What Happened to My PIP – Guest Commentary by Dr Mark Lipkin, DC
Auto Insurance Coverage in Florida, to Change
(or, What Happened To My Benefits!)
By Mark Z. Lipkin, DC
For over 25 years, I've helped hundreds of patients recover from injuries resulting from auto accidents. My heart goes out to those who suffer from long-term pain and weakness of soft-tissue injuries. Mandatory Florida Personal Injury Protection (PIP) insurance is required to assist all victims of accidents up to $10,000 of medical benefit for diagnosis and treatment of such injuries.
That is, until December 31, 2012.
No-Thanks to the recent legislative session passing of HB119, your 'required' benefits will now be significantly limited, and you may be left paying for medical care due to the negligence of others.
On the guise of preventing insurance fraud (which has been the subject of recent insurance company led media hype of "staged accidents." Their answer to "staged accidents" is to upend the current benefits which will result in ANTI-Consumer, ANTI-State Budget, and PRO-insurance company ramifications.
(It seems the only thing this will reduce, is legitimate insurance company payments for legitimate injuries, in exchange for you paying full premiums for reduced coverage)
Here how things will change (with the signature of Governor Scott) to become Florida Law.
Medical benefits for "soft tissue" or non-emergent care are limited to $2,500 at 80% coverage.
Care for emergent conditions will be paid at the $10,000 benefit.
After Governor Scott signs the bill, the primary provisions in the new law concerning PIP reimbursements go into effect January 1, 2013.
There is a time limit for a patient to receive benefits. Patients must first present for treatment within 14 days of the car accident, to an emergency room or upon referral to a MD, DC or DO and obtain a diagnosis during this time. If ANY condition is not INITIALLY diagnosed within 14 days, it is NOT Covered.
(Including late-onset symptom of conditions (such as headaches, radiation of arm/leg pain, or conditions you "thought may go away"). Just today I had a patient complain of jaw pain of her TMJ, which was evaluated for ligamentous injury (as confirmed on an imaging study) and related to an accident 45 days ago.
EMERGENCY MEDICAL CONDITION (EMC)
As of now, we don't know what the diagnostic codes the PIP law defines as an EMC, but the law refers to an EMC as:
A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
(a) Serious jeopardy to patient health.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.
NON-EMC Benefits are limited to $2500.00,
Q. If a patient is diagnosed with a non-EMC, the patient's benefit is $2500.
After reaching that benefit, can my health insurance company be billed?
YES. (They can be billed, but Who Pays?)
After receiving a denial of claim from the PIP carrier, Secondary (Health Insurance) may be billed. The patient is responsible for contractual deductibles, copays or co-insurance. (With more claims for auto-related medical benefits, the health insurance companies may raise premiums for care).
Other possible scenarios:
If the patient is under Medicare. Medicare pays.
If the patient is under Medicaid. The taxpayers pay (Medicaid is already a financial burden for the state).
If the patient is un-insured. The patient pays.
If the patient is not 'at fault' – The patient hires an attorney to collect payment (if the other party has adequate coverage). With less PIP benefit for treatment, settlements or judgments will be used to pay off outstanding balances from letters of protection with your treating physician (ie. less money in your pocket, more money for the insurance company).
Unfortunately, diagnostic testing is included in the $2500 limit. A trip to the hospital with diagnostic testing may exhaust your benefits by the time you leave the emergency room.
EXAMINATIONS UNDER OATH
Because of the anti-fraud measure, the insurance company has the power to hold claim payments until you, the patient, respond to an Examination under Oath (EUO). Your medical bills will be put on hold.
MASSAGE AND ACUPUNCTURE EXCLUDED
PIP insurers are not required to reimburse massage "as defined in s. 480.033 or acupuncture as defined in s. 457.102, regardless of the person, entity, or licensee providing massage or acupuncture."
PIP PREMIUM REDUCTION?
Although there is language to suggest the carriers to reduce premiums, the carrier may challenge the requirement by justifying why it could not reduce the premiums.
UNINSURED MOTORIST (UM) and MEDICAL PAYMENTS (Med Pay)
From my understanding, Medical Payments policies do NOT follow PIP statutes or limitations.
The problem is that many insurance companies do not offer or suggest these policies in order to be competitive with other insurance companies for your business.
If PIP premiums are eventually reduced, you will still need to purchase additional Med Pay or UM coverage to protect yourself and your family for financial liability. (ie. More money/profit for the insurance companies)
DEATH BENEFIT INCREASED:
The death benefit has been increased to $5,000 in addition to $10,000 in medical and disability benefits used. Previously the death benefit was the lesser of any unused PIP benefit up to $5,000. So, if the medical benefit is unused, the death benefit remains at $5,000. Why don't they just increase the death benefit to $15,000 if medical/disability benefits are unused? Do they not consider death a "serious" medical condition or a disability for gainful employment?
So, WHAT DOES THIS LAW DO?
Takes away conservative treatment of most legitimate auto related injuries (ie. soft-tissue).
Increases (false) perception that "Soft-Tissue" injuries are fraudulent in nature.
Increases (false) perception that those who treat "soft-tissue injuries" are fraudulent (ie. Massage therapists, chiropractors, acupuncturists).
Increases (false) perception that "soft tissue injuries" are not ‘serious' or cause lasting impairment worthy for medical benefits.
Shifts care to the most expensive ER Hospital Diagnostic and MD specialists.
Less treatment available for injured (absorbed by high ER and Ambulance costs)
Limited (non-emergent) chiropractic care increases exposure and dependency (addictions) to pain medications
Increases non-covered costs to consumers and Medicaid (taxpayers)
Increases injured responsibility for care of conditions which present after 14 days (or for the injured who did not get a diagnosis within 14 days.
Benefits insurance companies and stockholders (Less payout) (increased sales of Med Pay or UM for benefits not paid by PIP).
Helps to raise funds for Governor Rick Scott, who accepted a $100,000 political committee contribution from an affiliate of United Auto Insurance 2 days before the voting to pass this bill.
For more information or a free consultation on your legal issue contact The Law Offices of Charles D. Scott PLLC, your injury law and family law attorneys, at 727-300-4878. http://www.yourstpetelawyers.com