Due to insurance companies’ continual lobbying, the Florida Legislature passed a bill that changed the Personal Injury Protection (PIP) coverage law.
The changes are significant and do not seem to represent the best interests of Florida drivers.
Medical Doctor or Hospital Visit
After an accident, the law mandates that each victim seek medical treatment within two weeks (14 days). If you do not see a licensed medical doctor within this time period, your PIP benefits and coverage will be deemed ineligible. Therefore, you will not receive compensation for your medical bills.
Change in PIP Coverage
Your medical coverage is no longer an automatic $10,000 you can immediately access for medical expenses. As of January 1, 2013 your coverage is $2500 or $10,000. Although, you’re still required by law to purchase $10,000 from your insurance company, only a licensed medical doctor can deem your accident an “Emergency Medical Condition,” allowing you to collect full PIP compensation for lost wages and medical bills. When a doctor determines an incident a “Non-Emergency,” the auto accident victim is only entitled to $2,500 for lost wages and medical bills.
An “Emergency Medical Condition” is defined by the State’s criteria:
- A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such as that the absence of immediate medical attention could reasonably be expected to result in any of the following:
- Serious jeopardy to patient health
- Serious impairment to bodily functions
- Serious dysfunction of any bodily organ or part
Coverage Points You Must Know:
- A visit to a hospital emergency room does not guarantee your accident an “Emergency Medical Condition”
- According to the State, chiropractors cannot make the determination on whether your accident is an “Emergency Medical Condition”
Suggested Steps After an Auto Accident to Receive Full PIP Coverage
- 1. Immediately following your auto accident go to the hospital to ensure your injuries are not life threatening.
- 2. Contact an attorney to speak with your insurance company.
- 3. Make an appointment with a licensed osteopathic doctor or medical doctor to assess your condition.
Changes in Auto Accident Treatment Coverage
During your first, osteopath or medical, doctor appointment you must inform the doctor of all your injuries and symptoms. Make sure you explain in detail any pain, numbness or tingling that is occurring after your auto accident. If you do not, the law states that any conditions or symptoms that arise after that first appointment may not be covered with your PIP coverage.
The guidelines on what treatments are covered with PIP have also changed:
- You can still treat with a chiropractor, but he or she cannot determine your auto accident a “Medical Emergency.”
- Massage therapy and acupuncture treatment are no longer covered
New Delay Tactic–EUO’s & IME’s
In 2013, insurance companies have another reason to celebrate, two additional steps in the way of an accident victim and their insurance compensation.
The new PIP law states all accident victims requesting compensation must participate in an Examination Under Oath (EUO) and an Independent Medical Examination (IME) when the insurance company requests.
These two changes slow down the payment process for accident victims. Instead of quickly receiving compensation you rightfully deserve, you have to meet with your insurance company and possibly see another doctor for a separate medical evaluation.
How EUO Works:
- 1. Your insurance company requests an EUO.
- 2. You meet at a court reporter’s office in a conference room. If you have an attorney, he or she can arrange a meeting to be at a location of your choosing. And it’s a good idea to have your attorney present.
- 3. An associate of your insurance company will ask you a series of questions.
- 4. A court reporter asks you to raise your right hand and swear to tell the truth, then your statement is recorded in full.
How IME Works:
- 1. Your insurance company requests an IME
- 2. You are given an appointment to see a licensed medical doctor
- 3. You must appear – if you reschedule or miss two appointments, your insurance company can refuse payment
- 4. The doctor performs a medical evaluation based on the medical report the doctor at your initial visit created.
- 5. The information is sent to your attorney and insurance company.
Do Not Go Against Your Insurance Company Alone
Your auto insurance carrier is a for-profit business that provides a service Florida car owners and drivers are required by law to have—Insurance. Unfortunately, your best interests do not necessarily align with your insurance company’s profit margins.
Do not go against your insurance company without legal representation. You need an attorney on your side to provide legal assistance and guidance through the maze of PIP Coverage.
Every day, we help people just like you; get the assistance and compensation they rightfully deserve. Contact us today.
