New Bill Enacts Changes to PIP Insurance

New Bill Enacts Changes to PIP Insurance

Posted on Mar 4, 2013 8:08pm EST

According to the Florida Senate, a new bill recently revised the Florida Motor Vehicle No-Fault Law. Generally speaking, the law addressed issues related to Personal Injury Protection (PIP) under the No-Fault Law, along with laws related to PIP insurance fraud. The bill enacted major changes regarding:

  • PIP medical benefits
  • PIP death benefits
  • PIP medical fee schedule
  • Attorney fees
  • Investigation/payment of claims
  • PIP insurance fraud prevention
  • Data call and mandatory rate filings

Major Changes to PIP Medical Benefits
The new bill revised PIP medical benefits under Florida’s no-fault law. These changes will go into effect on January 1st, 2013. In order to receive PIP medical benefits under the no-fault law, you must receive medical attention for your accident-related injuries within two weeks (14 days) of the initial crash. Additionally, your medical expenses will only be covered if you see a licensed physician or other qualified professional, such as a licensed osteopathic physician, licensed chiropractor, licensed dentist. Follow-up appointments and expense will only be covered if related to your initial injury.

According to the bill, accident victims can collect up to $10,000 in benefits for emergency medical conditions. This type of condition is characterized by acute symptoms and severity. Without treatment, emergency medical conditions can place the victim is serious danger and may result in death. Victims who are not diagnosed with emergency medical conditions can receive up to $2,500 in PIP benefits. Under no circumstances will PIP reimburse patients for acupuncture or massages. Additionally, the new bill allows $5,000 in death benefits.

PIP Medical Fee Schedule
The new bill also revised PIP medical fee schedule provisions in an effort to resolve conflict between accident victims and their insurance providers. In the past, ambiguities in the medical fee schedule led to misunderstandings between claimants and insurers. According to the bill, reimbursement levels for clinical laboratories, ambulatory surgical centers, and durable medical equipment is 200% of the Medicare Part B schedule. Also, insurers must include notice of the fee schedule in their policies.

Attorney Fees
The bill also affects attorney fees and no-fault disputes. In short, the bill disallows any attorney fee multipliers. The bill states that attorney fees should comply with professional standards and states that legal professionals are never allowed to overstate the number of houses necessary for a case. Simply put, the bill requires reasonable attorney fees.

Claim Investigation and Payment
Although insurers are allowed to take examinations under oath (EUO). However, the insurer cannot request EUOs as an unreasonably. This would be a violation of the Unfair Insurance Trade Practices Act. The bill also has provisions to help victims submit their claims. As of January 1st, 2013, claimants will be granted an additional 15 days to file their claims – but only if the claim was denied because of an error. In the event of a lawsuit, the insurer must be able to provide a log of all PIP benefits paid to the claimant. In the event of a dispute between the insurer and the claimant, the insurer must give a 15-day notice before exhausting the PIP benefits.

PIP Insurance Fraud
The bill also creates a standard for evaluating whether or not an entity that claims to be exempt from PIP claims is attempting to commit fraud. According to The Florida Senate, it is unfair and deceptive for an entity to avoid paying a PIP claim.

Contact a Clearwater Personal Injury Lawyer

At the Law Offices of Carey & Leisure, we handled a wide variety of personal injury case types. Our firm is committed to helping accident victims in Clearwater, Florida and the surrounding area. If you need help filing a PIP insurance claim, contact our office today. With the right attorney by your side, you can rest assured that your case is in good hands. Call our office today!