Florida car accident lawyer, Guy S. DiMartino, DC, JD, talks about the new PIP changes for 2013.
In an effort to deal with fraud that allegedly occurs under the PIP statute, the Florida legislature haphazardly passed sweeping changes to 627.736, Florida Statute (Florida's No-Fault/PIP Law). In this guy's opinion, the changes are going to do nothing but increase litigation and decrease the quality of healthcare services that Florida's citizens are going to receive if injured in a car accident.
Change 1 – Time Limit
Under the new law, in order to qualify for PIP benefits, the person injured in a Florida car accident has to see a healthcare provider within 14 days of the accident. Specifically, the statute reads:
(a) Medical benefits.–Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital, and nursing services if the individual receives initial services and care pursuant to subparagraph 1. within 14 days after the motor vehicle accident…
Change 2 – Limits of Coverage
In essence, there will be two tiers of coverage available under the new PIP law. The first level will be $2,500 in benefits. The second level will be $10,000 in benefits. In order to break the $2,500 ceiling and be eligible for $10,000, the patient's doctor, nurse practitioner or physician's assistant, excluding chiropractors have to find that the patient has an “EMERGENCY MEDICAL CONDITION.” “EMERGENCY MEDICAL CONDITION” is defined ambiguously and the law does not provide specific diagnoses, medical conditions or injuries that meets the definition. Let's see how confusingly the law is written:
…3. Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. up to $10,000 if a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced registered nurse practitioner licensed under chapter 464 has determined that the injured person had an emergency medical condition.
4. Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. is limited to $2,500 if any provider listed in subparagraph 1. or subparagraph 2. determines that the injured person did not have an emergency medical condition.
So under this new law, a nurse practitioner, who has a master's level education can certify an EMERGENCY MEDICAL CONDITION but a chiropractor cannot.
Change 3 – Medical Services Eliminated
Florida residents injured in car accidents will not receive payment or reimbursement for massage services and acupuncture. The law reads:
5. Medical benefits do not include massage as defined in s. 480.033 or acupuncture as defined in s. 457.102, regardless of the person, entity, or licensee providing massage or acupuncture, and a licensed massage therapist or licensed acupuncturist may not be reimbursed for medical benefits under this section.
I guess the legislature determined that massage and acupuncture have no therapeutic benefit to folks who have been injured in car accident or they just arbitrarily decided to cut out these services because doctors who perform acupuncture and massage therapists do not have the necessary political clout.
WE ARE GOING TO SEE AN INCREASE IN PIP LAWSUITS
I've been doing this long enough to see PIP litigation spike before and after PIP is revamped. This is how the scenario is going to play out. A person is injured in an accident. He/she is worked up by their doctor and begins treatment. The doctor believes the patient has an EMERGENCY MEDICAL CONDITION, which the law does not define. The insurance company will get the bill and take the position that the condition is not an EMERGENCY MEDICAL ATTENTION. Doctors who are busy seeing patients are not going to fight the issue with the insurance company and the insurance company gets to keep $7,500 in potential benefits that the patient paid purchased. The patient is going to get a bill from the doctor – the patient is going to take the position that the insurance company should have paid it – and the insurance company is going to draw a lawsuit from either the patient or the doctor.
One good thing about lawsuits against insurance companies is that if the doctor or patient prevails, and a court, judge or jury finds that the healthcare services should have been paid, the insurance company is on the hook for the doctor's or patient's attorney's fees.
If you have any questions about how the new PIP law is going to impact you after a car accident, contact Guy S. DiMartino, DC, JD at (352) 267-9168.