Monthly Archives: March 2012

Webinar to Discuss Changes to Florida PIP Law

Cole, Scott & Kissane will host a webinar to discuss the newly-passed changes to Florida PIP law.  The webinar will be hosted by Partner, Bill Davis, head of CSK’s PIP Department.  Registration and call-in details for the webinar will be sent soon.  The webinar will be free and 1-hour of Florida Adjuster Continuing Education is expected.

-Thursday, April 5, 2012, from 2:00 p.m. to 3:00 p.m. EST

-Tuesday, April 10, 2012, from 2:00 p.m. to 3:00 p.m. EST

Some highlights of the changes, most of which will take effect on January 1, 2013:

-The fraud provisions have been enhanced in a variety of ways, including the right of the Division of Insurance Fraud to establish an “Automobile Insurance Fraud Strike Force.”

-The death benefit of $5,000.00 is now in addition to the $10,000.00 policy limits.

-Acupuncture and massage are no longer compensable by PIP.

-PIP benefits are limited to $2,500.00 for non-emergency medical conditions.  “Emergency medical condition” is defined as an acute problem (including pain) that requires immediate care that could result in serious jeopardy to patient health or impairment of bodily functions or organs.

-To qualify for PIP benefits, the injured person must treat within 14 days of the accident.

-Medicaid must be reimbursed within 30 days of notice.

-The insurance company must notify the claimant of a fraud investigation within 30 days of claim submission, which then allows a 60-day period to investigate.

-Durable Medical Equipment Prosthetics/Orthotics and Supplies are now explicitly subject to the Medicare Part B fee schedule.

-In a dispute, the insurer must notify the claimant that benefits are exhausted within 15 days, when requested.

-The right to take Examinations Under Oath is now included in the statute; attendance is a condition precedent to receiving benefits (effectively overruling Custer Medical and related cases on the EUO issue).

-The claimant’s failure to attend 2 defense medical examinations creates a rebuttable presumption that the failure was unreasonable.

-Insurance companies are required to maintain PIP logs and produce PIP logs within 30 days when requested in litigation.

-Insurance companies must give notice of an intent to use fee schedules to the insured at the time of policy issuance or renewal (essentially codifying Kingsway).

-Failure of an insurance company to timely pay a PIP claim has been added to the list of “Unfair claim settlement practices” under Florida Statute section 626.9541(1)(i)3.i.  A violation of this section is one of the bases of a Florida insurance bad faith action.

-Insurance companies are required to reduce PIP premiums by 10% by October 1, 2012, unless a detailed explanation is filed with the Office of Insurance Regulation as to why not.