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Florida’s Insurance PIP Laws are Reformed

Insurance-00158984.jpgIn 1971, Florida became the second state in the country to adopt a no fault automobile insurance plan which took effect on January 1, 1972. From a policy perspective, the no fault plan was offered as a viable replacement for the tort reparations system as a means to quickly and efficiently compensate injured parties in auto accidents regardless of fault.

In other words, a trade off was implemented. On the one hand, those that were injured in accidents were assured of payment of medical, disability (wage loss) and death benefits, regardless of fault. On the other hand, those that were injured in accidents were restricted on their ability to sue for non-economic damages (pain and suffering.).

Simply put, PIP was implemented to ensure that anyone injured in a Florida car accident would have access to medical care and treatment as well as recover lost wages regardless of who actually caused the accident.

As a result, all Florida car and truck owners are required to have PIP insurance. PIP is designed to pay 80 percent of an injured person’s medical bills and 60 percent of lost wages up to $10,000 regardless of who or what caused the car accident and where and when they received medical care and treatment.

However, a law passed this past legislative session that will alter Florida’s PIP system for all Floridians. Sparked in large part due to the perceived increase in fraud in the filing of PIP claims, Florida’s governor signed into law some sweeping changes to Florida’s PIP laws.

Florida’s new PIP law will require anyone injured in a car accident who wishes to have their medical bills paid by their PIP insurance, to seek medical care and treatment within 14 days of the accident. And those injured are not free to seek care from just any health care provider for just any ache or pain. Now only medical doctors, osteopathic physicians, dentists, physician’s assistants or advanced registered nurse practitioners are approved to for PIP reimbursement, provided that they also find that the injured victim has an “emergency medical condition.” The law specifically excludes treatment given by either a chiropractor or acupuncturist.

The new law also has teeth, giving the insurance companies the right to question you under oath about the care and treatment you received and why. These interrogations are referred to as EUOs but they are conducted by insurance fraud adjusters. If the EUO is not enough, insurance companies are not legally permitted to force the injured insured to submit to a physical examination by a doctor of the insurance companies choosing and these examinations are called “Independent Medical Examinations.” Failure to attend an IME can result in having the PIP benefits denied.

This new legal scheme that was enacted may be well intended, but it misses the mark. The average person injured in a car accident will likely not receive the care and benefits they paid for as part of their PIP coverage in their policy. Thus, this will ensure that the insurance companies pay less in claims while keeping more of your insurance premiums since they have just made it more complex and difficult to submit a claim all in the name of saving a dollar to the detriment of all hard working Floridians.

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