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Thursday, January 31, 2013

HB 119 — Florida Personal Injury Protection PIP No-Fault

CS/CS/HB 119 — Motor Vehicle Personal Injury Protection Insurance

by Economic Affairs Committee; Insurance and Banking Subcommittee; and Rep. Boyd and others (CS/CS/SB 1860 by Budget Committee; Banking and Insurance Committee; and Senator Negron)

This summary is provided for information only and does not represent the opinion of any Senator, Senate Officer, or Senate Office.
Prepared by: Banking and Insurance Committee (BI)
Senate Bill 1860 revises the Florida Motor Vehicle No-Fault Law. The bill primarily amends laws governing Personal Injury Protection (PIP) benefits under the No-Fault law and laws related to PIP motor-vehicle insurance fraud. The major changes enacted by the bill are as follows:
 PIP Medical Benefits
The bill revises the provision of Personal Injury Protection medical benefits under the Florida Motor Vehicle No-Fault Law, effective January 1, 2013. Individuals seeking PIP medical benefits are required to receive initial services and care within 14 days after the motor vehicle accident. Initial services and care are only reimbursable if lawfully provided, supervised, ordered or prescribed by a licensed physician, licensed osteopathic physician, licensed chiropractic physician, licensed dentist, or must be rendered in a hospital, a facility that owns or is owned by a hospital, or a licensed emergency transportation and treatment provider. Follow up services and care require a referral from such providers and must be consistent with the underlying medical diagnosis rendered when the individual received initial services and care.
The bill applies two different coverage limits for PIP medical benefits, based upon the severity of the medical condition of the individual. An individual may receive up to $10,000 in medical benefits for services and care if a physician, osteopathic physician, dentist, physician’s assistant or advanced registered nurse practitioner has determined that the injured person had an emergency medical condition. An emergency medical condition is defined as a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health, serious impairment to bodily functions, or serious dysfunction of a body organ or part. An individual who is not diagnosed with an emergency medical condition, the PIP medical benefit limit is $2,500. Massage and acupuncture are not reimbursable, regardless of who the type of provider rendering such services.
PIP Death Benefit
Personal Injury Protection now offers $5,000 in death benefits in addition to $10,000 in medical and disability benefits. Previously, the death benefit was the lesser of the unused PIP benefits, up to a limit of $5,000. The increased death benefit is effective January 1, 2013.
PIP Medical Fee Schedule
The bill revises provisions related to the PIP medical fee schedule in an effort to resolve alleged ambiguities in the schedule that have led to conflicts and litigation between claimants and insurers. The bill clarifies that the reimbursement levels for care provided by ambulatory surgical centers and clinical laboratories and for durable medical equipment is 200 percent of the appropriate Medicare Part B schedule. The Medicare fee schedule on effect on March 1 will be the applicable fee schedule for the remainder of that year until the subsequent update. Insurers are authorized to use Medicare coding policies and payment methodologies of the Centers for Medicare and Medicare Services, including applicable modifiers, when applying the fee schedule if they do not constitute a utilization limit. The bill also requires insurers to include notice of the fee schedule in their policies. These provisions are effective January 1, 2013.
Attorney Fees
The bill amends provisions related to attorney fee awards in No-Fault disputes. The bill prohibits the application of attorney fee multipliers. The offer of judgment statute, s. 768.79, F.S., is applied to No-Fault cases, providing statutory authority for insurers to recover fees if the plaintiff’s recovery does not exceed the insurer’s settlement offer by a statutorily specified percentage. The bill maintains current law allowing a party that obtains a favorable judgment from an insurer to recover reasonable attorney fees from the insurer. The bill also requires that the attorney fees awarded must comply with prevailing professional standards, not overstate or inflate the number of hours reasonably necessary for a case of comparable skill or complexity, and represent legal services that are reasonable to achieve the result obtained.
Investigation and Payment of Claims
