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What is the New Florida PIP Law?


New Florida PIP Law: A Victory for The Car Insurance Companies

Florida’s new Personal Injury Protection (PIP) law HB 119, passed by a slim margin in the Senate on March 10, 2012. The new PIP law is hailed as a victory for insurance companies due to several provisions placing limits on the amount of PIP benefits, litigation and monies paid out during claims.

These personal injury law suits are blamed Florida governor Rick Scott and auto insurance companies believe that personal injury protection lawsuits are the cause of increased insurance rates. Florida is a no-fault state and requires all drivers to carry the basic PIP insurance with limits of $10,000.00 in coverage but lacks outlined parameters on types of medical treatments covered or attorney’s fees limits. This system is, according to insurers, full of loopholes and flaws and was in need of reform. The old system allowed for “excessive medical treatment” and “opportunities for unwarranted litigation”.

What does the new PIP law provide for car accident victims?

The new bill provides strict and rather biased definitions of what constitutes medical treatments and covered injuries. Accident victims now must seek medical treatment within a narrow 14 day (two week) window from the accident and only from specified licensed medical physicians. Acceptable treatment providers include emergency services determined by a physician, osteopath, dentist, physician’s assistant or registered nurse practitioner. Chiropractor visits are limited to $2,500 and can only be sought after a referral from an acceptable health care provider.

The new law excludes massage therapists and acupuncturists, which were previously covered under the old PIP law. The stringent nature of the new Florida PIP law greatly cuts the funds available for those injured in auto accidents and is worrisome to many consumer protection groups. Also, the law greatly limits the types of treatment covered under PIP. Those who seek a more holistic, less intrusive type of treatment are left out by the new law, a disconcerting reality to many. Florida Auto accident victims will be forced to rely on their health insurance rather than the $10,000 of medical benefits they were previously entitled to receive.

The new bill contains provisions for the reduction of consumer rates, which seems like a victory for consumers. The bill entails a plan for insurers to roll back rates 10% by October 1, 2013 and 25% by January 1, 2014 or to provide a “detailed explanation” as to why the rates were not reduced. However, the proposed rate reduction does not seem to equal out in policy premiums, a questionable fact which has left many consumer advocates puzzled. Furthermore, PIP accounts for a relatively small percentage of a total premium, which makes the 25% reduction rather insignificant.



41 comments

Wednesday, October 17, 2012
Mike:

You do not need to see a M.D. first. You can go right to a Doctor of Chiropractic.

Friday, December 28, 2012
Chris:

I am a Physical Therapist that has a few PIP cases now, can we continue to see them and get paid?

Chris

Wednesday, January 2, 2013
Attorney Greg Dell:

Chris,

The law is so new that is difficult to know how the insurance company is going to handle patients that had claims before the law change date. In our opinion you should be able to continue billing under the old pip law, but you should call the specific PIP Provider and ask their opinion.

Friday, January 4, 2013
Jose A. Justiniano Sr.:

Thank you very much for this good information. Keep up the good work.

Monday, January 7, 2013
Linda Holcomb:

Saw local agent at State Farm who said reductions would not occur until your billing date – she knew little about the expected reductions – but everyone would know that same agency is advertising reductions – which I suppose I am not entitled to? In any case, my car insurance is higher than my house insurance, even a newer car proposal elicited an INCREASE in my premiums!

Monday, January 7, 2013
Robert Peters, D.C.:

I find it mind boggling that by definition: Acceptable medical treatment providers are a MD’s, osteopaths, dentist, physician’s assistant or registered nurse practitioner. How is it that dentists who’s scope is ONLY the oral cavity, are more qualified than a Chiropractor that specialises in Musculoskeletal issues and is a Licensed Physician in the State of Florida?

Tuesday, January 22, 2013
Dr. Smith:

Thank God it’s the start to the end of the scam run by local attorneys and chiropractors. An attorney can no longer refer a client to his/her chiropractor that’s in his pocket to provide a bogus report that the client has a back injury. Everyone has degeneration in their spine – it’s called ageing.

