Changes to Florida’s Personal Injury Protection (PIP) Law

By Dean Xenick, Associate, Law Firm of Burman, Critton, Luttier & Coleman    

This year the Florida Legislature made broad, sweeping changes to Florida's Personal Injury Protection (PIP) law, limiting benefits and coverage. 

PIP is a type of motor vehicle coverage that covers an insured’s medical expenses and lost wages, or can provide a death benefit in fatal incidents. PIP is referred to as "no-fault" coverage, because PIP benefits are paid without regard to who is at "fault" for the automobile accident. All Florida drivers are required to carry PIP coverage for themselves.   

The new changes to the PIP laws are important and failing to follow them could preclude you from receiving the full PIP benefits you are entitled to under your PIP insurance coverage.  Below is a list of just some of these changes and it is by no means an exhaustive list.  Although some changes to PIP are effective July 1, 2012, the majority of the revisions do not take effect until January 1, 2013.

1) When involved in an automobile accident, individuals seeking PIP medical benefits are required to receive initial services and medical care within 14 days after the motor vehicle accident.   Initial services and care are only reimbursable if “lawfully provided, supervised, ordered or prescribed by a licensed physician, licensed osteopathic physician, licensed chiropractic physician, licensed dentist, or must be rendered in a hospital, a facility that owns or is owned by a hospital, or a licensed emergency transportation and treatment provider. Follow up services and care requires a referral from such providers and must be consistent with the underlying medical diagnosis rendered when the individual received initial services and care.”   This new requirement means that if you do not receive medical treatment for your injuries within two weeks after an incident, by any of the providers listed above, you could be precluded from receiving any PIP benefits.  Therefore, it is imperative that if you are injured in an automobile accident that you receive medical treatment within the 14 day time frame.  

2) In order to receive the full $10,000 PIP of benefits, you must have an "Emergency Medical Condition"   As the Florida legislature’s bill summary states, “the bill applies two different coverage limits for PIP medical benefits, based upon the severity of the medical condition of the individual. An individual may receive up to $10,000 in medical benefits for services and care if a physician, osteopathic physician, dentist, physician’s assistant or advanced registered nurse practitioner has determined that the injured person had an ‘emergency medical condition.’" Chiropractors cannot make this determination.   An "emergency medical condition" is defined as a “medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health, serious impairment to bodily functions, or serious dysfunction of a body organ or part.”  If an individual is not diagnosed with an emergency medical condition, the PIP medical benefit limit is only $2,500.   This “emergency medical condition” designation is obviously a subjective term, which could mean the difference between an injured person receiving $10,000 in medical benefits or only $2,500 for medical treatment.

3) Massage and Acupuncture are not covered by PIP Despite the palliative and pain relieving benefits of massage and acupuncture, these treatments are no longer covered or reimbursable by PIP, regardless of the type of provider rendering such services.   

4)  Your insurance company can force you to give an "Examination Under Oath" (EUO) and undergo a medical examination or you could lose your PIP benefits Insurers are authorized to take an examination under oath (EUO) of an insured. Compliance is a condition precedent for receiving benefits (which means that the insurer owes zero benefits if the insured does not comply).

The bill also provides that if a person unreasonably fails to appear for an independent medical examination (IME), the carrier is no longer responsible for benefits.  An IME is an examination undertaken and paid for by the insurance company's physician, not the insured's treating physician. The purpose of an IME is not to render treatment to the insured, but rather to determine if the insured is injured and, if so, if the treatment he or she has received was reasonable and necessary.  Although called an "Independent Medical Examination," the doctors who perform IMEs are chosen and paid for by the insurance companies, not the patient/insured.  Refusal or failure to appear for two IMEs raises a rebuttable presumption that the refusal or failure was unreasonable and thus PIP treatment could cease.

Given the new limitations, requirements and time restrictions of the PIP statute, it is more important than ever to be vigilant and proactive after an automobile accident, in order to protect your right to receive medical benefits available under your PIP insurance policy. For more information on the PIP law or any legal issue, please contact any of our attorneys.  This article is not a complete analysis of the PIP statutes, nor does it constitute legal advice. 

To view the new PIP law in its entirety, visit the Florida Senate's website at http://flsenate.gov/Committees/BillSummaries/2012/html/215  and http://flsenate.gov/Session/Bill/2012/119