No-Fault (PIP)

Since 1972 owners of vehicles registered for use on public roads have been required to have PIP coverage in various amounts. Currently, and for the past few decades, the amount of coverage mandated is $10,000. PIP pays for 80% of reasonable and related medical care and 60% of wage loss or lost services, with some medical expense reimbursements capped by “fee schedules” contained within the very detailed payment provisions of Florida Statute, Section 627.736.

The Florida PIP statute sunset or expired on October 1, 2007, before being reinacted effective January 1, 2008, with increased provider reimbursement requirements, and fee schedules or caps for select types of medical care tied to Medicare B payment schedules. The legal confusion concerning the application of the 2008 PIP law, and insurance policies issued both before and after the effective date of the new law, has resulted in a large volume of PIP lawsuits filed throughout the State, including class actions.

Typically, when a person insured for PIP benefits is injured in an automobile accident, and visits a doctor, hospital, chiropractor or health clinic of any sort, the person must sign an assignment of benefits, transferring their rights to payments under the PIP policy in exchange for medical care. That being the case, insureds do not bring PIP claims or suits, but rather the person or business entity taking the assignment of benefits typically controls the PIP claim or lawsuit. 

PIP claims are frequently the subject of fraud investigations by insurance companies. Reasons include claims found to involve staged accidents, “phantom injuries”, insurance policies obtained based on misrepresentation of facts, or the involvement of health care providers who or which participate in fraudulent billing, overbilling, and some even arranging the staging auto accidents or paying kickbacks to runners who find PIP patients or to the patients themselves. With much recent press concerning the abuses surrounding PIP claims, the Florida legislature will again modify the Florida No Fault Act in 2012.  The bills introduced in the Senate and House for consideration during the 2012 Florida Legislative Session each expand the rights of insurers to conduct investigations into suspected PIP fraud.  The House bill goes a great deal further than the Senate bill in expanding the use of EUOs (Examinations Under Oath) by insurance companies, and in allowing the denial of all PIP payments where evidence of fraud is uncovered.  (A summary and comparison of both Bills is posted on this site's blog.) 

PIP REFORM - Florida Legislative Update 1-23-12  ... Meet the revised "CS"/HB119

While all other PIP reform bills are slow or not out of the gate, the House Banking and Insurance Subcommittee appoved today a "Committeel Substitute" (CS) version of HB119 that renames the Florida No Fault Law, the "Emergency Care Coverage Law", limits attorneys fees, and gives emergency transport and hospital care* the sole right to claim benefits.  

*Subsequent care is only reimbursable if it is related to an "emergency medical condition" as diagnosed at the hospital.

Attorneys fees are limited based on a three part scale:

1. Disputed amount of less than $500.00; max fees = 10x disputed amount, up to $5,000;
2. Disputed amount of less $500.00 up to $5,000.00; max fees = 10x disputed amount up to $10,000; and
3. Disputed amount of $5,000 and more, up to $10,000; max fees = 10x disputed amount up to $15,000.

Also, class action fees are capped at $50,000 or three times any disputed amount recovered in a class action.

Read the "Staff Analysis" of the new Bill here, or the text here.  Also, take a look at my Blog for more information on the other competing bills, and the provisions of each.  CS/HB119 is very much pro insurer, with no signs of influence from chiropractic or medical clinics or other of the usual PIP assingees who claim benefits, OR from the trial lawyers.