The New PIP Legislation

The governor has just signed into law the new PIP legislation that will significantly affect your rights and the medical care that you will receive (or not receive) should you unfortunately be involved in a vehicle-related accident in the state of Florida beginning January 1, 2013. Although a portion of this bill becomes law on July 1 2012, the vast majority of the significant changes will become law on January 1, 2013.

  1. If you are not evaluated for the injuries sustained in a vehicle-related accident within 14 days of the accident, all of your PIP benefits (presently by law a minimum of $10,000 coverage) disappear immediately. It is thus critical that you be evaluated by a competent physician who has a significant amount of experience in treating vehicle-related injuries, as soon as possible after the accident. This does not necessarily mean in an emergency room. As I have described in great detail in a previous blog, probably only 5% of patients involved in a vehicle-related accident need to be seen in an emergency room. These include those that have lost consciousness for more than a few seconds, have bleeding that will not stop, have an obvious fracture, have significant chest or abdomen pain, etc. The vast majority of patients do not fall into this category and can safely be evaluated within a few days of the accident. If in any doubt, contact the emergency room staff after the accident and follow their instructions.

  2. Massage therapy will no longer be covered by your PIP insurance. Massage therapy presently is a significant and highly valuable part of the care provided in our practice. Unfortunately, the abuse of certain massage therapists around the state has led to excessive billing and inappropriate use of PIP funds. This, unfortunately, has led to the highly professional, legitimate massage therapists, who significantly assist patients, no longer being able to do so. You will, however, continue to be able to receive this care through your health insurance or in a private-pay capacity.

  3. Probably the most controversial part of the new PIP legislation is the following: While everybody is still required to pay insurance premiums that provide $10,000 worth of PIP coverage, you only get to use the full $10,000 if your initial evaluating physician (MD, DO, PA, ARNP, but not chiropractor) deems you to have an “emergency medical condition”. Unfortunately, the law does not state what these conditions are. If you are not designated as having an “emergency medical condition”, your $10,000 of PIP coverage that you have paid for will be limited to $2,500. This would be like going to the gas station and paying for a full tank of gas but having the pump automatically shut off when your tank is one-quarter full. We suspect that the insurance companies will only pay out $2,500 of PIP coverage on almost every case and require the treating physician to take legal action to attempt to recover the additional $7,500 worth of care even if it was legitimately provided. We are extremely concerned that this is going to lead to lengthy legal battles and in fact increased, rather than decreased, cost of medical care for those injured in vehicle-related accidents.

Obviously, the only real winner in this legislation is the insurance companies. They are collecting a full premium for $10,000 coverage and yet will only be paying out $2,500 in the vast majority of cases. This sounds like at least a 300% increase in profit at the expense of the drivers in the state of Florida. We strongly recommend that you contact the insurance agent that you bought your auto insurance policy from and ask them to justify why you should pay for a full $10,000 worth of PIP when it is highly unlikely that the insurance company is going to pay more than $2,500 worth of benefits. We also recommend you contact your legislators who passed this bill and ask them to explain the rationale for this situation. We also recommend that you buy two additional policies to protect yourself. One is Med-Pay (or Medical Payments). An extra premium would allow you to receive additional medical care so that you can receive all the treatment that you need to get maximum medical recovery from your injuries. Lastly, you can purchase UM coverage (Uninsured Motorist or Under-insured Motorist). This means that if the person who causes the accident is not carrying any insurance, once your $2,500 of PIP insurance (or $10,000 of PIP insurance if the insurance company feels you have an “emergency medical condition) has been exhausted, this coverage will take over for ongoing care.

While there is no doubt that PIP reform was needed, we strongly feel that this legislation will possibly minimally decrease the amount of fraud that was present in the system, but the most significant result of this new legislation is going to be to massively increase  profits of the auto insurance companies.

A Better Way to Get Better,
Adrian Lewis
Adrian Lewis, MD