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Personal Injury Protection Insurance In Florida

Several states in the U.S., including Florida, require every vehicle owner to carry a minimum of $10,000 in personal injury protection automobile insurance. Personal injury protection (PIP) is “no fault”, meaning that regardless of the reason for a car accident, each individual is responsible for his or her own injuries. PIP insurance provides up to the policy amount in “immediate medical coverage” directly to injured drivers. Before PIP insurance was mandatory, injured drivers would have to go to the court for a determination of fault.

Since PIP insurance became mandatory in Florida, it has seen a significant rise in PIP claims, many of which have been deemed “questionable” by the National Insurance Crime Bureau, indicating that the claims are potentially fraudulent. In fact, the Bureau has listed multiple cities in Florida that report the highest amounts of “questionable” claims on a national level. With the inception of the mandatory program came many fraudulent claims; 50% of fraud referrals were from PIP premium claims, which only make up 2% of Florida’s statewide collected insurance premium.

Revisions to the PIP Law

In an attempt to reduce the fraud problem, Florida passed revisions to the personal injury protection statute in 2012. Effective January 1, 2013, the revisions require those who pursue PIP medical benefits to receive medical care within 14 days after the incident. The coverage limits were also revised; $2,500 for those not diagnosed with an “emergency medical condition” and $10,000 for those determined by a physician, osteopathic physician, dentist, physician’s assistant, or advanced registered nurse practitioner to have an emergency medical condition. Chiropractors could no longer be compensated for the full $10,000 if they provided that much in services. PIP no longer covers charges for massage therapists and acupuncturists.

The revisions also changed the claim investigation process. Now, insurers are able to take examinations of the insured individual under oath and the insurer will not have to pay any benefits if the insured claimant does not comply with orders for such examinations. The insurer has no responsibility to pay if the insured “unreasonably fails to appear” for an independent medical examination. Specifically, with regard to the efforts to prevent and curtail fraud, the bill defined fraud as “knowingly presenting a PIP claim to an insurer for payment or other benefits on behalf of a person or entity that committed fraud when applying for health care clinic licensure, seeking an exemption from clinic licensure, or demonstrating compliance with the Health Care Clinic Law” and indicates that those claims are not reimbursable. The penalties for for health care practitioners found guilty of fraud include a 5-year loss of license and no PIP reimbursement for up to 10 years.

Questions of Constitutionality

Since its enactment, the PIP revision did receive pushback in the form of an initial constitutional challenge from massage therapists, chiropractors, and acupuncturists who were singled out in the law and denied the ability to recover the full value of their services from insurance companies. In addition to the aforementioned provisions regarding those three professions, the constitutional challenge also focused on the perceived injustice that consumers only receive $2,500 in insurance compensation for $10,000 worth of insurance unless they fit into the very narrow category of those with an “emergency medical condition.”

Individual consumers are also bringing lawsuits based upon the lack of constitutionality regarding their inability to receive compensation for the full value of their insurance policies. However, recent data indicates that legislators may be unwilling to make significant changes to the law just yet. Recent reports have shown that the notoriously high PIP insurance fraud rate has decreased significantly. Many legislators understood such reports as a success for the revisions of the law.

Many issues related to automobile incidents and accidents are complicated, and these complications, if dealt with correctly, can be the difference between meeting your related medical needs or going without much needed care. If you find yourself in need of help dealing with any automobile injuries, call the experienced Florida attorneys at Roman & Roman for assistance.

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