NEW FLORIDA PIP LAW
The current law requires all owners of motor vehicles in Florida to carry PIP insurance which covers 80% of reasonable medical bills and 60% of lost wages as a result of injuries sustained in an accident, up to a limit of $10,000.
The new PIP law which went into effect on January 1, 2013, requires vehicle owners to carry the same $10,000 PIP coverage, but provides some distinct changes or rather, hurdles. Primarily, the law requires a party injured in a motor vehicle accident to seek treatment at a hospital or with a doctor within 14 days of the date of accident. Additionally, the doctor or hospital must determine that you have an "emergency medical condition" . An emergency medical condition is defined as a medical condition manifesting itself by symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following: a)serious jeopardy to patient health b) serious impairment to bodily functions c) serious dysfunction of any bodily organ or part
This definition is at best ambiguous, and I predict it will lead to many lawsuits asking the courts to define this provision.
In the event injured driver/passenger does not get a doctor, dentist, physician assistant or advanced registered nurse practitioner to determine that they have an emergency medical condition they only get $2,500 from their PIP insurance policy to apply toward medical coverage.
Furthermore, the statute excludes from medical benefits any services provided by a licensed massage therapist or licensed acupuncturist. So even if a doctor refers you or acupuncture treatment or massage therapy, these services are not reimbursed at all under the new law.
Does the new law benefit consumers?
- It will not necessarily reduce insurance premiums. The statute does provide that if the insurance company requests a rate in excess of a 10% reduction of its overall base rate for PIP insurance, they must include a detailed explanation of the reasons for not achieving a 10% reduction.
- It is an advantage to the insurance industry because their payout exposure for PIP claims will be reduced from $10,000 to $2500 or even zero if the insured does not seek treatment with 14 days.
- The new law does not eliminate accident clinics or for-profit referral services such as 411 pain.
- Accident victims who suffer legitimate injuries will not have sufficient coverage to pay for medical bills if the injury is not ruled an emergency medical condition.
- The new statute will open up the floodgates of litigation for an interpretation of the definition of what an emergency medical condition really is.