Major Effects Of New Changes To Florida PIP Law 2013

Since 1972, it has been a requirement that every registered automobile owner in Florida must have an insurance policy which includes no-fault coverage. No-fault insurance is a form of coverage which is not based upon who is responsible for an accident but rather it compensates for certain types of damages regardless of who caused the accident. In particular, the No-Fault insurer would pay 80% of the medical bills, 60% of lost wages and 100% of replacement services of anyone injured in a motor vehicle accident up to $10,000.00, minus a deductible, if applicable.

However, significant changes to Florida PIP law have been set forth in the new House Bill 119 - New PIP Law 2013. Although the new PIP law went into effect July 1, 2012, most of the changes will not take place until January 1, 2013.

The new PIP law sets limits on medical treatment paid for by PIP insurance. In particular, any person injured in a motor vehicle accident will be required to obtain a determination of the existence of an emergency or non-emergency condition within 14 days of the accident in order for the related medical treatment to be covered by the PIP insurance.

The determination of an emergency medical condition allows for up to $10,000 in PIP benefits to treat the injuries, whereas the determination of non-emergency medical condition allows for only up to $2,500. Furthermore, only MDs, DOs, ARNOs, physician assistants or hospital owned facilities will be allowed to determine the existence of the emergency medical condition.

Chiropractic physicians are not authorized to make that determination. However, chiropractors, as well as the physicians mentioned above, may make the determination of a non-emergency medical condition, which is subject to a $2,500 cap.

Emergency Medical Condition is defined in the bill 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:

  • Serious jeopardy to patient health;
  • Serious impairment to bodily functions;
  • Serious dysfunction of any bodily organ or part.

Failure to obtain a determination of one's medical condition within the prescribed 14 day time frame will most likely result in a denial of payment for treatment received after it by PIP insurers. At this time, it is also early to say whether this failure will have any effect on the underlying bodily injury claim against the at-fault driver.

Additionally, massage therapy and acupuncture will be not covered under the new PIP law. However, the Medical Payments insurance is not affected by these changes because of the underlying contractual relationship between the Med Pay insurer and the automobile owner. Therefore, these services still can be paid for if there is Med Pay coverage on the auto policy.

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