The beauty for the attorneys running the scam is it’s usually not worth the insurance companies’ time to fight it so they just pay the $10,000 and pass that onto the policy holders.

Thursday, January 24, 2013
Jack PT:

What this new law does is to eliminate the DC from sucking the system dry. The DC will see the patient until all the insurance benefits run out and then discharge the patient. Unlike physical therapy or medical doctors whose goals are to treat the patient by healing them not sucking their insurance dry and then tell them there is nothing else that can be done and then send them back to the attorney that orginally referred them to the DC. Bless this new law.

Saturday, April 6, 2013
Ronald:

I’ve been paying over 14 years on my vehicle to the same insurance company. Now my Rates increased this past month on the new Renewal policy, and I was recently hurt inside my vehicle, and having to rely on these new PIP rules that are nothing but an excuse for the insurance company’s to still collect more in Premiums, and pay out even less.

(The bill entails a plan for insurers to roll back rates 10% by October 1, 2013 and 25% by January 1, 2014 or to provide a “detailed explanation” as to why the rates were not reduced.)

The above is nothing but a JOKE, we already know the insurance industry will provide a detailed explanation and the Premiums will still rise,

Just another example of our Politicians that’re abusing their authority after being elected. The recent arcade law that’s about to be Signed and passed to shut down these arcades that millions in Florida have enjoyed playing.

A person that pays PIP for years, and when it’s time to depend on the benefits, The benifits are reduced, yet the Premiums keep rising and when mine recently rose after my participation in the snapshot program reduced my insurance premiums, my policy renewal unexplainely increased.

Thursday, April 18, 2013
Katie:

This law is so ridiculous… I do agree there should be a time limit to receive treatment but not paying for massage is outrageous! I am a massage therapist and this law has made a lot of LMTs lose their job. And the most important part of helping a person heal is with massage. Instead, people are paying all this money for PIP and receiving very little. In return the insurance companies are robbing everyone!

Thursday, June 13, 2013
Arlene:

Any idea how much money is left on the table uncollected by the providers per year?

Friday, June 14, 2013
Attorney Greg Dell:

Arlene, I do not have any data regarding this question.

Tuesday, July 23, 2013
Ashley:

Our patients’ claims are now being denied by health insurances because PIP being limited to $2,500, while the health insurance believes the limit should have been $10,000 based on the bills they are receiving. It is becoming difficult to provide quality care to our patients with auto unable to inform you ahead of the treatment what policy benefits will be and health insurances not agreeing.

Wednesday, July 24, 2013
Attorney Greg Dell:

Ashley,

This is a big problem and one that you need to litigate if claims are not being paid. Also there are other methods of payment such as letters of protection, which could allow your patients to continue to receive treatment while the billing disputes are dealt with.

Saturday, August 10, 2013
Greg Park:

I really like this new law, because lots of people were making easy money using insurance for that, and increasing the prices to everyone, Florida people need to stop doing fraud to be able to have better rates and more benefits, people there really abuse of the resource during years.

Tuesday, October 8, 2013
Bonnie:

I am finding it very hard to find a dentist that will take my PIP and bill the insurance company, they all want to be paid by me and I go after my insurance for my money back. This is after having an accident. If you know of any dentist in St. Lucie County or Palm Beach County please write back.

Thursday, October 10, 2013
Gregory Dell:

Bonnie,

A dentist is required to bill your PIP if you had an auto accident. You can also pay for the treatment and submit the bill to your auto insurance company.

Sunday, October 27, 2013
Geri:

When PIP benefits are exhausted are we legally obligated to continue to see the patient. We are a small privately owned physical therapy clinic and have a few L.O.P’s which went into effect after benefits were exhausted. We have some L.O.P.’s that are 2 to 3 years old so we are not taking anymore L.O.P’s because waiting for (reduced) payments does not pay our bills now. If the law says that there is only $2,500 for P.T. that is only about 10-15 visits. Some patients require much more depending on the diagnosis. Our concern is if we start to treat a patient with PIP benefits and they are exhausted before therapy is complete and we do not take their personal medical insurance what is our legal obligation to the patient, if any.

