Changes to your automobile insurance policy are coming in January 2013, specifically, your right to claim Personal Injury Protection (PIP) benefits! Lets briefly talk about PIP benefits and what changes you should expect.
First, built into almost every automobile insurance policy in Florida is a form of health and/or lost earnings insurance coverage called Personal Injury Protection (PIP) benefits. This coverage is often referred to as No-Fault Insurance. Generally, these terms are interchangeable. This coverage is available to the insured driver, passengers in the insured’s motor vehicle, and pedestrians that may have been injured by the insured’s motor vehicle. It is important to note that the insurance policy of the tortfeasor or negligent driver does not pay PIP benefits to the injured claimant. So, if you have been injured in a motor vehicle accident, look to your own insurance company first to make payments on your medical bills or reimburse your lost wages. In Florida, the mandatory PIP coverage is $10,000.00. This coverage pays for 80% of your reasonable and necessary medical bills arising from the motor vehicle accident and/or 60% of your lost wages. Regardless of how you use your benefits, they benefits are capped at $10,000.00.
Now that you have a snapshot of what Personal Injury Protection benefits provide, you should know what new limitations the Florida Legislature have approved in a recent bill. The new law will require that anyone seeking PIP medical benefits to receive treatment and care within 14 days after the accident. The initial services must be provided by a licensed physician, osteopathic physician, chiropractor, dentist or rendered at a hospital. Of greater importance is the new requirement that the ER physicians make a referral for followup care. This care must be consistent with the underlying medical diagnosis rendered when the individual received initial services and care. Although I do not agree with this limitation and restriction, it will be in affect by January 1, 2013. My concern with this new amendment falls into circumstances such as the following:
A woman is rear-ended on Monday. She is immediately taken to the emergency room where she is treated for neck pain. The doctor diagnoses her with a cervical sprain (sprain to neck) and she is released. The doctor tells the woman to f/u with her family doctor if her symptoms continue. The next morning, the woman’s lower back begins to hurt. She makes an appointment with her family doctor and complains about neck and lower back pain.
Should the woman be entitled to PIP benefits for the treatment rendered to her neck and lower back? The new statute seems to indicate that PIP benefits would not be paid for treatment to her lower back because her lower back was not in the medical diagnosis provided by the ER physician. Further, the treatment that the woman’s family doctor provides to her neck may also be denied by the insurance company because she did not obtain a “referral” from the emergency room physicians.
This is but one example that could likely occur where someone was legitimately injured in a car accident, but fails to obtain the PIP benefits that she has rightful paid for over many years. Many other changes have been made. I encourage you all to make an independent investigation of the 2013 changes so that you can better protect yourself and your family. If you have any questions regarding your rights after being involved in an accident, please call my law firm. We can help!
C. Paul Brannon, Esq.