Summary of 2012 Changes to Florida's PIP Statute

The onerous PIP legislation that passed late last Friday night was concocted behind closed doors and was not available for public viewing until 7:30 p.m. that evening. Soon after it was unveiled, it was branded as a "compromise measure," then rushed through the House almost immediately. Then, after a furious flurry of lobbying, heavy arm-twisting by the Governor himself and much heated debate in the Senate, it barely escaped defeat by that body by just one vote. It passed at 10:30 that same evening. While the insurance industry is heralding the sweeping revisions to the PIP statute as a victory in the war on fraud, they are secretly celebrating knowing full well that the changes to the PIP statute will mean soaring profits for the insurance companies and their investors. Most Floridians have no idea what negative impact the new PIP law will have upon them if they are involved in an automobile accident. To render it down to its purest form, most accident victims will see a 75% reduction in PIP benefits even though they will continue to pay the same premium for this state-mandated coverage. What follows is a very basic summary of the changes to the PIP statute which takes effect for policies issued or renewed after July 1, 2012:

-The accident victim must seek treatment within 14 days of the accident.

-The insured is allowed to seek his/her full $10,000.00 in PIP benefits only if he/she is diagnosed with an "Emergency Medical Condition (EMC)"

-EMC is defined as:

-Acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in:

SERIOUS jeopardy to patient health

SERIOUS impairment of bodily function

SERIOUS dysfunction of any bodily organ or part.

-Only an M.D., D.O., P.A or ARNP is authorized to make the diagnosis of EMC

-Massage therapy by a licensed massage therapist and acupuncture treatment is not reimbursable at all under the new PIP statute

-If the insured is not diagnosed with an EMC or if the insured wants to seek treatment initially with a chiropractor, the patient gets to use up to $2,500.00 in PIP benefits.

-The insured gets $0 in PIP benefits if he/she seeks treatment beyond the 14 days after the motor vehicle accident

-While the bill appears to include diagnostics such as x-rays and mri scans in the $2,500.00 limitation, the bill is ambiguous in that regard

-The insurance company gets an additional 60 days to pay benefits if it "suspects" insurance fraud. There is no definition or test as to what "suspect" means in the statute

-The bill allows the insurer to use Medicare coding policies and payment methodologies to further reduce bills

-While the bill requires an insurer to furnish a PIP log to the insured or provider, it only must do so "if litigation commences"

-An insured must sit for an examination under oath (EUO) as a condition precedent to receiving benefits. In other words, before the provider gets paid for his/her services, the patient has to sit, if requested by the insurance company, for an EUO

-No attorney fee multipliers are allowed

-The bill failed to incorporate the Senate's 25% rate rollback for consumers