Florida Emergency Medical Condition PIP No-Fault

Florida Emergency Medical Condition PIP No-Fault

Alan Himmel, DC.  
December 29, 2012

The changes to Florida's new PIP No-Fault law did not actually include any requirement that the insurance companies must advise policy holders of the changes.  This means that after Jan 1, 2013, if a Florida consumer gets into a car accident, they are going to expect to have their full $10,000 in coverage, but they will not, unless the injuries are considered a medical emergency.  Because car insurance companies are not required to tell, and the details of this new law are not explained in the language of the insurance policies, this is obviously an unfair tactic, and would expose insurance companies to the possibility of a law suit, which would be rightly justified.  When you buy insurance, its a contract that both the policy holder and insurance company agree and sign.  Nowhere in the current policy does it state that you are only entitled to $2500 for non emergency care.  It states that you are entitled to $10,000.





Imagine having an accident, going to the hospital to get checked, which could be thousands of dollars if any diagnostic test or injections for pain are given, and then you go for follow up care, to be left with unpaid medical bills.  This is exactly what is going to happen under the revised PIP law beginning 01-01-13.

So, in regard to this dilemma, the Florida Cabinet and Insurance Commissioner have adopted and approved an emergency form that will be either included in your new policy or mailed out to you separately advising you of this change.  Here is an article that explains what is going to happen:

  http://www.claimsjournal.com/news/southeast/2012/12/18/219368.htm


By the way, I hate claimsjournal.com.  This is a  "journal" or newsletter if you will, which is totally and completely biased toward insurance companies.  It is not meant for policy holders to read, it is meant for insurance adjusters, agents, representatives, etc.  You can tell this by the sponsors on the page and what they write in their articles...  but I digress.  This is really a topic for another blog post.

The main thing is that you should be made aware of the emergency provision on your auto policy starting Jan 1, 2013.  It looks like you can read it, as long as you take the time to look in the letter sent by your auto carrier.

If you don't use it, you lose it. (after 14 days)--Your Florida PIP Benefit

Your Florida PIP No-Fault benefits:  If you don't use it, you lose it.  (after 14 days)

That's exactly what happens.  If you have an accident, and you don't use your insurance, you lose it.

Imagine having insurance coverage that you paid for, but because you did not use it within a certain window, your insurance coverage expires and you get nothing.  Well, if you have an accident after Jan 1, 2013, and you decide to wait more than 14 days to go get checked out, your insurance will expire, and your insurance company which you pay good money, will deny your claim.  That's not much time is it, just 14 days?  Well according to the insurance companies, if you have an injury from a car accident in Florida, if there is truly an injury, you should have enough time, within those 2 weeks, to be looked at by a doctor.  Their rational is that pain, headaches, and impairments never arise after 14 days have passed.

Yes.  Its downright silly, yet it is exactly the way the law reads.

Anyway, I was talking to a friend of mine tonight, who lives in Colorado, and in regard to the recent changes to the Florida PIP law, he pointed something out to me that I had not even thought of.  First and foremost, we know that people NEED TO BE MADE AWARE OF THE CHANGES TO PIP, because their insurance company is not required to advise them of this change, and the new insurance policies don't even include this language in the paperwork.  It's a fact that they plan on keeping this detail hidden, because "the less an injured person knows about the procedure, the better."  Its obvious that your insurance company is banking on the fact that you will wait 14 days and one second, so they will be off the hook for any medical claims.

So, this brings up something very interesting and this is what he said:  If a person were to know that they would have no insurance if they waited too long to file a claim for injuries, why wouldn't you expect an increase the PIP claims that the insurance companies will get?  In other words, this may bring more claims to the insurance company, because  people are not going to want to lose their benefit.  

Could this 14 day thing backfire on the insurance companies?

Its very possibly could backfire.  I expect to start seeing radio and TV advertisements talking about the 14 days, which would prompt people to go get checked out who normally would have just dealt with the pain.  Some people may go to a doctor once, just for the purpose of securing their insurance benefit, which means some people may go get checked out, even if they have absolutely no pain.  Most intelligent people are cognizant of the fact that problems often show up later, due to injuries they suffer today.  I hope it doesn't cause people to bring in completely fake claims, just so future claims are not denied, but this is exactly what might happen when people become aware of the 14 day cut-off.  This may be a completely unintended consequence of the PIP change.  But, it was his opinion that even the most honest person would go get checked out by a doctor, if he knew that he would lose his insurance if he didn't go.

...just something to think of, right?

Have a Happy Holiday!

Dr. A. Himmel

954-659-8600 

Car Accident Victims: 14 Days Left to Begin Treatment

Attention Car Accident Victims in Florida

Beginning January 1, 2013, you will have UP TO 14 DAYS to initiate treatment of painful injuries if you have been involved in a Car Accident.  If you wait one extra minute, you will have NO COVERAGE for these injuries under the new State Law.



This is what our Doctors Do:

1.  We are licensed Doctors who will Personally See you at a moments notice at your home, your work, or our office BEFORE the 14 days have passed.

