As many in the insurance industry have recently discovered, long awaited changes to Florida’s PIP laws have been passed in Florida’s recent 2012 legislative session. These changes were aimed at reducing the occurrence of automobile insurance fraud in Florida and the impact of fraud on consumers. These new changes will significantly impact the way PIP claims are adjusted and litigated in Florida. But don’t get too excited, the new PIP statute doesn’t take effect until January 1, 2013. The full text of the bill can be found at
. Some of the most significant changes are outlined below:
Treatment:
• Claimants must obtain medical treatment within 14 days of the automobile accident
• Initially, only $2,500 of medical benefits are available to the claimant
• If a physician, osteopathic physician, dentist, or a supervising physician’s assistant or advanced registered nurse practitioner
determines that the claimant has an “emergency medical condition,” the full $10,000 of PIP benefits becomes available
* Note, a chiropractor cannot make the determination that the claimant has been affected with an “emergency medical condition”
• Massage and acupuncture are no longer reimbursable medical services Examinations Under Oath:
• Permits insurers to take EUOs of insureds as part of the PIP statute
• Requires insured’s compliance with the insurer’s request for an EUO as a condition precedent to receiving PIP benefits
• If an insurer unreasonably requests EUOs as a general business practice, the insurer may be in violation of the
Unfair Insurance Trade Practices Act (Fla. Stat. 626.9541)
Independent Medical Examinations:
If a claimant unreasonably fails to appear for an IME, the insurer is no longer responsible for the payment of PIP benefits.
A claimant’s refusal or failure to appear for two IMEs raises a rebuttable presumption that the refusal or failure was unreasonable.
Attorney Fees:
• Prohibits the application of attorney fee multipliers
• Florida’s offer of judgment statute (Fla. Stat. 768.79) is applied to all PIP cases, allowing insurers to recover attorney fees if the Plaintiff does not meet the offer of judgment threshold
Fraud Related Changes:
• Provides insurers 60 additional days after an initial 30 day investigation time period to investigate suspected fraudulent claims.
The insurer must deny or pay the claim within the 90 day period. Any payments beyond the 90 day period will be subject to interest.
• If fraud is suspected, the insurer shall notify the claimant, in writing, within 30 days after submission of the claim that the claim is being investigated for suspected fraud
• An insurer’s failure to pay PIP claims within the provided time limits is considered an unfair and deceptive practice
Accident Reporting:
• Law enforcement will be required to use long-form accident reports when there is any indication of pain or discomfort by any party to the automobile accident
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