Law or Med-Pay, feel free to send us a message using our contact form and select “Florida PIP Changes” as the Category.