As many motorists continue to endure the ever-increasing auto insurance
premiums, the topic of PIP law reform in Florida has gained traction.
In 2012, Florida Governor Rick Scott and Chief Financial Officer Jeff
Atwater launched an initiative calling for massive reforms to Florida’s
no-fault personal injury protection insurance. Colossal insurance fraud
schemes, notorious throughout the metropolitan areas of southern Florida,
are the driving factor behind skyrocketing auto insurance premiums.
Florida PIP Law Reform
In early 2013, Governor Rick Scott’s campaign met initial success
as lawmakers signed into effect
Florida Statute 627.736. Florida accident victims must now meet additional criteria before benefits are paid.
Here is an overview of the changes to Florida’s PIP law:
Proof of medically necessary emergency treatment: Accident victims must receive medical care within 14 days of the accident
and must obtain proof from a qualified physician that treatment was necessary.
$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. Only emergency conditions
may receive the $10,000 amount. Note: This only applies to PIP coverage.
A motorist’s bodily injury coverage and other benefits may cover
non-emergency treatments beyond $2,500, but the insurance company will
have greater power to verify the legitimacy of the injury and investigate
any suspicion of fraud.
60 to 90 day Payout Period: Insurers are now allotted 60 to 90 days to investigate suspicious claims
and verify documents. With old law, they were only provided 30 days.
Greater ability to require a second opinion: Insurers may demand an independent medical examination as a precondition
to receiving PIP benefits. The aim is to eliminate false or altered MRIs
and exaggerated diagnoses.
Exclusion of massage therapy and acupuncture: The new law also excludes PIP payment for supplemental treatments. The
idea behind the change is that it is much easier for would-be fraudsters
to obtain massage therapist licenses and participate in fraud scheme.
Financially, it does not make sense for most people to complete medical
school with the intent of defrauding PIP benefits.
Florida Judge Blocks PIP Exclusion Clause
In February, shortly after the statute was enacted, second Circuit Court
Judge Terry Lewis filed temporary injunction partially blocking the exclusion
of massage and acupuncture therapy. Following pressure from insurance
regulators, the injunction was revisited, but upheld, in April.
Many supporters of PIP law reform were outraged and disagree with Judge Lewis.
“We are highly disappointed with this injunction, which temporarily
invalidates the crux of the reform and thereby reopens the door to the
fraud and abuse that the law was designed to counteract,” said Donovan
Brown, Florida counsel for state relations for Property Casualty Insurers
The Coalition Against Insurance Fraud also expressed its frustrations with
the ruling. The organization states the injunction ignores the harm done
by fraudulent medical providers that initially led to the law changes.
“Curbing crooked medical providers in this manner is a reasonable
way to reduce runaway fraud,” said Dennis Jay, executive director
of the coalition. “Its constitutional validity has a strong basis.”
Judge Lewis backed his decision to uphold the injunction. Skeptics are
critical of the judge’s receptiveness to opposition brought on by
massage and acupuncture medical providers. However, he said, the injunction
is foremost to protect individuals’ rights to access the courts.
“The reason for issuing the injunction was to protect the constitutional
right and prevent the potential harm to citizens injured in auto accidents
who, under the present PIP statute, may not receive necessary medical
care,” Lewis stated.
The Office of Insurance Regulation (OIR) filed a motion with Florida’s
First District Court of Appeal seeking an expedited review of the temporary
injunction and plans on pursuing any available legal options geared at
overturning the judge’s ruling.