Monday, October 28, 2013
Gregory Dell:

Geri,

You are required to provide appropriate medical treatment, however you are not obligated to work for free. If insurance benefits are exhausted then you can stop treating. In many cases, you should be able to get paid on an LOP if you are working with legitimate law firms.

Sunday, November 10, 2013
Lisa:

My daughter was critically injured in a motorcycle accident. She was a passenger and a lady hit them from behind, cited with careless driving.I am inquiring about my PIP coverage. I have wage loss (as her mother) I stayed with her in the hospital for 11 days till she was discharged and am caring for her at home. My employer terminated me (they are excluded from FMLA) while I was caring for her. Does PIP not cover my loss of wages? My daughter is a minor. Thank you!

Tuesday, November 12, 2013
Gregory Dell:

Lisa,

If you were not involved in the accident, then the PIP will not cover you as a result of your daughter’s accident. Your daughter may have specific rights to coverage which will depend on what insurance both she and you may have. Please contact us privately to discuss your daughter’s motorcycle accident.

Saturday, November 30, 2013
Hal Maynard:

My insurance company has told me that the 2 week requirement does not apply to 3rd party injuries. Are they correct?

Sunday, December 1, 2013
Gregory Dell:

Hal,

We need more information in order to answer your question. Please contact us privately.

Monday, December 16, 2013
Phil:

Is a pedestrian covered under the PIP law?

Monday, December 16, 2013
Admin:

Phil,

It depends if the pedestrian owns a car. If a pedestrian owns a car and get struck by a car, then the pedestrian’s PIP would apply.

Monday, February 17, 2014
Alan:

So the state can mandate what Medicare pays in the event of an auto accident.
If the injured person is covered by Medicare?

Tuesday, February 18, 2014
Gregory Dell:

Alan,

There are set fee schedules for all medical treatment and procedures.

Wednesday, March 19, 2014
TJ:

I’m a permanently disabled veteran on benefits in Florida. I go to the VA for all my medical care, no matter what (better to have all your medical records in one spot). I also have Medicare because of my service-connected injury.

My PIP premium is more than my comp & collision on my cheap little car. I should be able to waive PIP if I have adequate medical coverage. Especially now, with Obamacare being required, this is redundant, and just another way for insurance companies to get free money.

My car isn’t new, I’m on a fixed income, and my car insurance, because of the required yet totally unnecessary for me PIP – is more than my car payment!

I’m at the point where I’m just about ready to sell my car, and walk everywhere. And I live out in the rural part of the state!

I think PIP as a requirement needs to be abolished – at least if you can prove sufficient medical coverage upon renewal of the policy.

Thursday, March 20, 2014
Jason Macri:

TJ,

PIP is required by Florida Law. There is a strong lobby to abolish PIP, and we are not opposed to such an action as long as there is a minimum $25,000 of bodily injury coverage required for all vehicle owners.

Monday, March 24, 2014
Jeff Angel:

PIP should be abolished. The chiropractors abused it more than any profession. PIP had a good intent, but those that lack morality hijacked the system. Florida is one of the few places in the world that have billboards on every street corner begging people to call a lawyer referral service. The soft tissue injuries they claim to treat will resolve themselves in a few weeks without intervention. These scumbags are now trying to affiliate with other medical professionals to get another bite of the $10,000 apple.

Thursday, April 10, 2014
Katrina:

We are a dental office who provided care in restoring a patient’s front teeth after a car accident. When we first called Geico, they told us the benefits covered up to $10,000. Now, after doing $6,500.00 of work for the patient, Geico paid us a $2,567.00 donation and called our office to tell us that we were not allowed to bill the patient for the remainder of the bill that was incurred. What is our responsibility as the providers to the patient and do we have a recourse in collecting our unpaid amount? Can the patient consult an attorney to make them cover more on her claim?

At the moment, her case is not completed and the doctor is considering finishing the case as inexpensively as possible to not incur more of a loss than we already have with this case. We are a private office that doesn’t even accept Medicaid/Medicare. We just weren’t aware of a new PIP law, which will now result in our office not accepting accident victims in the future.

