For several decades, Florida has been a “no fault” state when it comes to motor vehicle accidents. What does this mean? In essence, owners of motor vehicles have been required to have PIP (“no fault”) insurance which would pay for the first $10,000.00 of medical expenses and/or lost wages as result of an automobile accident, regardless of fault.
Recently, the Florida legislature has enacted changes which will significantly affect your rights to benefits under the PIP portion of your automobile insurance policy. These changes will go into effect on January 1, 2013. I will summarize some of the more important changes.
Timing of Care
The patient will be entitled to PIP medical benefits if, and only if, the patient receives an initial service within 14 days after the accident. If the patient’s first doctor or hospital visit is on the 15th day after the accident, or beyond, there is no PIP coverage. Therefore, it is imperative to seek initial medical treatment within 14 days after the accident if you intend to avail yourself of PIP benefits for medical expenses.
How Much Will PIP Insurers Pay for Medical Benefits?
If the patient is diagnosed with an emergency medical condition (EMC) by and M.D., D.O., dentist, physician assistant, or advanced registered nurse practitioner, the patient will qualify for a maximum of $10,000.00 in benefits. A chiropractor cannot make this diagnosis. However, the patient will only be entitled to $2,500.00 in PIP benefits if there is a determination by one of the above providers, including a chiropractor, that there is not an emergency medical condition (EMC). It will be important for all persons who have been injured in an automobile accident to be aware of any findings made by hospital staff and/or treating medical care providers with regard to any emergency medical condition, as this alone can determine whether or not the injured person is entitled to $10,000.00 of benefits or is limited to $2,500.00 of benefits.
What is an Emergency Medical Condition (EMC)?
EMC means a condition manifesting itself by acute symptoms of sufficient severity which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
a. Serious jeopardy to patient health b. Serious impairment to bodily functions c. Serious dysfunction to any bodily organ or part
What About Massage and Accupunture?
Massage and acupuncture are no longer covered under PIP. It does not matter if the provider is a doctor, licensed physical therapist, or a massage therapist.
Lost Earning Capacity
The statute on this issue has not changed. There is still $10,000.00 in lost earning capacity regardless of whether or not the injury is considered an emergency medical condition. Payment is made at 60% every two weeks.
Insurance Medical Examinations
If your PIP insurance company advises you that you must attend an insurance medical examination, then you must in fact attend the examination. If you fail to appear for the examination, in all likelihood, your bills will be denied and it will be very difficult for you to overcome this denial.
Examinations Under Oath
You may be required by your PIP insurance company to sit for an examination under oath at a time and place of the insurance company’s choosing. Your compliance with a request to an examination under oath is now a condition precedent to receiving benefits. As a condition precedent, this means that the insurance company will not be under any obligation to pay outstanding medical bills, unless you attend the EUO and provide the insurance company with answers to their questions under oath. An insured’s refusal to submit to, or failure to appear at two examinations under oath raises a rebuttable presumption that the insured’s refusal or failure was unreasonable. In all likelihood, at that point, your benefits will be terminated, your PIP coverage will be denied, your medical bills will remain unpaid, and it will be very difficult for you to prevail against your PIP insurance company on these issues.
As you can see, there are numerous changes to Florida’s PIP statute which will have significant and longstanding effects to your ability to recover payment of medical expenses incurred as a result of a motor vehicle accident.
The Lawyers of Greenberg Stone and Urbano Can Help
Regardless of what your condition may be after being involved in an accident, one of your first thoughts should be to hire an attorney. Even if incapacitated and unable to make contact yourself, you should have a friend or relative contact a lawyer with experience handling car accident cases so that the attorney may help you recover any compensation you may be owed. Insurance companies for the other driver(s) will promptly have their own lawyers and investigators working very hard by collecting evidence and interviewing witnesses from the moment the accident was reported to them. Shouldn’t you have someone working as hard for you too?
With more than 100 years of combined experience, the Miami Dade County Car Accident Law Offices of Greenberg Stone and Urbano have helped thousands of victims of car accidents, tractor trailer accidents, motorcycle accidents, accidents at amusement parks or any other kind of accidents recover the funds they were owed. Visit our website to learn more about our firm and contact us today for a free consultation.