Perhaps the most controversial bill the legislature passed this year is the personal injury protection insurance (PIP) reform bill, which was quite literally passed at the final hour of the final day of session. This bill is waiting for Governor Scott’s signature, which should not be a problem since the governor has strongly supported—and some would argue even lobbied for—PIP reform. The majority of the bill’s content will take effect on 1 July 2012, while one large part will not take effect until 1 January 2013. (The bill was signed into law on May 4, 2012)
Florida has had a PIP law in place for 40 years and has been revised several times. The 2012 Florida legislature has revised it once again. This time we find the PIP law still in place in principle but with many substantive changes that almost make it a brand new law.
The legislature claimed that comprehensive reform of the state’s no fault car insurance program is necessary to reduce fraud and therefore premiums. Apparently, people have taken advantage of the PIP benefits by creating fraudulent accident and injury claims to collect the $10,000 PIP benefit through their own insurance carriers. Florida leads the nation in staged accidents, most notably in Miami and Tampa. The legislature passed the 2012 PIP reform bill to address the issue of fraud on PIP.
How? By implementing policies and procedures that make collecting legitimate PIP benefits much more difficult. Here are some of the changes to PIP that will impact accident victims:
• An auto accident patient must receive medical treatment from a legitimate medical care provider (as defined by the statute) within 14 days of the accident to qualify for PIP benefits.
• A patient must have a physician, osteopath, dentist, supervised physician’s assistant, or advanced registered nurse practitioner officially diagnose him with an “emergency medical condition” to receive the entire $10,000 PIP benefit; otherwise, the patient is limited to $2,500.
• A patient must have a referral from a physician, osteopath, chiropractor, or dentist before seeing another doctor for follow-up treatment to qualify for PIP benefits.
• Massage therapy and acupuncture are no longer covered under PIP as treatment options.
• A patient can receive medical treatment under PIP only at licensed medical clinics and facilities. A patient who submits a PIP claim from a non-licensed clinic is not only ineligible for PIP benefits but is also subject to criminal penalties.
• An insurance carrier typically has by law 30 days after submission of medical bills to provide PIP benefits to the insured. The PIP reform bill now allows a carrier to delay making PIP payments for 90 days if it decides completely on its own that the policyholder’s claim might be fraudulent and thus needs to be investigated.
• An insurance carrier may lawfully compel a policyholder to take an examination under oath (EUO) regarding his or her accident claim as a condition to receiving PIP benefits. A policyholder who fails to comply with an EUO is owed zero benefits.
• If a patient twice fails to appear for an independent medical examination at the carrier’s initiative, there is a strong presumption that the carrier is no longer responsible for benefits.
The PIP reform bill also places many new provisions regarding how attorney’s fees are awarded in a PIP dispute. These provisions decrease potential fees that attorneys can collect, which serves as a disincentive for filing a civil lawsuit for PIP benefits.
Stay tuned as we report further on the full impact of the PIP reform.
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Hello, I am Jeffrey Meldon. As an accident attorney, I strongly believe that public education is the first step in the prevention of an accident or in the recovery from one.
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