PIP coverage pays out claims of up to $10,000 in medical expenses and lost
wages for each person in a vehicle injured in an accident. Regardless
of fault, motorists are required to access the first $10,000 in accident-related
costs from their own insurance benefits. Recent reform to PIP law has
heightened claim requirements in an effort to curb rampant fraud throughout
the state. However, injured motorists will still have access to benefits
and care if they follow the appropriate protocol.
Here, we’ll discuss a few tips motorist should follow to ensure their
access to benefits when they need them while avoiding the potential pitfalls
of scams and other questionable organizations who aim to exploit PIP payout benefits.
Tips for Filing a PIP Claim and Avoiding Problems
Get the Long-Form Accident Report: If you’re involved in an accident, call the police immediately.
If you suspect you may need medical treatment or evaluation, inform the
police and request a copy of the “long-form” accident report.
It is ok to let the police know that you plan to explore your PIP benefits
and also plan to comply with the new law. The police should be able to
tell you how you can obtain a copy of the long-form accident report to
provide to your insurance company.
Follow Protocol: Florida
statute 627.736 states that anyone injured in an auto accident is subject to the following:
Medically necessary emergency treatment: Accident victims must receive medical care within 14 days of the accident.
Hospital admissions and surgeries needed to treat injuries will be covered
by the $10,000 limit, provided the treating physician provides documentation.
Most true emergencies should require treatment on the same day of the accident
$2,500 benefit limit for non-emergency medical diagnoses: If medical treatment is needed, but isn’t necessary to prevent serious
injury or death, benefits are capped at $2,500.
60-90 day Payout Period: Insurers are now allotted 60 to 90 days to better investigate suspicious
claims. Submitting paperwork and proof of medical treatment should satisfy
this requirement for injured motorists.
Insurer Requested Second-Opinion: In most cases, legitimate injuries and documented treatment plans should suffice.
Exclusion of massage therapy and acupuncture: The new law also excludes PIP payment for supplemental treatments, but
a recent injunction has temporarily blocked this provision. For the time
being, injured motorists are better off seeking treatment with a licensed
physician or licensed chiropractor to ensure adequate access to benefits.
If the injunction is lifted, massage and acupuncture therapies may again
Be Wary of Referral Services: As a consumer, your best route may be to conduct your own research regarding
lawyers and injury treatment. Local lawyer-referral services have come
under harsh criticism following large-scale allegations of fraud and unethical
practices. 1-800-ASK-GARY and 411-Pain have been publicly criticized for
allegedly forcing accident-injury victims to meet with lawyers at pain
clinics, placing priority on reaping PIP coverage benefits over actual
medical diagnosis and appropriate patient care. Instead, ask a friend
or loved one to recommend or lawyer or reputable chiropractor. If your
injury is severe, go right to the emergency room and follow the hospital’s
instructions for treatment.
If you decide to consult a lawyer-referral service, do not tolerate any
high-pressure tactics. Ask for three options for lawyers and medical clinics
and tell them you plan to also compare the choices. Any legitimate service
should not object to your decision or attempt to dissuade you from making
Ignore Unsolicited Offers – If you are solicited by a medical practitioner or other similar
service after an accident, and you did not request information from them,
they may be fraudsters attempting to take advantage of your injury and
access to PIP benefits. It is important to only pursue treatment options
with which you have initiated contact. Doing so will help to ensure you
aren’t taken advantage of by PIP fraudsters.
Online Sunshine (Legislature)
Florida PIP Fraud News
The Insurance Journal