Insurance Fraud Gauranteed by New Florida PIP Law

The Florida legislature in the last hours of the 2012 legislative drastically changed the PIP law that since 1972 had guaranteed people in an auto accident quick repayment for medical bills and lost wages. Touted as a measure to avoid insurance fraud that drives up our policy premiums, it instead invites fraud in a way you probably don’t expect.

PIP stands for personal injury protection. Until the new law, which is called Emergency Care Coverage Law (ECC), took effect in 2012, a person injured in an auto accident, regardless of who was at fault, was entitled under the PIP coverage to medical care up to $10,000 by any healthcare provider. But after the old PIP law was replaced by the ECC, we have to get the care within fourteen days of the wreck and by medical care providers the state dictates to us. If we don’t, we lose $7,500 of our coverage unless the doctor certifies that the care is for an emergency issue related to the accident.

The new law also gives insurance companies the privilege to challenge the doctor’s statement that it was an emergency. They will do exactly that, and the injured person, maybe you or me, could have to pay for the treatment out of our pockets. Even worse, the law doesn’t require the insurance companies to lower our premiums in proportion to the drastically reduced coverage. We will still pay for $10,000 of coverage but in most cases get only $2,500 of it even if the full amount is needed.

The new law simply says that if an insurance company doesn’t reduce its rate for this insurance by ten percent, it has to explain why to the insurance regulators. Not a problem for insurance companies. They are used to generating hundreds of pages of explanations whether they have merit or not. That’s why I said earlier, the new law invites fraud in a way you don’t expect. Directly from the insurance companies.

To protect yourself if you’re in a wreck, get medical care within 14 days, and let the doctor know you consider it an emergency.

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