The Florida legislature recently passed a bill with numerous changes to the current Personal Injury Protection (PIP) law. With ever-increasing insurance rates and a seemingly never-ending wave of PIP cases being litigated, the bill has an ultimate goal of reducing both the number of PIP cases in litigation and insurance rates for consumers. Rate reductions are even written into the bill… well, sort of.

The problem is that these reductions are quasi-mandatory. The bill attempts to require two major rate reductions from insurers: one by October 1, 2012 that is to provide at least a 10 percent reduction to the insurer’s current rate, and another by January 1, 2014 that is to provide at least a 25-percent reduction. This sounds great for consumers except for one major flaw: the bill leaves insurer’s with a loophole to avoid these reductions. The bill states that if an insurer fails to achieve these reductions, it must explain in detail its reasons for failing to do so. This would be tantamount to legislation that gives citizens the option to submit to the IRS a detailed explanation of why they were unable to pay their taxes this year instead of actually paying them. It seems absurd that the legislature doesn’t think that the insurance companies aren’t going to utilize this exception instead of actually reducing their rates. It’s not hard for one to envision the devious, Grinch-like grin on the face of insurance executives while they were reading the provisions in the new law allowing them to explain there reason for not reducing there rates.

In an attempt to make these reductions possible, the bill has numerous provisions aiming to reduce fraud and frivolous litigation. Whether or not these changes will be effective is yet to be seen. Here are some of the major changes the new legislation will have on Florida’s current PIP law:

- An insured is only entitled to reimbursement for services and care provided up to $10,000
if a licensed physician, physician’s assistant, dentist, or an advanced registered nurse
practitioner has determined that the injured person had an “emergency medical
condition.”
The statute defines an emergency medical condition, 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 serious jeopardy to patient health, serious impairment to bodily functions, or
serious dysfunction of any bodily organ or part.”

- If any of the above mentioned medical providers determine that the injured person did not
have an “emergency medical condition,” reimbursement for services and care provided is
limited to $2,500.

- An insured seeking PIP medical benefits now must have received there initial medical
services within 14 days of the motor vehicle accident.

- Medical benefits will no longer cover massage and/or acupuncture therapy regardless of
the person, entity, or licensee providing the massage or acupuncture, and a licensed
massage therapist or licensed acupuncturist may not be reimbursed.

- PIP will now offer $5,000 in death benefits in addition to $10,000 in medical and disability
benefits, rather than the $5,000 being included in the available $10,000.

PIP litigation can be very complex. Insurance companies often refuse to pay their insureds the benefits they are rightfully owed. Don’t let this happen to you. Visit www.LaBovick.com for more information. Our attorneys can help you receive the benefits you are legally entitled to.

Around our courthouse here in West Palm Beach, Florida there has been a constant grumbling by our judiciary about unprepared injury lawyers appearing in court. They have stated their new “policy” of enforcing their pre-trial orders and holding the lawyers’ feet to the fire to get the cases tried and justice served.
In our country, the respective parties have a right to a speedy and public trial, this holds true not only for criminal cases but for civil disputes as well. With every case noticed for trial, the court issues a pre-trial order directing the timing of the case and handing out deadlines for the progress of the case.
I was in court the other day to object to a move by the other party who was trying to obfuscate the judge’s order by scheduling a medical exam of my client well after the applicable deadline. After much bluster, the court granted the other side’s request for this exam. This came over my strong objections to the contrary. My plea to the court centered on the respect for the rules of the court and orders handed down by the Judges that are equally applied to both parties. I realized, at that moment, that the same court in West Palm Beach, Florida that complains about lack of diligence on the part of the lawyers rewards this very conduct by refusing to enforce their own orders for fear of reprisal from insurance companies, the appellate court and who knows what else.
My job as an officer of the court is to zealously represent my client, uphold the constitution and the orders of the court. This is becoming increasingly difficult when the final authority allows its own rules to be broken but only after complaining about the parties being allowed to break the rules. Our system is what is really broken and it needs to be fixed from the top down.

One question I often hear from medical providers who accept assignments of benefits from an insured is “What do I do when my patient provided me with incorrect insurance information regarding his personal injury protection insurance, and now the insurance company is refusing to issue any payment for services I rendered because I didn’t submit the bills within the time frame set forth in the Florida No-Fault Statute?”

One important change brought about by amendments to Florida’s No-Fault Statute was an exception to the billing time limits contained in F.S. 627.736(5) allowing providers who are furnished incorrect insurance information by a patient to re-bill the correct insurer upon discovery of the proper insurance information. Prior to the amendment, a provider who was furnished with incorrect insurance information from his patient was precluded from being reimbursed for services rendered by personal injury protection if the bill was not submitted within the 30 day time frame. There was no exception to this time frame regardless of whether there were “reasonable” delays caused by the patient or any third party.

The No-Fault Statute currently allows providers who have suffered from this scenario a second chance. All that is required is proof demonstrating that the provider reasonably relied on erroneous information from the insured and either: (1) a denial letter from the incorrect insurer; or (2) proof of mailing reflecting timely mailing to the incorrect address or insurer.

Don’t let the insurance carriers rob you from money rightfully owed to you due to delays caused by incorrect insurance information or misrepresentation by your patient!