2.  We have 18 years experience treating and documenting painful car accident injuries.

3.  We handle ALL the paperwork on our end.  You don't have to worry.  We file the claim for you.  Don't go to any doctor for this type of injury care.  Most doctors are not familiar with the New No-Fault Law.  You will likely get stuck with a large out of pocket expense if you do not use the right doctors.

4.  If you wait one extra second you LOSE YOUR BENEFIT.

5.  Call if you Have Had a Car Accident.

954-659-8600:  Dr. Himmel

Professionally yours,

Doctors Mobile Rehab
http://www.MiramarChiropractor.com

Florida No-Fault PIP injunction denied by Judge Lazarra

FLORIDA PIP INJUNCTION DENIED

Okay, the injunction for the Jan 1, 2013 PIP legislation was denied.  The Judge said that the plaintifs have not demonstrated that they had a chance of winning based on the arguments or merits of the case.

This is no big surprise.  Most of the House and Senate voted to move the bil to the governors desk, and the governor pledged that he was going to sign the bill into law.  At one point he said this will be the highlight of his career.  They keep touting this new law as such a savior of money for Florida drivers.  They say how its going to reduce premiums and eliminate fraud.  All sounds so good especially if you paint the picture you want to paint, and leave out the facts of this case.  Based on this, and its all political--no Judge wants to be the one to allow this injunction to go forward, and potentially delay the implementation of the new no fault law.  Especially before anyone has had a chance to see if it would actually work.

There are some very important changes to the law, which the Judge says has no merit.  The following are a list of things that you should know about this law.  The first thing is that you have up to 14 days to initiate treatment after an accident.  If you wait one extra minute, your insurance carrier will deny your injury claim.   In an environment where there is an insurance crises in the first place, I have no idea how this has no basis for an injunction.    Second, is that massage and acupuncture, which have been proven to be of great value for soft tissue injuries, are now eliminated. Even if you are a licensed doctor, your patient is not entitled to (under the terms of the no-fault law) any kind of soft tissue rub on the body.   The patient can have it, as long as they are willing to pay out of pocket.  This is wonderful for those who have suffered an injury in an automobile.  Third, the benefit is now 75% less than it used to be.  In most cases, you now have only $2500 in no fault insurance if you are injured.  This amount of money will last about 4 minutes in any emergency room.  Finally, there are thousands of people who make a living treating accident patients, who will now be out of work.  Oddly enough the majority of legislators in Florida are Republicans, who claim want to get people back to work.  I guess the trick to getting people back to work is to eliminate their income.

 What they have essentially accomplished is increasing insurance corporate profits by taking the insurance company responsibility away.  Yes, its true.  These people just do not care about the working man or the average Joe.

Anyway, I'm not sure about this. I would like to ask a lawyer what the next step is from here.  If anyone knows, please let me know.

Professionally yours,

Dr. Alan Himmel

Federal Lawsuit Filed Against Florida HB119 PIP No-Fault Law

LAWSUIT FILED IN FLORIDA AGAINST 

       THE NEW 2013 PIP BILL, HB119.

Dear Colleagues, 

Below is a letter written by Adam Levine, MD, JD., in regard to the Federal lawsuit recently filed Florida HB119.  Thanks to Dr. Levine, Esq., and Mr. Lirot, Esq, and for all their efforts on behalf of all Florida citizens and health care providers, who will be effected by this horrible legislation.  What you need to do is fill out the affidavit (below), get it notarized and fax it back to the lawyer.  Evidently there is a hearing on December 13, so these affidavits must be in by then.  Do this right away.

Share this on your facebook page, send it out by twitter, etc.

There are a lot of people affected by this.  Everyone should have a chance to at least be heard.

Thanks,

Alan

Re: Federal Lawsuit against HB119

Dear Friends,

Good morning. On behalf of a Florida Licensed Acupuncture Physician, a Florida Licensed Chiropractic Physician, two Florida Licensed Massage Therapists, John Doe (representing all Florida Licensed Acupuncture Physicians, Chiropractors, and Massage Therapists), and Jane Doe (representing all those injured as a result of a motor vehicle collision), o

n November 23 Luke Lirot, Esq., (Luke Charles Lirot, P.A.), and I filed a Complaint in Federal Court against Mr. Kevin McCarty in his Official Capacity as Commissioner of the Florida Office of Insurance Regulation respectfully requesting that the Court prevent the State of Florida from enforcing the provisions of the 2012 PIP Act. [also referred to as HB 119, and here I have taken the liberty of shortening the title because the actual title is 63 lines long]. The Florida Legislature enacted the 2012 PIP Act to prevent PIP Insurance Fraud and the provisions detailed below, preventing all care by all Acupuncture Physicians and all Licensed Massage Therapists, and severely limiting the care provided by all Chiropractic Physicians, applies to all patients injured as a result of a motor vehicle collision.

