Insurance Company Secret #4 - No Emergency Medical Condition

It took less than a year from the time the new provisions of Florida's PIP statute took effect for insurers to start putting the squeeze on their insureds in an attempt to maximize insurance company profits. On January 1, 2013, Florida's PIP statute was revised which had a devastating effect on Florida motorists. Among other draconian changes, insurance-backed revisions to the PIP statute put a cap on damages paid out under PIP to $2,500.00 unless the insured had an "emergency medical condition (EMC)." If the insured had an EMC, the insured could use the full amount of PIP benefits available under the policy ($10,000.00). However, if the insurance company determined that no EMC existed, the insurance company can declare that the insured does not have an EMC and they can cap PIP benefits at only $2,500.00.

In recent months, our office has seen an increase in the number of cases where our client's automobile insurers have declared that there is no EMC thereby allowing the insurance company to cut off PIP benefits at $2,500.00 versus allowing access to the full $10,000.00 in PIP coverage that Florida motorists have paid for. The scheme works like this: after an insured has been in an accident and has begun treating, the PIP insurer sends what medical bills and medical records it has obtained on the insured out for some sort of peer review. Based exclusively on the review of the medical bills and medical records, an opinion is rendered that the insured does not have an EMC. Based on this opinion, the PIP insurer cuts benefits off at $2,500.00. Insurers are generally not even having the insured examined by one of their own physicians to make this determination of no EMC, rather, the determination that there is no EMC is done purely by paper review.

The most appalling part of the $2,500.00 EMC cut-off is this: Insureds all over Florida have paid for $10,000.00 in PIP benefits. When the statute was revised in 2013, insurers were required to examine the amount of premiums they charged for PIP benefits in light of the watered-down nature of the newly-revised PIP statute and to make adjustments to their premiums accordingly. Needless to say, most Florida motorists have not seen a decrease in their auto insurance premiums despite the fact that their benefits have been severely diluted or in some cases extinguished altogether.

To learn more about car accidents, personal injuries and PIP benefits available under Florida law, contact Layman Law Firm.