Effective January 1, 2013, Florida Personal Injury Protection (No-Fault Coverage) law has changed.Changes in the law that broaden your PIP coverage are effective on January 1, 2013.Changes that restrict your coverage are effective on your first renewal that occurs on or after January 1, 2013.Changes in the law include the following:
Medical expenses. Your insurance company may restrict its policy so that it only pays 80% of properly billed and documented reasonable charges for medical expenses that are medically necessary, but only if the insured (the injured party) receives initial services and care from a "health care provider" within 14 days after the motor vehicle crash.
Your insurance company may not pay for any medical expenses if the insured (injured party) does not receive initial services and care from a "health care provider" WITHIN 14 DAYS AFTER THE MOTOR VEHICLE CRASH.
Death benefits.Your insurance company may pay $5,000 per deceased individual insured.
Limits of coverage.
The most your insurance company may pay for each injured insured (injured party) as a result of any one motor vehicle crash is $10,000 for all combined medical expenses, income loss, and replacement services lost.
Death benefits.Your insurance company may pay $5,000 per deceased individual insured.The death benefits limit is in addition to the medical expenses, income loss, and replacement services loss limit.
Medical expenses.The limit for an "emergency medical condition" is $10,000.
Medical expenses.The limit for a "non-emergency medical condition" is $2,500.
Medical expenses.The insurance company may limit reimbursement of medical expenses to 80% of a properly billed and documented reasonable charge, but may pay no more than 80% of the No-Fault Act "schedule of maximum charges" as described in the insurance policy.
Limitations of PIP Insurance Coverage.
There may be no PIP/No-fault coverage for a person who:
Refuses to submit to or complete an examination under oath or fails to appear at an examination under oath; or
ii.Refuses to provide or complete a statement under oath or fails to appear at a statement under oath.
There may be no coverage for any massage or acupuncture treatment.
There may be no coverage for services, care or treatment provided by a massage therapist or acupuncturist.
Definitions relevant to the above:
"Emergency medical condition" has been added by the statute and I suspect will be added to most every PIP/No-fault policy issued in the State of Florida and it means a medical condition manifesting itself by acute symptoms of sufficient severity, which may include sever pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
Serious jeopardy to the patient health;
Serious impairment to bodily function; or
Serious dysfunction of any bodily organ or part.
"Medical expenses" means reasonable charges incurred for medically necessary medical, surgical, x-ray, dental, and rehabilitative services, including medically necessary prosthetic devices and medically necessary ambulance, hospital, and nursing services. Medical expenses DO NOT include massage, acupuncture, or any services, care, treatment or supplies provided by any massage therapist or any acupuncturist.
"Reasonable charge" includes reasonable expense and means an amount determined to be reasonable in accordance with the Florida No-Fault Act including:
Usual and customary charges.
Payments accepted by the provider.
Reimbursement levels in the community.
Various federal and state medical fee schedules applicable to motor vehicle and other insurance coverages.
The schedule of maximum charges in the No-Fault Act.
Other information relevant to the reasonableness of the charge for the services, treatment, or supplies.
Medicare coding policies and payment methodologies of the Federal Centers for Medicare and Medicaid Services, including applicable modifiers, if the coding policy or payment methodology does not constitute a utilization limit.
Of course this new No-Fault law just came into effect and is subject to judicial determination which I am reasonably certain will occur.I whole heartedly expect a strong Constitutional challenge to this law and await the Florida Supreme Courts ruling with regard to same.
As always, should you have any questions or comments regarding the foregoing comments, feel free to contact Charpentier Law Firm, P.A. at (321) 308-8020.