Changes to Florida PIP Insurance and Your Rights after a Traffic Accident

After years of effort (and plenty of money spread around Tallahassee by powerful lobbyists) the insurance industry has finally succeeded in limiting a motorist’s right to collect under Personal Injury Protection (PIP) coverage.

As advocating for the rights Floridians injured in auto accidents is a large portion of or our practice, we have been watching this issue very closely.

For years, the industry has been blaming Florida’s no-fault law for staged accidents and other health care fraud. Portions of the Florida no-fault law requires every motorist to carry $10,000 in PIP coverage. This coverage is meant to pay the first $10,000 in expenses after an accident, regardless of who is at fault. The at-fault driver’s liability insurance and a victim’s health insurance come into play after the PIP benefits have been exhausted.

These minimums have been in place since the Florida legislature adopted the PIP law in 1972, according to the Insurance Journal. With the rising costs of medical care these amounts really should have been raised — today, you can easily spend over $10,000 during an initial emergency room visit. However, insurers instead convinced lawmakers to place a series of limits on an accident victim’s ability to obtain medical care in the wake of a traffic collision.

Some medical procedures — including acupuncture and massage therapy — will no longer be covered. But perhaps most concerning to victim’s advocates is the new 14-day time limit for treatment under PIP coverage, which will take effect Jan. 1. As the Tampa Bay Times reports, only those diagnosed with an “emergency medical condition” within the first 14 days of an accident will be eligible for the $10,000. Everyone else will be limited to a maximum of $2,500. Additionally, many soft-tissue injuries like swelling and bruising are not expected to result in an emergency determination. Chiropractors who wish to provide services under PIP, will be limited to $2,500 without a previous EMC determination by a physician within those first 14 days.

“Floridians are in for a rude awakening,” Florida Consumer Action Network spokesman Bill Newton said. “Instead of measures aimed at preventing true fraud, we’re left with a bill that pads the pockets of big insurance companies.”

The new measure (HB 119) does require insurers to reduce PIP insurance premiums at least 25 percent by 2014 – a move meant to return some of the savings to the consumer that results from eliminating the fraud the industry has complained about for so long. However, the legislation includes an exemption clause that permits insurers to return to lawmakers with a request to avoid the rate cuts. According to a recent article in the Miami Herald, Most companies have already filed the necessary paperwork asking to increase their rates.

Even if insurers were to hold up their end of the bargain, the cost of PIP insurance only represents about 20 percent of a consumer’s bill. So a 25 percent reduction in PIP cost only equates to a 5 percent reduction in your insurance bill. Many consumer advocates think any savings realized by insurance companies will be more than negated by the increase in litigation costs related to the poorly worded, possibly unconstitutional  law  as it will allow lawyers to argue over the presence of an “emergency medical condition” for clients seeking $10,000 in coverage, rather than $2,500.

“That’s a pretty big disparity, so you can bet that there will be litigation over what is and is not an EMC,” said Paul Jess, general counsel of the Florida Justice Association.

Even insurance industry advocates admit the new law is going to put the courts in a position of defining what constitutes an emergency medical condition.

“Are we going to have to rely on the courts in Florida to determine whether a certain kind of sprain is an EMC?” asked Michael Carlson, of the Personal Insurance Federation of Florida, which represents some of the largest insurance companies.  “A bulged disk in your spine, is that an EMC?”

If there is anything to be learned for a Florida motorist involved in an accident: Consulting an experienced personal injury attorney is now more important than ever when it comes to protecting your rights in the wake of a serious crash.

To speak to our personal injury lawyers in  Fort Myers or Fort Lauderdale contact the Garvin Injury Law at 888-524-2426.