The Florida Legislature passed a Bill in the 2012 legislative session massively overhauling Florida’s Personal Injury Protection Statute, otherwise known as the “PIP Statute.” This legislation was formulated and strongly pushed by Governor Rick Scott and instead of addressing its intended purpose of battling fraud and saving consumers money; it in effect was a massive gift to the insurance companies and according to newspaper reports has not caused any savings to Floridians.
This Bill does very little, if anything to battle fraud, but took away the rights and benefits of consumers and provided them with little or nothing in return. Click here to view and read Florida’s new PIP Statute.
PIP in Florida
Prior to the new PIP Bill, dating all the way back to the early 1970’s, PIP was a way for Floridians who did not have health insurance and who were in a car crash to receive up to $10,000.00 in medical benefits. This law applied to anyone who was in a car crash and it did not matter whether the person who was seeking the benefit caused the crash or not.
Thus, it was a blanket way to insure that everyone had some sort of medical care, and allow hospitals to know that the person they were treating would be able to pay them, thus insuring they could continue seeing these individuals. Also, it provided additional protection to them under Florida Law by keeping down the number of lawsuits. This was done by having a threshold. Threshold meaning that in car crashes, individuals would not be able to seek non-economic or pain & suffering damages unless they had a permanent injury as defined by Statute.
Thus, the PIP Statute was designed to be a counterbalance to a limiting to a constitutional right of access to the courts which was impaired or lessened by adding this threshold. This new PIP Bill effectively turns the tort system on its head because the bill that was passed and just took effect is so onerous and limiting that it effectively will get rid of the tort threshold. This will mean there will be a lot more auto accident cases filed, which will unfortunately clog up our court system.
This could have easily been avoided if the bill would have been designed to address its stated purpose, attacking fraud. The main reason for fraud is a loophole that allowed massage therapists to operate a clinic. All the legislature or governor needed to do was to prohibit non-doctors clinics from operating and close the loophole allowing massage therapists to own clinics. These two (2) items would have rid over 99% of any PIP fraud and would have not lowered the amount of benefits each Florida driver could receive. Unfortunately, as you are about to see in the following sections, this was not the case.
Thresholds
Under Florida’s new PIP Bill, effective 1/1/2013, there are thresholds that have been put in place in order for injured to get the PIP benefits they paid for. First, a person must receive treatment within fourteen (14) days after the motor vehicle accident in order for that individual to receive their PIP benefits. If a person is unable to see a doctor or unable to get treatment due to work related purposes or simply hopes that their condition will get better over time and does not treat within the fourteen (14) days, they will absolutely get no PIP benefits whatsoever. This is a major concern to most individuals, especially in these economic times who find it difficult to take off work and see a doctor even when they are injured.
Beginning on line #555 of the Bill it states…
“The medical benefits must provide reimbursement only for such…
Initial services and care that are lawfully provided, supervised, ordered, or prescribed by a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, or a chiropractic physician licensed under chapter 460.”
This effectively means that initial services must be by a Medical Doctor, DO, dentist, chiropractor or physician.
These initial services can be provided in a hospital or facility that owns or is wholly owned by a hospital. Though most people would generally see an MD or DO after an auto crash, some people choose to take less expensive and less aggressive means to treat, what they hope, is only a temporary condition. Thus, the effect of this section of the Bill is forcing individuals to choose the care that the legislature wishes them to use instead of what they and doctors feel is in their best interest.
If the thresholds in my previous mentioned blogs have been met, there are two (2) different levels of PIP medical benefits that a person paying for PIP may receive.
- $10,000.00 of medical bills could be paid if the person has an “emergency medical condition”.
- $2,500.00 for treatment that is not for an initially diagnosed “emergency condition”
This difference is significant. For the past 40 years, persons in the state of Florida who paid for PIP received $10,000.00 of benefits whether they were responsible for the accident or not. The Florida Supreme Court has stated this is the reason how they have upheld the tort threshold is that compensates for taking away people’s right; however the institution of this $2,500.00 amount could easily wipe away the tort threshold[i] in the state of Florida for people who are injured.
The fact that an emergency medical condition was not initially diagnosed or realized is going to be a serious problem for many individuals. A doctor may have failed to notice it; the doctors in emergency rooms or walk-in clinics may not care to diagnosis it or even want to get involved in litigation. Thus, there are a number of reasons why a person still may qualify for emergency medical condition but yet not have it initially diagnosed by the treating medical doctor, DO, DS or Physician Assistant or Advanced Registered Nurse Practitioner (ARNP).
The “definition” under the new PIP State of an emergency medical condition is stated as such:
“Emergency medical condition” means 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.
(b) and (c) are the two sections of this definition which may allow individuals to receive the high level of PIP benefits. Thus, if someone is in severe enough pain that impairs a bodily function such as using the neck, back, shoulders, arms or knees or causes a serious dysfunction in any bodily organ or part, which could be the inability to use it in its full capacity then that individual may be able to use the full $10,000.00 in PIP benefits to pay their medical
[i] The requirement in auto cases which requires an injured person, to get non-economic damages (pain suffering and loss of enjoyment of life), they must have a permanent injury. The “threshold” does not appear anywhere else in the law.
The Role of PIP in Florida
Under Florida law PIP is primary over all other forms of insurance. What this means is that PIP must be used and exhausted before any other form of insurance will pay a medical bill. Thus, as an example, if someone is in a car crash and there are PIP benefits available, Medicare, Medicaid or private health insurance would simply refuse to pay the bill saying that there is still PIP available and that they are not responsible for paying at this point in time.
Thus, PIP is responsible for paying the bills. The benefit of PIP is that there usually is no deductible and no co-pay. This saves Floridians, most of which live pay check to pay check, millions of dollars a year over what their private health insurance would require them to pay. Most people who get in car crashes do not have the wherewithal to pay their private health insurance, a $5,000.00 deductible plus their co-pay, much less if the case takes a couple years of the required treatment past the first of the year.
Also, while PIP only pays 80% of any bill, most health providers will agree to defer collection of the difference until after any type of lawsuit or case is resolved. Thus, again, it makes it much more financially viable for someone to seek the treatment that they need instead of having to sacrifice or simply go through significant amounts of pain or not getting diagnostic testing that’s necessary or not getting the surgical procedure that’s necessary because they simply cannot afford the co-pay or deductible with their private health insurance.
PIP is a valuable resource for most Floridians and is a huge saving; however under the new PIP Statute if someone is only able to receive $2,500.00 in PIP benefits or no benefits at all, the burden of paying this is going to be shifted directly back to the injured person, saving the insurance company money but not providing the individual the benefits in which they are paid and would usually be entitled.