On November 30 we filed a Motion for Preliminary Injunction, scheduled for a hearing next week, because we believe that enforcement will irreparably harm all Acupuncture Physicians and all Licensed Massage Therapists in Florida and most likely harm many if not all Chiropractors in Florida. We believe that the 2012 PIP Act violates the Equal Protection and Due Process clauses of the 5th and 14th Amendments to the United States Constitution. Further, we believe that the 2012 PIP Act violates numerous provisions of the Florida Constitution. Essentially, the terms of the 2012 PIP Act require: 1) That despite a requirement that citizens owning a motor vehicle purchase $10,000 in Personal Injury Protection (PIP) insurance coverage, citizens failing to obtain medical evaluations within two weeks of an accident will receive no coverage, and citizens not diagnosed by an MD, DO, or DDS with an emergency medical condition will only receive $2,500 in coverage; 2) That Chiropractors (DC) may only provide manual manipulations and no other therapies (e-stim, traction, massage, heat/cold etc.) for a period limited to that allowed by Medicare or Workers Compensation, depending; 3) That all Acupuncture Physicians may not provide any evaluation or treatment of any kind; 4) That all Licensed Massage Therapists may not provide any evaluation or treatment of any kind.

Unfortunately, although we can all agree that PIP fraud exists, the mechanism chosen by the State Legislature abrogates our fundamental rights protected by the United States Constitution and violates multiple provisions of the Florida Constitution. Logically, preventing all patients from accessing all Florida licensed Acupuncture Physicians and all Licensed Massage Therapists that have already been providing care for motor vehicle accident victims for many years cannot rationally be related to preventing PIP fraud – these same providers may continue to provide care under any other 3rd party payor – just not PIP Insurance which just happens to be mandatory in Florida. Similarly, preventing all patients from accessing all the modalities available to all Florida licensed Chiropractic Physicians and limiting those patients to one quarter of the care previously allowed and then only to manual manipulations cannot rationally be related to the prevention of PIP fraud.
Please contact me by email, aslevine@msn.com, if I can provide you with any further information, if you can provide us with any information or would like to file an affidavit documenting any irreparable harm that will occur to you as a result of the 2012 PIP Act, or if you would like to participate in any way.

Best wishes and warmest regards,

Adam Levine, M.D., J.D.
Florida Legal Advocacy Group of Tampa Bay

Thanks again!

Best wishes,

Adam Levine

********************************************************************************

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

TAMPA DIVISION

ROBIN A. MYERS, A.P., an individual
person and Acupuncture Physician,

GREGORY S. ZWIRN, D.C., an individual
persona and Chiropractic Physician,

SHERRY L. SMITH, L.M.T., an individual
person and Licensed Massage Therapist, Case No. 8:12-cv-2660-T-26TBM

CARRIE C. DAMASKA, L.M.T., an individual
person and Licensed Massage Therapist,

“JOHN DOE,” on behalf of all similary
situated health care providers,

“JANE DOE,” on behalf of all those injured
by motor vehicle collisions,

Plaintiffs,

v.

KEVIN N. McCARTY, in his Official Capacity as
Commissioner of the Florida Office of Insurance
Regulation,

Defendant.
__________________________________________/

AFFIDAVIT OF  ______________[INSERT YOUR NAME HERE]_______________

STATE OF FLORIDA )
COUNTY OF [FILL IN COUNTY] )

Before me, the undersigned authority, appeared    [YOUR NAME HERE], having been duly identified and who states under oath the following:

1. I am over the age of 18 years and otherwise competent to make this affidavit;
2. I have personal knowledge of the facts set forth herein;
3. I am a resident of  [FILL IN COUNTY] County;
4. I am a [INSERT TYPE OF HEALTH CARE PROVIDER OR PATIENT];
5. I own [OR WORK IN OR WHATEVER - INSERT THE BUSINESS NAME];
6. My business is located in [INSERT COUNTY HERE] County;
7. I possess license number [INSERT LICENSE NUMBER HERE] issued by the State of Florida to practice [INSERT TYPE OF LICENSE HERE];
8. I read the 2012 Motor Vehicle Personal Injury Protection Insurance Act;
9. Although I [UNDERSTAND, AM CONFUSED BY ETC.] the aforementioned Act, I believe that the Act will [what you think the Act will do in your own words. Generally injunctions are granted for things that will cause you irreparable harm – i.e. even if they could give you money, you would still be harmed because your business was destroyed etc.  With an injunction, you are asking the Court to provide you with an extraordinary remedy – something that will potentially cause you such harm that you will be permanently damaged.];
10. At this time, this Act has already  [what was the impact of the act on your business?];
11. Further, I have the following comments:
12. I am requesting that this Court maintain the status quo so that I am not irreparably harmed until the Court can proceed with a full hearing or trial regarding this matter.

FURTHER AFFIANT SAYETH NAUGHT.
_______________________________________________
[INSERT YOUR NAME AND SIGN ABOVE]

NOTARY ACKNOWLEDGMENT

The foregoing Affidavit was sworn and acknowledged before me on this ___th day of _____________________ 2012 by  [INSERT NAME HERE], ___who is personally known to me, or ___ who produced the following identification: __________________________________________.

Notary signature: ________________________________
Notary name: ________________________________
Notary Expiration Date: ____________________________
Notary Seal: