For those who may have missed Governor Scott’s “State of the State” address on January 10, 2012, there was an interesting note about potential changes in personal injury protection (“PIP”) insurance. This is the no-fault insurance that is required in Florida pursuant to ss. 627.730-627.7405, Florida Statutes. Governor Scott’s message was clear.
“THIS YEAR WE MUST ALSO REFORM AUTO INSURANCE TO CRACK DOWN ON THE FRAUD AND ABUSE THAT HAS RUN RAMPANT AND IS ESTIMATED TO COST FLORIDIANS 900 MILLION DOLLARS. IF WE DO NOT ACT, THE OFFICE OF INSURANCE REGULATION PREDICTS THAT COSTS FOR CONSUMERS WILL CONTINUE TO SPIRAL OUT OF CONTROL. OUR BEST ESTIMATES SHOW A 30 PERCENT INCREASE IN PURE PREMIUM COSTS, YEAR AFTER YEAR. THESE COSTS ARE BEING DRIVEN UP EVERY DAY ALL AROUND OUR STATE BY SCAMS THAT ARE ULTIMATELY PAID FOR BY FLORIDA’S WORKING FAMILIES. IF WE ARE GOING TO BE SERIOUS ABOUT KEEPING THE COST OF LIVING LOW FOR FLORIDIANS, WE MUST GET TOUGH ON THE FRAUD AND ABUSE IN THE AUTO INSURANCE SYSTEM. IT IS THE CONSUMERS IN OUR STATE THAT WE MUST PROTECT, NOT TRIAL LAWYERS OR THOSE INVOLVED IN THESE SCHEMES. FLORIDIANS CANNOT AFFORD ANOTHER YEAR OF THIS FRAUD AND ABUSE OR THE COST THAT WILL COME WITH IT.”
This comes at a time when a number of bills have been presented in the House and Senate addressing PIP Insurance. The two that seem to be heading for a showdown are Senate bill S 1860 and House bill H 119.
Some highlights of the Senate bill include:
- Eliminating PIP medical benefit reimbursement for massage as defined in s. 480.033, F.S., and acupuncture as defined in s. 457.102, F.S.
- Applying the offer-of-judgment law (Section 768.79, Florida Statutes) to PIP disputes.
- Requiring long-form crash reports for all crashes involving a passenger or when any party complains of pain or discomfort.
- Requiring all entities providing health care services must be licensed clinics in order to receive PIP reimbursement except for a licensed hospital, licensed ambulatory surgical center, or entities wholly owned by hospitals, licensed physicians (ch. 458, F.S. and ch. 459, F.S.), licensed dentists, and licensed chiropractors or jointly owned by such practitioners and specified family members.
- Increasing the criminal penalties for PIP fraud.
- Specifying that the Medicare fee schedule in effect on January 1 will apply to all medical care and supplies rendered in that calendar year.
- Expanding the requirement to reserve $5,000 of PIP benefits to physicians or dentists providing emergency treatment to include hospitals.
- Providing that an insurer that rejects a claim or pays only a portion of a claim due to an alleged error in the claim must include with the rejection or partial payment an itemized specification or explanation of benefits of the specified error. The claimant then has 15 days to submit a revised claim.
A stronger or “more radical” PIP reform bill is working its way through the House.
CS/HB 119 creates a new no-fault motor vehicle insurance system, the Emergency Care Coverage (ECC) law, to replace the personal injury protection (PIP) system. While the ECC system represents a significantly different approach to no-fault law, it retains many aspects of PIP. ECC is identical to PIP with respect to persons covered by the no-fault policy, the amount of mandated coverage ($10,000), and the availability of lost wage and funeral benefits.
Medical benefits are payable only for:
- Emergency transport and treatment by licensed ambulance providers within 24 hours after the accident.
- Emergency services and care rendered at a hospital within 72 hours after the accident.
- Services and care rendered to an insured who is admitted to a hospital within 72 hours after the accident.
- Services and care rendered to an insured who is determined more than 72 hours after the accident to have an emergency medical condition related to the initial diagnosis and arising from the motor vehicle accident.
- If the insured receives services and care pursuant to 2), 3), or 4), subsequent services and care directly related to the medical diagnosis arising from the accident, so long as the diagnosis is rendered in a licensed hospital and rendered by a physician licensed under chapter 458, F.S., or a licensed osteopathic physician and the care and services is rendered by a physician licensed under chapter 458, a licensed osteopathic physician, or a licensed dentist, licensed physician assistant, or a licensed registered nurse practitioner.
The ECC Law also:
- Caps attorney fee awards in individual and class action no-fault disputes, and bars the use of contingency risk multipliers in such cases.
- Creates rebuttable presumption that a diagnosis of emergency medical condition is correct.
- Tolls the 30-day payment period when fraud is suspected under specified conditions.
- Bars payment of any ECC benefits to persons who submit false statements or false information.
- Provides that compliance with ECC policy terms is a condition precedent to receipt of benefits.
- Creates rebuttable presumption that an insured’s failure to appear for two examinations (mental or physical) is an unreasonable refusal or failure to submit to examination.
- Provides that compliance with all ECC policy terms is a condition precedent to receipt of policy benefits, including submission to examination under oath.
- Provides for a single motor vehicle crash report form and requires insurers to use forms and rates that reflect the ECC Law for no-fault policies issued or renewed on and after October 1, 2012.
It is unfortunate when politicians so clearly promote policies and laws to favor big business and insurance companies and do it under the guise of helping the consumer. One look at what has been done to the victims of medical malpractice and what the politicians are still trying to do to them is quite disappointing.
Regardless of the efforts of these politicians and their big money lobbyists, the Benenati Law Firm remains committed to helping the consumer in these trying times. If you or a loved one has suffered a personal injury as the result of an accident, contact the Benenati Law Firm in Orlando to discuss your legal rights. We handle accidents and injuries of all types and will be honored to discuss your claim.