Florida State’s New P.I.P Law

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Are you aware of what it is and how it is going to effect your practice?

Are you prepared to handle the demands?
This new law will take effect January 1,2013. In case you haven’t heard about it yet we thought we would provide some important information for you to be aware of and prepared for.

What are PIP benefits in Florida (pre-January 1, 2013)?

Florida first enacted what is known as personal injury protection (PIP) in 1971 as a way of guarantying individuals that their medical bills, whether they were at fault for the crash or not, are paid. In exchange for that guaranteed payment, the Florida Legislature enacted a restriction on lawsuits that would only allow individuals to seek non-economic damages (pain and suffering) if they received a permanent injury.

More specifically, an individual’s automobile insurance policy would be the first to pay for their medical bills and lost wages via their personal injury protection (PIP) benefits. An individual’s insurance would be responsible for 80% of their reasonable medical expenses related to the accident and 60% of their lost earnings up to $10,000.00, notwithstanding any deductible.

What are changes to PIP law in Florida (post January 1, 2013)?

On January 1, 2013, Florida’s new PIP law takes effect. Some changes to the PIP law include:
1.  Starting January 1, 2013, the initial treatment must be obtained within fourteen (14) days from the accident.

2. That “initial treatment” and care must be lawfully provided, supervised, ordered, or prescribed by a licensed physician, D.O. (Doctor of Osteopath), Dentist or Chiropractor or provided in a hospital or in
a facility that owns or is wholly owned by a hospital.

3. Follow up treatment: PIP will only pay for follow up services if there was an initial treatment within fourteen (14) days and the following occurs:

1.  The follow up services are referred from an licensed physician, D.O, Dentist, Chiropractor, supervised Physician’s Assistant
or Advanced Registered Nurse Practitioner; and
2.  The follow up services are consistent with the underlying medical diagnosis rendered on the initial visit.

4. If the thresholds are met, there are two (2) levels of PIP medical benefits:

1. $10,000 for an emergency medical condition; and
2. $2,500.00 for treatment that is not for any initially diagnosed emergency medical condition.

5. Up to the full $10,000 PIP medical benefit is available only if a licensed physician, D.O, Dentist, supervised Physician’s Assistant or Advanced Registered Nurse Practitioner determines that the insured
has an “emergency medical condition.” Otherwise, the PIP medical benefit is limited to $2,500.

6. Massage therapy and acupuncture are not reimbursable under the new PIP Statute (change from old PIP laws).

7. A Chiropractor cannot diagnose an emergency medical condition and thus will be limited to $2,500.00 in reimbursements for services provided unless referred by one of the specified medical professionals
listed above.

The Statute defines “emergency medical condition” as:

medical conditions manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention would be reasonable expected to result in any of the following:
1.   Serious jeopardy to the patient health.
2.   Serious impairment to bodily functions.
3.   Serious dysfunction of any bodily organ or part.

Until the term “emergency medical condition” is more clearly defined by the Courts, it is crucial to retain an experienced personal injury attorney to fight to secure these higher benefits in “gray-area” matters.

“WINNERS” under the new PIP laws

•Insurance Companies. The new PIP laws should keep the insurance companies flush with cash for years to come.

•  D.O.s (Doctor of Osteopath) and Dentists. Non-traditional / Holistic medical professionals (think Chiropractors and Acupuncturist) will have no choice but to align themselves with D.O.s in order to get treating patients qualified under  the new guidelines.

•Orthopedic Surgeons. Once chiropractors “run through” the first $2,500.00 in benefits for “non-emergency” conditions, patients will be recommended for more expensive / invasive medical treatment from Orthopedic Surgeons and/or physiatrists.

•Individuals covered under Medicare or Medicaid or have excellent medical insurance. This is presuming that auto insurance premiums decrease as a result of the new PIP laws.

LOSERS under the new PIP laws

•ALL INDIVIDUALS, especially individuals without medical insurance. Although championed as a way for auto insurance companies to reduce fraud, and in turn, reduce premiums, the accident and injury attorneys Lyons, Snyder & Collin do not foresee this transpiring, especially in the short-term. The new PIP laws include a 10% rate reduction (not guaranteed). Any insurer who offers PIP but does not provide its consumers a 10% rate reduction must provide an explanation (i.e. financially infeasible).

•Unsavy or naïve accident victims that are not familiar with the 14 day initial treatment requirement – especially considering that some back pain does not fully manifest itself for weeks.

•Chiropractors, Massage Therapists, and Acupuncturists

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