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Florida Personal Injury Protection Insurance

Florida is one of ten states across the country that are considered “no fault” states and require drivers to carry personal injury protection (PIP) auto insurance. The intention of the legislature was to provide drivers with $10,000 in immediate medical coverage instead of waiting to assign fault through the court system. PIP insurance is meant to reduce the delay in payment to injured drivers as well as reduce the number of cases going through the Florida courts. However, recent changes in the law have defined different standards and requirements on drivers if they want to make use of their PIP coverage.

Florida PIP Law

Also called Florida “No Fault Insurance,” PIP insurance covers you regardless of fault in an accident up to the limits of your policy. Your PIP insurance will also cover your child, members of your household, and certain passengers. PIP also covers your child if he or she suffers an injury while riding on a school bus, and it protects you while in someone else’s vehicle, as a pedestrian, or bicyclist if you suffer an injury in a crash involving another motor vehicle.

The Florida Motor Vehicle No-Fault Law requires all owners of a motor vehicle to carry a minimum of $10,000 of PIP insurance if you own a motor vehicle in Florida and requires you to maintain PIP insurance continuously throughout the licensing and registration period.

In 2012, the Florida legislature passed HB 119 – Personal Injury Protection (PIP) for Auto Insurance Fraud and codified it into law. The law was meant to benefit insurance companies and consumers, alike. The law placed several provisions on the limits of PIP benefits, when and how insureds could use them, and closed loopholes in the previous law that insurance companies claimed that many people were using for fraud.

Requirements of PIP

Under the new PIP law, motorists must follow a stricter set of guidelines in order to use their benefits. Motorists injured in car accidents will have only 14 days to seek initial treatment as opposed to the previous policy that placed no time limit on treatments. If treatment is sought after two weeks, nothing will be reimbursed by the insurance company.

In addition, two levels of benefits on PIP are now imposed. You may receive up to the normal $10,000 limit in medical benefits for services and care if a physician, osteopathic physician, dentist, physician’s assistant or advanced registered nurse practitioner has determined that you had an emergency medical condition. An emergency medical condition is defined as “a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health, serious impairment to bodily functions, or serious dysfunction of a body organ or part.”

For an individual who is not diagnosed with an emergency medical condition, the PIP medical benefit limit is $2,500. This limit also applies to any chiropractor visits, and those can only be sought after a referral from an acceptable health care provider. The new law excludes acupuncturists and massage therapists from PIP coverage.

A group of previously PIP-included acupuncturists and massage therapists challenged the law, but their appeal was ultimately denied by the Florida Supreme Court.

In order to qualify for PIP benefits, your insurance company can force you to give an “Examination under Oath” (EUO) and undergo a medical examination. If you refuse, you could lose your PIP benefits. Compliance is a requirement for receiving benefits, which means that the insurer does not owe you anything in PIP benefits if you do not comply.

The new law also provides that if a person unreasonably fails to appear for an independent medical examination (IME), the insurance company is no longer liable for the payment of PIP benefits. The purpose of an IME is not to give medical treatment but to determine if you are actually injured and, if so, if the treatment received was reasonable and necessary. Refusal or failure to appear for two IMEs raises a rebuttable presumption that the refusal or failure was unreasonable and PIP benefits can be stopped.

PIP Supposed Consumer Advantages

One advantage of the new PIP law is regarding death benefits. PIP insurance now offers $5,000 in death benefits in addition to $10,000 in medical and disability benefits if the holder of the insurance or someone in the vehicle covered by the driver’s benefits is killed in an accident. Before the new law was imposed, the death benefit was the lesser of the unused PIP benefits, up to a limit of $5,000. PIP benefits can also cover your lost wages up to 60% and your mileage getting to and from medical care.

In addition, the law contained provisions for the reduction of consumer insurance rates in Florida. The plan was for insurers to roll back rates by 10% by October 1, 2013 and 25% by January 1, 2014. However, PIP accounts for a relatively small percentage of a total premium; according to some experts it is only around 20% of the entire insurance premium bill, which makes the 25% reduction rather insignificant.

In addition, the requirement of insurance companies to reduce their PIP rates by at least 25% can be avoided if the insurers petition the government to be excluded from these requirements. Even more concerning is that the law does not require insurance companies to notify policyholders that changes are forthcoming, effectively pulling coverage away without their knowledge or understanding.

Contact a PIP Insurance Attorney Today

The new requirements for PIP coverage are more challenging and complex than ever, and getting benefits from your own insurance company should not be this much of a struggle. If you or a loved one has been injured but has been denied their PIP coverage benefits in Orlando, Tampa Bay, Fort Myers, Jacksonville, or West Palm Beach, let the experienced PIP benefit attorneys at The Pendas Law Firm help. Call or contact the office today for a free and confidential consultation of your case.

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