- Posted January 18, 2013 by
Florida's new auto insurance PIP law, how it will affect us all.
The new law severely limits your rights to obtain your benefits under your own insurance policy that you pay dearly for. Finally, it now caps payment for chiropractic treatment at $2,500, excludes massage therapy and other legitimate medical treatments while increasing the amount of time in which an insurance company can pay what they consider a valid claim.
As if limiting coverage was not bad enough, this new law advocates prescription drug use (pain medication) by limiting the type of treatment (capping Chiropractic care and excluding massage therapy, etc.) and forcing the insured to resort to more of a pain management style of treatment. As Floridians we are all too aware of the serious problems we already face with prescription drug abuse in our state. This new law may very well compound that problem, all to benefit the Insurance companies and drug manufacturers.
Advocates of this new law argued that it was necessary in order to curb insurance fraud cases. However, they never offered real statistics on the amount of fraud existing. The insurance company’s statistics on fraud cases are biased to say the least as most Insurance companies suspect fraud in most every claim filed. They also argued that the new law will result in a 10% premium savings to the insured in time. The savings are, however, NOT GUARANTEED and poorly defined and in the grand scheme of things insignificant even if they actually happen. Is it a 10% reduction of your total insurance premium? or 10% of the premium for the PIP portion of your policy which is only a fraction of your total premium? Even if it was 10% off of your total premium, they are reducing your coverage by 75% in exchange for the promise of a mere 10% reduction in premiums.
PIP Law Generally:
For over 35 years Florida Law has required that everyone purchase Personal Injury Protection (PIP) Insurance. This type of auto insurance coverage (also referred to as No-Fault Insurance) provides for the insured’s medical bills to be paid by their own auto insurance company, whether or not they were at fault in the accident. Typically PIP coverage would pay for 80% of any medical bills, and 60% of lost wages, up to $10,000, in addition to providing a death benefit.
The New Law in Effect since January 1, 2013 requires:
1. The initial medical treatment must be obtained within fourteen (14) days from the accident. Waiting for the aches and pains to go away longer than 14 days may result in NO COVEAGE AT ALL FOR THE INSURED.
2. The Initial services and care are only reimbursable if lawfully provided, supervised, ordered or prescribed by a licensed physician, licensed osteopathic physician, licensed chiropractic physician, licensed dentist, or must be rendered in a hospital, a facility that owns or is owned by a hospital, or a licensed emergency transportation and treatment provider.
3. Follow up services and care require a referral from such providers and must be consistent with the underlying medical diagnosis rendered when the individual received initial services and care. For example, if you go to the emergency room right after an accident complaining of severe neck pain and you fail to mention that your back hurts too but not as much, coverage for later treatment for your worsening back condition will be denied.
4. This follow up treatment must be supervised, ordered, or prescribed by a medical doctor, chiropractor physician, doctor of osteopath, a dentist, physician assistant or ARNP (advanced registered nurse practitioner).
5. The New Law then applies two different coverage limits for PIP medical benefits, based upon the severity of the medical condition of the insured, who is paying the same or higher premiums than in 2012:
• An individual may receive up to $10,000 in medical benefits for services and care if a physician, osteopathic physician, dentist, physician’s assistant or advanced registered nurse practitioner has determined that the injured person had an emergency medical condition. An emergency medical condition is defined as a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health, serious impairment to bodily functions, or serious dysfunction of a body organ or part.
• An individual who is not diagnosed with an emergency medical condition, the PIP medical benefit limit is $2,500. Massage and acupuncture are not reimbursable, regardless of who the type of provider rendering such services.
The full text of this new law can be viewed by following this link: http://flsenate.gov/Committees/billsummaries/2012/html/215
It remains to be seen if this new law will stand once challenged in the courts. In the meantime be informed, ask your insurance agent what supplemental coverage may be available to you such as “Medical Payment” coverage. Visit my website at www.Alexlawyer99.com
By Alex Hernandez Esq.