The changes to Florida’s Personal Injury Protection (PIP) law that took effect in 2013 were supposed to help prevent insurance fraud, but in reality those changes have ended up hurting injured motorists and other accident victims. The fact is that the current PIP law lets insurance companies charge higher rates while providing consumers with fewer benefits. Florida law requires every driver to carry at least $10,000 in PIP insurance coverage, which allows a Florida motorist to receive medical benefits even when the accident is the motorist’s own fault.

In 1972, Florida became only the second state in the nation to adopt a no-fault automobile insurance plan. The no-fault plan was offered as a viable replacement for the tort reparations system as a way to compensate injured parties swiftly after traffic accidents regardless of fault. The principle behind no-fault automobile insurance laws is a trade-off, assuring payment of medical, disability, and death benefits in return for a limitation on the right to sue for non-economic pain and suffering damages. Florida is now one of twelve states with a no-fault system for automobile insurance.

WHAT THE CHANGES ARE

One of the changes that took effect in 2013 is that persons who are injured in Florida traffic accidents now have only 14 days to seek initial medical attention. Previously, there was no time limit on seeking medical treatment. Today, if you are injured in a traffic collision in Florida and you do not obtain treatment within that 14-day window, the insurance company will compensate nothing.

Another change in the law now means that many Florida policyholders may be eligible for only $2,500 in coverage rather than the previous figure of $10,000. Under the new PIP law, although you are required to have (and pay for) $10,000 in PIP insurance, you are limited to $2,500 of the $10,000 unless you have what the statute calls an “Emergency Medical Condition” (EMC). Although the statute does not state that the EMC must be diagnosed within the 14-day period, the EMC nevertheless must be diagnosed by a licensed physician (an M.D. or a D.O.), a dentist, a physician assistant, or an advanced nurse practitioner. The law does not define – even vaguely – what an “EMC” actually is, although other Florida laws define an EMC as acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could have or will reasonably be expected to result in serious and possibly permanent dysfunction of one more parts of the body. Only victims with a diagnosed EMC are eligible for a higher limit: those with less severe injuries will receive only up to $2,500. If you do not go immediately to an ER, you can still choose to be seen by your own healthcare provider. However, massage therapists and acupuncturists may no longer treat patients under PIP under the new law.

DEFINING AN “EMERGENCY MEDICAL CONDITION”

To access the full $10,000 of your PIP insurance, it’s actually best for your medical provider to use the phrase “emergency medical condition with acute symptoms of sufficient severity, including severe pain and requiring immediate medical attention.” If your healthcare provider simply states that you were injured in the traffic accident and require treatment, you’ll be limited to $2,500 of your PIP insurance to cover that treatment. If you receive a letter from the insurance company telling you that your PIP benefits have been exhausted, they may be referring only to the $2,500 and not the full $10,000. Find out. If the insurance company is limiting your benefits to $2,500, contact an experienced personal injury attorney for help.

The new PIP law was also supposed to force insurance companies to reduce their PIP rates by at least 25 percent by 2014, but insurance companies may petition the state to be excluded from that requirement, and many insurance companies have done just that. The effect has been windfall profits for insurance companies at the same time as a significant reduction of benefits to consumers. Florida drivers pay now the nation’s fourth highest car insurance premiums, according to the Palm Beach Post.

YOU MUST SEEK TREATMENT AFTER A CRASH

Feeling no pain after an accident is common – adrenaline is running through the body and it can hide the sensation of pain. Alternately, you may feel a little pain and think you can just brush it off, but in several days or weeks that “little” pain could become serious. If you’re involved in a traffic accident anywhere in Florida, it’s imperative to seek medical attention at once – even if you don’t “feel” injured. You face not only Florida’s 14-day limit, but you should also consider that some injuries are not immediately obvious but later become serious medical conditions.

Refusing medical treatment is never a good idea for a long list of reasons. The excuses are many; fear of medical costs and fear of missing work are at the top of the list. Forget about the excuses. If you are injured or even if you think you might be injured in a traffic accident, you truly must seek medical attention at once. Immediately after receiving that treatment, discuss the accident and your injury or injuries as quickly as possible with a good personal injury lawyer. In central Florida, you can speak with an experienced Orlando personal injury attorney.

THE FUTURE OF PIP

After nearly half-a-century, one proposal the Florida Legislature will consider this year would end Florida’s no-fault automobile insurance system by 2019. It’s a legislative proposal authored by State Senator Jeff Brandes of St. Petersburg. “The system is broken and rife with fraud and abuse,” Brandes told the Palm Beach Post. “There is no amount of tweaking that will fix PIP.”

SB 1112, filed on December 11, 2015, would repeal the law requiring drivers to buy $10,000 PIP coverage. Historically, attempts to kill PIP have failed in Florida as interest groups including hospitals and insurance companies have lobbied to protect the system. Governor Rick Scott has said that he wants to preserve PIP and give reforms a chance to work. The filing of SB 1112, however, follows comments by the state’s top insurance official at an industry conference last October. “What do you do?” Insurance Commissioner Kevin McCarty said. “Here’s an idea. I’m just throwing it out there for discussion. Let’s just repeal PIP and do nothing.”

The most recent reforms to PIP law have not accomplished their stated goals. Consumer savings on overall insurance costs have been virtually zero, and a highly-publicized series of insurance fraud arrests in south Florida means that PIP fraud has not ended despite reform attempts. Nevertheless, the Florida Hospital Association’s immediate reaction to the filing of BB 1112 was this: “PIP serves as the only form of coverage for uninsured individuals who seek emergency care following an auto accident. If PIP is eliminated, coverage for uninsured motorists must be addressed through options such as medical payment policies, which provide a limited form of insurance coverage.”

• Posted on February 23, 2016
• Personal Injury