Friday, April 11, 2014
Jason Macri:

Katrina,

You have a few options. First, there may be a potential PIP lawsuit which the claimant or your office can bring against the carrier for failure to pay the bill. It is possible that the claimant exhausted the $10,000 of pip that the patient had. You can still recover the remaining portion of your bill from any third party recovery that the patient may have against the person that caused the accident. If the patient was not at fault in the accident, then he or she can bring a claim for medical bills as well as pain and suffering against the person that caused the accident. If your patient has a lawyer, then you should send a copy of your bill to the patient’s attorney and contact the patient’s attorney to discuss your bill. You can also ask the attorney’s office for the patient to sign a letter of protection.

Monday, April 14, 2014
Anita:

How is the 14 day (2 weeks) defined in the new PIP change as of Jan. 1, 2013? I believe the law states treatment within 14 days after the MV accident. So if an accident occurs in the evening of the 3rd of the month is the 16th or the 17th day of the month within the 14 days after the accident, when does the clock start – 24 hours after the accident occurs?

Thank you.

Tuesday, April 15, 2014
Jason Macri:

Anita,

Great question. It seams reasonable that treatment would have to be completed on or before the completion of the 17th as you have described above.

Saturday, May 10, 2014
Cynthia Johnson:

After a rear-end collision by another car I had X-Rays taken and was treated at a chiropractic clinic. They show damage to neck and jaw. Is this considered a diagnosis as described by PIP or should I go to the ER? Date of accident 4-28-14 in FL. Still in pain.

Sunday, May 11, 2014
Jason Macri:

Cynthia,

Thanks for contacting us regarding your accident. Sorry to hear about what happened to you. The date that you first went to the chiropractor and the results of your x-rays are two important factors to your claim. Please contact us privately so that we can let you know how we can help you.

Monday, May 12, 2014
Brian:

I was recently hit by a truck while riding my bike from work; the guy only had PIP. I sustained a broken foot, a broken rib and contusions. I contacted an attorney, they took my case, but when they found out the guy only had PIP, they dropped me. What can I do? I’ve lost 3 weeks of work.

Thanks.

Tuesday, May 13, 2014
Jason Macri:

Brian, thank you for contacting us. Sorry to hear about what happened to you. Please contact us privately so that we can let you know if there is anything we can do to help you.

Saturday, June 7, 2014
Jorge:

What happens in the case where problems don’t show up immediately? I had an accident a couple of years ago and I was fine, but a couple of months later I had a consistent pain in my right leg. If I had an accident and went to the doctor within two weeks, I was fine, two months later I have an issue I really think was caused by the accident, with the new law am I not able to use my PIP benefits?

Sunday, June 8, 2014
Jason Macri:

Jorge,

Under the new law if you don’t get treatment in two weeks then your PIP MAY NOT pay coverage. Some insurance companies are enforcing the two week rule and others are not.

Sunday, July 13, 2014
Dr. Jeff:

Another insurance gambit by insurers having their politicos in their hip pocket. And once again, the paying public is the one who suffers. FL residents are now forced into the ghastly more expensive route or allopathic medicine for physical injuries which, as frank and honest MDs admit, have little training in treating or even diagnosing.

How long will it take in an E.R at say, $1000-2000 per HOUR to exhaust your PIP policy (I paid $2000/hour in Port Richey ER a few years back)?

And expert spinal treatment is not even available in the allothpathic (‘medical’) facilities, save for the few that have chiropractors on staff (incredible but google it).

Sure, lifetime sentences for these DCs bilking the system-we DCs police our own FAR better than the good ol boy medical system. We round up the wagons and shoot inward.

And why would you want to pay more and get less? DC care is less than 1%, yes, one percent, of the entire medical bill of the US. It’s safer by an number approaching infinty vs overall medical care, too. http://www.health-care-reform.net/causedeath.htm

I predict this biased and unconstitutional ‘reform’ will be reformed soon. And chime in, all those that have had their auto PIP premiums reduced lately.

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