The essential parts of Florida House Bill 119, addressing Personal Injury Protection (PIP) benefits, were crafted in the closing days of the 2012 legislative session, sometimes behind closed doors, mostly without any public or committee vetting, and, of course, with undue influence from the insurance industry and not enough input from consumers. As has been widely reported, just as Governor Scott, the leading proponent of revising PIP, was lobbying legislators, United Group Underwriters, an affiliate of United Automobile Insurance Company, a leading Florida PIP carrier, gave $100,000 to his Let's Get to Work political committee. Not surprisingly, the end result of the bill is that consumers will receive less while PIP carriers profit more.
The beat goes on....
That said, consumers and lawyers must know the changes. Here's a brief summary of some of the important changes:
MEDICAL (unless otherwise indicated, these provisions become effective January 1, 2013):
- 14 Day Rule (Florida Statute 627.736(1)(a)1): Unless the insured receives medical care within 14 days after the motor vehicle accident from a hospital facility, emergency transport, an M.D., D.O., D.C., or D.D.S., there is no PIP coverage for any medical benefits.
- Followup medical care and services must be "consistent" with the underlying medical diagnosis provided pursuant to the services furnished within the first 14 days (F.S. 627.736(1)(a)2). Put another way, medical coverage is limited to the initial injury diagnosis.
- Medical Coverage Limited to $2500 unless "Emergency Medical Condition": The definition of "Emergency Medical Condition" is located at F.S. 672.732(16). Only the types of medical providers listed in F.S. 627.736(1)(a)3 are allowed to determine if the injured person has sustained an "Emergency Medical Condition." Chiropractors are not included in this list. Interestingly, if any medical provider listed in subparagraph 1 or subparagraph 2 determines that the injured person did not have an emergency medical condition, PIP benefits are limited to $2500. Chiropractors are listed in this group of medical providers.
- Massage and acupuncture no longer covered by PIP
OBTAINING PIP LEDGER (627.736(4)(j). The new statute only requires insurers to provide their insureds with PIP payment logs once litigation is commenced. This is silly; PIP carriers should be required to produce logs at all reasonable times including presuit. Some litigation is commenced because the insured, through no fault of his own, does not know what benefits have been paid. A ledger avoids this situation. Also, logs are needed to help resolve personal injury claims. It lets both sides know how much the amount of outstanding medical expenses. Even though current law, Southern Group Indemnity, Inc. v. Humanitary Health Care, Inc.
, 975 So.2d 1247 (Fla. 3rd DCA 2008), does not require carriers to provide ledgers presuit, they typically do as a courtesy. Let's hope the revised PIP statute does not put an end to this courtesy.
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