There are seventeen states in the U.S. where personal injury protection (PIP), or “no-fault,” coverage is required. PIP coverage is designed to cover medical expenses that a normal insurance policy may not cover, and it is often referred to as “no-fault” because bills are usually paid regardless of legal liability. Florida has mandatory PIP coverage, but within the last year and a half, there have been major changes to the regulations surrounding benefits. You may need a good attorney to help clarify what you are owed under the new law.
Changes in PIP Benefits
The first major change to PIP benefits is the time frame you have in which to accrue them. To receive full benefits, your initial medical treatment must be sought before fourteen days have gone by. This does not mean all your medical treatment must be completed in that time, but you must begin to see a medical professional within that two-week time frame. If you do not, you are precluded from receiving full PIP benefits, regardless of whether or not you completed the other steps to obtain them.
The second important change to be aware of is that there are two levels of benefits: emergency and non-emergency. Emergency benefits can amount to $10,000, while non-emergency benefits cap out at $2,500. A medical provider (not including chiropractors) will make the determination as to whether or not an injured person has an emergency medical condition (EMC), which means that the final determination as to your PIP benefits can be quite subjective. An EMC is defined in the law, but the definition itself is subjective, and is based on the medical provider’s understanding.
The third change is that while massage and acupuncture were formerly covered under most PIP plans, the Florida law now disallows that coverage. No benefits or reimbursements are available for those treatments at all. However, groups of acupuncturists and massage therapists in Florida, as well as chiropractors, are trying to have that section of the law overturned. They argue that the palliative benefits of these practices merit the re-inclusion of massage and acupuncture under the PIP benefit umbrella. However, no decision has yet been reached on the group’s appeal to the state’s high court.
The fourth change is that insurers are given much more power over their insured customers. Insurers may now require that before any benefits are paid out, the potential payee must submit to an Examination Under Oath (EUO). An EUO is very similar to a civil deposition; the insurance company will question the insured about information relevant to their claim, and both parties are recommended to have their attorneys with them. If an insured does not attend the exam, they will likely receive no benefits, as their attendance is listed in the law as a condition precedent.
Insurers may also require the insured submit to an Independent Medical Exam (IME), and if they ‘unreasonably’ fail to appear, the insurer is no longer responsible for paying benefits. An IME, despite its name, is when a physician hired by the insurance company examines the insured to verify their injuries. It is a measure designed to cut down on fraudulent claims.
Consult an Attorney if You Have Been Injured
Some of these changes may possibly be reversed by the Florida Supreme Court, but as of this writing, they are all still on the books. If you have been injured in an accident, it is important to know your rights. Contact the Miami firm of Kaire & Heffernan, LLC today.