Florida No-Fault (PIP) Law

The 2012 Florida legislative session resulted in several meaningful changes to the Florida No-Fault (PIP) law.  The changes generally make it more difficult for an injured person to qualify for the same PIP benefits that used to be available. Most of the changes take effect on January 1, 2013.  A summary of the significant changes is as follows:

1. “Use it or Lose it” – 14 days

An accident victim has to obtain medical treatment within 14 days of the date of the accident or there is no PIP coverage for any medical benefits.  This means that if you think you might get better on your own and decide not to go to the doctor for a few weeks, you will not be entitled to any PIP coverage for medical bills. This is true even though you paid money for PIP insurance. This is a huge change in the PIP law since there was no time limit in the old PIP law.

In addition, your first visit to a doctor must be at a hospital or emergency transport, or by a medical doctor, osteopathic physician, chiropractor or dentist. Massage therapy and accupuncture are no longer covered by PIP.

2. Medical Coverage is limited to $2,500.00 instead of $10,000.00 unless you have an “Emergency Medical Condition”

The old PIP law granted $10,000.00 in PIP coverage for medical bills. The new PIP law changes this by creating 2 different categories of injured people. One category of injured people is limited to $2,500.00 in medical coverage.  The other category is limited to $10,000.00 in medical coverage. The categories are as follows:

Category #1:

If a person has an “Emergency Medical Condition,” the injured person is entitled to $10,000.00 in PIP medical coverage.  An “Emergency Medical Condition” is defined as

A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:

A.  Serious jeopardy to patient health;

B.  Serious impairment to bodily functions;

C.  Serious dysfunction of any bodily organ or part.

A chiropractic physician cannot make the determination that a person has an “Emergency Medical Condition.”

Category #2:

If a person does not have an “Emergency Medical Condition,” the injured person is only entitled to $2,500.00 in PIP medical coverage.

3. Follow up care must be Consistent with the Initial Diagnosis

If an injured person is in Category #2 such that PIP coverage is limited to $2,500.00, any follow up care must be “consistent with the initial diagnosis” in order to be covered by PIP.  This means that if you are diagnosed with low back pain – and no other problems – during your initial office, any complaints of headaches, shoulder pain or something other than “low back pain” at a follow up visit will not be covered by PIP since it is not “consistent with the initial diagnosis.”

4. PIP Death Benefit is $5,000.00

The new PIP law offers $5,000.00 in death benefits.

5. Miscellaneous

The new PIP law changes the rules about insurance company investigations of PIP claims. In short, under the new law, insurance companies have been given more time to investigate any claim they reasonably believe may involve fraud. The insurance company can also require the injured person to submit to an examination under oath before any benefits are owed.

Another change to the PIP law involves regulation of the billing procedures of doctor’s offices. That is, the “fee schedule” sets forth more clearly the amount of money that a doctor can charge for a particular type of treatment. In addition, billing and communications can be made electronically if they are transmitted by secure electronic data transfer.

The new PIP law also regulates the amount that attorney’s can be awarded if they win a PIP case against an insurance company.  Contingency fee risk multipliers are not allowed.  Also, upon request, a Judge can be required to make written findings to support the amount of attorney’s fees that is awarded.

6. Legal Thoughts

There is considerable debate in the legal community on whether some of the changes to the PIP law are constitutional. In particular, the old PIP law contained a limitation as it concerns an injured person’s “right to sue” an at-fault party for pain and suffering damages.  This limitation on the right to sue was generally thought to be constitutional given that $10,000.00 in PIP insurance benefits was broadly available regardless of who was at fault for the accident.

The new law is not nearly as broad. It contains a 14 day time restriction to qualify for benefits.  It also reduces the available benefits by 75% in that the benefits are reduced from $10,000.00 to $2,500.00 in many cases.  It may be unconstitutional to limit the “right to sue” when the PIP  benefit is only $2,500.00 in PIP coverage.  Many lawyers believe this amount of money is insufficient to supplant the right to sue, particularly when a single visit to the emergency room after an accident can easily absorb most or all of the $2,500.00.  The constitutionality of the new PIP law will be decided in the Florida Courts.  For now, the law has been signed by the governor and it most of its provisions will be in effect on January 1, 2013.

Jeffrey D. Starker, Esq., has been an insurance and injury lawyer in Orlando, Florida, for over 15 years.  Mr. Starker formerly represented insurance companies, and he currently represents people that have been injured in car accidents, motorcycle accidents, trucking accidents, and many other accidents.