Effective January 1, 2013, the Florida legislature changed the law concerning Personal Injury Protection Benefits (PIP), which is part of every automobile policy sold in Florida. These legislative changes have sweeping effects on everyone that is injured in an automobile accident. While some people may have already heard about these changes, I talk to be people daily that do not know how the legislature has limited their rights to PIP benefits. I write this blog today to explain 2 of the major changes, and to explain how the insurance companies are using this law against you.
The Law on the 14 day Rule
It isn’t uncommon for someone to feel no pain after an accident due to the adrenalin that is going through their body. It is also not uncommon for someone to only have a little pain after an accident, but then the pain get worse the next morning or over the next few days. In fact, how many times have you heard people say “you will feel it tomorrow”. The truth is that these situations occur all of the time. So what are you to do, run to the hospital immediately? Call in sick to work and miss a day of pay that you desperately need? Try to tough it out and see if it gets better? Well, under the new PIP law, the insurance company has made this decision for you.
Under the old version of the PIP law, there was no time limit as to when you could first present to a doctor and still use your PIP benefits. However, under the new law, if you want to use any your $10,000 in PIP benefits that you are required to have, and which you pay for, you have to seek medical care within 14 days of the accident. If you don’t seek medical care within the 14 days, then you waive all rights to you PIP benefits. You should know that the law does not have exceptions to the failure to get treatment within the 14 days. The fact that you were busy or trying to “tough it out” is totally irrelevant. That is why we encourage all of our friends and clients, to seek health/medical care immediately after an accident, if they feel that they may be injured, so that they can preserve their right to the PIP benefits. Moreover, you should know that you do not have to go to the ER, but can see a chiropractor, MD, DO, hospital, urgent care center, EMT, or dentist. Therefore, if you don’t want to wait at the ER, you have other health care providers that you can see to preserve your rights.
Emergency Medical Conditions
Under the new PIP law, you are required to have $10,000 in PIP insurance. However, you are limited to $2,500 of the $10,000 unless you have what the statute calls an “Emergency Medical Condition” (EMC). Although the statute does not state that the EMC must be diagnosed within the 14 days as discussed above, the EMC must be diagnosed by a licensed physician (MD or DO), a dentist, a physician assistant, or an advanced nurse practitioner. Also, the PIP statute does not even define what is an EMC. However, another Florida statute defines EMC as an emergency medical diagnosis to include a medical condition manifesting itself by acute symptoms of sufficient severity, which include severe pain, such that the absence of immediate medical attention could have/will reasonably be expected to result in serious dysfunction of a bodily part.
Initially, after the law went into effect, because of various legal challenges, some insurance companies were not requiring a patient to have an EMC. However, over the last 8 months, essentially all of the insurance companies are demanding that the medical records state that the patient has an EMC. A typical tactic of the insurance company is that they will deny the medical bills unless the medical records say exactly what the adjuster wants to qualify as an EMC. A medical diagnosis related to the automobile accident or suggestion for additional treatment is not enough for most insurance companies. For example, in the last month, we have had one patient undergoing surgery and one patient undergoing an advanced medical procedure, which were not paid by PIP because the doctor did not state the “magic language” that the insurance company wanted. To combat this problem, we are simply having the doctor sign a declaration indicating that the patient has an emergency medical condition manifesting itself by acute symptoms of sufficient severity, which include severe pain, such that the absence of immediate medical attention could have/will reasonably be expected to result in serious dysfunction of a bodily part. If the insurance company still disputes the EMC, we suggest our clients allow us to file suit.
Another tactic that we are seeing is the insurance companies will send out a letter saying that the PIP benefits have been exhausted, but not telling the patient that they were limiting benefits at the $2,500 cap due to the insurance company having an issue with the doctors EMC. If you receive a letter from the insurance company, make sure you check to assure that you have used all of your $10,000 in PIP. If not, and the insurance company is limiting your benefits to $2,500, please contact an attorney for assistance.
If you have questions about the new PIP law, or your rights after an automobile accident, please give the Law Office of J.J. Talbott and Associates a call a free Consultation, or visit us on our website