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RD- an actual child support client
"My case was handled quickly and with ease."
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Changes to Florida’s PIP Statute for 2012

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Our Gainesville Automobile Accident Attorneys take note of significant changes in Florida’s personal injury protection laws were signed into law last week.  The insurance industry claims the changes will help reduce fraud.   Obviously, they are not really concerned about fraud.   Their only goal is to create vastly increased profits due to changes to the PIP statute.   However, will it help accident victims? In short—NO.  In effect, most accident victims will see a 75% reduction in PIP benefits even though they will continue to pay the same premium for this state-mandated coverage. The essence of the changes for policies issued or renewed after July 1, 2012 are:

  • The accident victim must seek treatment within 14 days of the accident.
  • The insured is allowed to seek the full $10,000.00 in PIP benefits only if they are diagnosed with an “Emergency Medical Condition,” or EMC for short. EMC is defined as:
    • Acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in:
    • SERIOUS jeopardy to patient health
    • SERIOUS impairment of bodily function
    • SERIOUS dysfunction of any bodily organ or part.
  • Only an M.D., D.O., P.A or ARNP is authorized to make the diagnosis of EMC
  • Massage therapy even by a licensed massage therapist and acupuncture treatment is not reimbursable at all under the new PIP statute
  • If the insured is not diagnosed with an EMC or if the insured wants to seek treatment initially with a chiropractor, the patient only gets to use up to $2,500.00 of the PIP benefits they have paid for.
  • The insured gets $0 in PIP benefits if he/she seeks treatment beyond the 14 days after the motor vehicle accident no matter the seriousness of the injury.
  • The insurance company gets an additional 60 days to pay benefits if it “suspects” insurance fraud—and there is no definition or test as to what “suspect” means in the statute.
  • The bill allows the insurer to use Medicare coding policies and payment methodologies to further reduce bills.
  • An insured must sit for an examination under oath (EUO) as a condition precedent to receiving benefits. In other words, before the provider gets paid for his/her services, the patient has to sit, if requested by the insurance company, for an EUO.
  • And finally, probably most importantly, considering the purported reason for the new rules being the desire to reduce fraud and thus save customers money, the bill failed to incorporate the Senate’s 25% rate rollback for consumers.

In the end, the insurance companies got a guaranteed benefit while the citizens of Florida got no guarantees at all. As residents of Florida, auto insurance policy holders, and accident attorneys—we find this highly problematic. As such, the Law Office of Alba & Yochim P.A. believes  is our professional obligation to do what we can to contribute to insurance reform—not just for ourselves, but more importantly, for the clients that we represent.

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