Question:
In Florida, what changes are there to the PIP coverage? I've heard
a lot of talk about changes in 2013, but I don't know the
details.
Answer:
Even with changes to Florida's
no-fault insurance
, car owners here are still required to purchase $10,000 worth of
personal injury protection (PIP) coverage. PIP will continue pay
out 80 percent of medical expenses that are found to be
necessary and reasonable
, regardless of fault.
However, starting in Jan. 1, 2013, there are changes in
Florida
concerning how quickly you must receive medical treatment for your
injuries and who can treat them. How much you can be paid will
depend upon your medical condition -- if your injury isn't declared
serious, then you can only receive up to $2,500 in PIP
benefits.
Under the revisions to Florida's no-fault law (Florida Statute
627.736
), you must initialize medical services and care within 14 days of
the accident in order for to be eligible for benefits. The law is
also strict about who can see you for your initial medical
treatment.
Starting in 2013, your initial medical care must be:
- provided by emergency medical services personnel, or
- provided in a hospital, or
- in a facility that owns or is wholly owned by a hospital,
or
- provided by a medical doctor, an osteopath, a dentist, or
chiropractor.
For follow-up medical treatment to be covered under your PIP
benefits, it must be based on a referral from the approved
healthcare professional that provided you the initial medical
care. Follow up services may be provided by a:
- Hospital
- Ambulatory surgery center
- Medical doctor
- Osteopath
- Dentist
- Chiropractor
- Physician's assistant
- Advanced registered nurse practitioner (ARNP)
- Physical therapist
- Certain health care clinics
Under the changes to the no-fault coverage, massage therapy and
acupuncture won't be covered, even if an authorized physician
prescribes it.
If the appropriate health-care professional determines that you
suffered from an emergency medical condition, then you can receive
reimbursement for all medical services and care up to your $10,000
PIP limit. If, instead, you're found to have a non-emergency
medical condition, then your PIP benefits are limited to only
$2,500.
Florida statute 627.732(16) defines an emergency medical
condition as a medical condition manifesting itself by acute
symptoms of sufficient severity, which may include severe
pain. Without seeking immediate medical attention, your
medical condition could result in any of the following:
- Serious jeopardy to your health;
- Serious impairment to bodily functions;
- Serious dysfunction of any bodily organ or part.
A provision in the no-fault law now also allows that after a
claim has been made for PIP benefits, an auto insurance company can
request that the insured submit to a mental or physical examination
by a physician (paid for by the insurer) to verify the initial
medical findings.
PIP will continue to pay 100 percent for necessary for
reasonable replacement services that may be required due to your
injuries and 60 percent of work loss -- up to your limit.
Death benefits are capped at $5,000 but are in addition your
$10,000 medical and work loss benefits.
All portions of your Florida PIP, except the death benefit, will
continue to be subjected to the deductible you selected.
Why the changes?
Florida is trying to curtail the rampant insurance fraud that
has taken place under the no-fault system.
The Florida Office of the Insurance Regulation (FLOIR) says that
the state established a no-fault system of car insurance to speed
up payment for injured drivers and limit lawsuits. However,
in recent years the amount of motor vehicle accidents has remained
relatively the same in Florida but PIP claims have skyrocketed -
nearly 50 percent of fraud investigations are in regards to
PIP.
Lawmakers also hoped the PIP reforms would lower car insurance
rates in Florida, but thus far the rate filings show the savings to
be minimal at best. The state's insurance commissioner says
that it appears the PIP revisions are mitigating rate increases
instead of producing rate reductions.
The best way to save is to shop around for the cheapest car
insurance rates for your coverage needs. Comparison shopping
for auto insurance can result in a savings of hundreds of dollars,
if not much more. (See "Pocket $1,102 just by shopping
around")