In 2012, Florida Governor Rick Scott signed into law House Bill 119, outlined in Statute 627.736. This law mandates PIP as a part of every auto insurance policy. In addition, it lays out rather strict guidelines for what kinds of treatment qualify under PIP, and deadlines for enacting the policy. These were put in place to reduce PIP fraud, which was becoming a major issue in Florida. While there was initially some concern over the law and its ramifications on insurance and medical providers, it has since become an integral part of Florida drivers’ policies.
REDUCING AND ELIMINATING PIP FRAUD IN FLORIDA
Under the PIP laws of Florida, drivers who are injured in an accident can receive up to $10,000 immediately to cover medical costs, instead of going through the court system to assign fault in the accident. That process could take months, causing a delay in payments for injured drivers, and puts heavy strain on the court system. PIP puts that responsibility on the driver instead.
The original issue with PIP was the number of claims being made. While the number of accidents and injuries remained relatively constant, PIP claims soared. In fact, some Florida cities were listed as having the highest numbers of “questionable claims” across the nation. About half of all insurance fraud claims in the state were a result of PIP. The cost of that fraud was being paid by taxpayers and insurance holders, causing rates to increase. That’s why Governor Scott signed into law the Personal Injury Protection (PIP) for Auto Insurance Fraud law in 2012.
WHAT PIP POLICIES COVER
Florida Statute 627.736 lays out the specifics of what PIP coverage can be used for. First and foremost, it is used to cover a variety of medical benefits. After all deductibles are paid, PIP will pay 80 percent of the expenses for:
- Out-of-pocket prescriptions
- Dental work
- Ambulance, hospital and nursing costs
All of these expenses must be directly related to the auto accident. Unlike in some other states, Florida’s PIP laws do not cover acupuncture and massage therapy.
In addition, PIP can be used to cover:
- 60 percent of lost wages
- Mileage reimbursement for doctor visits
- $5,000 in death benefits (in addition to medical and disability benefits)
Though the law states that PIP may cover up to $10,000 in medical costs, if you do not sustain an “emergency medical condition,” that payout is limited to just $2,500. An emergency medical condition is one in which immediate attention is needed, and not getting immediate treatment could seriously jeopardize your health.
DON’T MISS THE DEADLINE
Perhaps the absolute most important clause in the Personal Injury Protection (PIP) for Auto Insurance Fraud law is the statute of limitations set for filing a claim. You must receive treatment for your injuries within 14 days of the accident in order to get your medical bills covered. If you do not, you will be responsible for your own expenses. These may be covered later on after a personal injury lawsuit, but that may take months to be completed.
Another important section to take note of is what continuing treatment is covered. If you sustained serious injury, like a traumatic brain injury or a spinal cord injury, only treatment related to those specific injuries can be covered by PIP. Finally, PIP will not be paid out if you intentionally tried to get yourself injured; you were injured while committing a felony; or if you were driving a car under whose insurance policy you are not covered, and you did not have express or implied permission to drive it.
HIRING AN ATTORNEY FOR PIP CLAIMS
Often, PIP claims are easily handled by insurance companies with little to no conflict. However, there can be issues with payment to the medical provider if the insurance company drags their feet. Claims payouts are considered overdue 30 days after insurers are given written notice of the monetary amount of covered loss. The insurance company then has 60 days to investigate and ensure there is no fraud. In the meantime, your doctor may ask for a letter of protection, when is a contract ensuring all unpaid expenses will be covered by your PIP claim.
If you insurance company is taking too long to pay out your benefits, an attorney may be able to help. They can work to make sure your insurer pays you in a timely fashion. In addition, they can review any letter of protection to make sure it is sound before you sign it.
If you were not at fault for the accident, and PIP doesn’t cover all of your expenses after you sustain serious injuries, it may be prudent to hire a personal injury attorney to file a claim against the at-fault driver. They will make sure the serious injury you sustained is not downplayed by the defendant’s attorney. Even if you get a PIP payout, you may be entitled to further compensation under Florida law. Contact the attorneys at Steinger, Greene & Feiner today for a free consultation and to learn more about your legal options.