Provisions relating to the investigation of PIP claims by insurers are revised, effective January 1, 2013. Insurers are authorized to take an examination under oath (EUO) of an insured. Compliance is a condition precedent for receiving benefits (the insurer owes zero benefits if the insured does not comply). An insurer that unreasonably requests EUOs as a general business practice, as determined by the Office of Insurance Regulation (OIR), is subject to s. 626.9541, F.S. of the Unfair Insurance Trade Practices Act. The bill also provides that if a person unreasonably fails to appear for an independent medical examination (IME), the carrier is no longer responsible for benefits. Refusal or failure to appear for two IMEs raises a rebuttable presumption that the refusal or failure was unreasonable.
Changes are made to the statutory process for the payment of PIP benefits, primarily to assist claimants in their claim submissions, effective January 1, 2013. A claimant whose claim is denied due to an error in the claim is given 15 additional days to correct the erroneous claim and resubmit it timely. The insurer must maintain a log of all PIP benefits paid on behalf of the insured and must provide the log to the insured upon his or her request if litigation has initiated. If a dispute between insurers and insureds occurs, the insurer must provide notice within 15 days of the exhaustion of PIP benefits. Insurers must reimburse Medicaid within 30 days. The electronic submission of records is authorized, effective December 1, 2012.
Prevention of PIP-Related Insurance Fraud
House Bill 119 contains numerous provisions designed to curtail PIP fraud. The bill defines insurance fraud as knowingly presenting a PIP claim to an insurer for payment or other benefits on behalf of a person or entity that committed fraud when applying for health care clinic licensure, seeking an exemption from clinic licensure, or demonstrating compliance with the Health Care Clinic Law. Claims that are unlawful under the patient brokering law (s. 817.505, F.S.) are not reimbursable under the No-Fault Law. A health care practitioner found guilty of insurance fraud under s. 817.234, F.S., loses his or her license for 5 years and may not receive PIP reimbursement for 10 years. Insurers are provided an additional 60 days (90 total) to investigate suspected fraudulent claims, however, an insurer that ultimately pays the claim must also pay an interest penalty.
All entities seeking reimbursement under the No-Fault Law must obtain health care clinic licensure except for hospitals, ambulatory surgical centers, entities owned or wholly owned by a hospital, clinical facilities affiliated with an accredited medical school and practices wholly owned by a physician, dentist, or chiropractic physician or by such physicians and specified family members. The bill creates standards for evaluating whether an entity claiming it is exempt from the requirement to obtain clinic licensure is actually wholly owned by a physician.
The bill defines failure to pay PIP claims within the time limits of s. 627.736(4)(b), F.S., as an unfair and deceptive practice. The OIR may order restitution to the insured or provider, but is not limited in its other administrative penalties, which may include suspending the insurer’s certificate of authority.
Law enforcement is required to complete a long-form crash report when there is an indication of pain or discomfort by any party to a crash. All crash reports completed by law enforcement must identify the vehicle in which each party was a driver or passenger. For all crashes that do not require a law enforcement report, the vehicle driver must submit a report on the crash to the Department of Highway Safety and Motor Vehicles within 10 days of the crash.
The bill creates a non-profit direct support organization, the Automobile Insurance Fraud Strike Force, which can accept private donations for the purposes of preventing, investigating, and prosecuting motor vehicle insurance fraud. Monies raised by the Strike Force may fund the salaries of insurance fraud investigators, prosecutors, and support personnel so long as such grants or expenditures do not interfere with prosecutorial independence. Funds may not be used to advertise using the likeness or name of any elected official or for lobbying.
Mandatory Rate Filings and Data Call
The Office of Insurance Regulation must contract with a consulting firm to calculate the expected savings from the act, which must be presented to the Governor and Legislature by September 15, 2012. By October 1, 2012, each insurer that writes private passenger automobile personal injury protection insurance must submit a rate filing. If the insurer requests a rate that does not provide at least a 10 percent reduction of its current rate, it must explain in detail its reasons for failing to achieve those savings. A second rate filing must be made by January 1, 2014. If the insurer requests a rate that does not provide at least a 25 percent reduction of the rate that was in effect on July 1, 2012, it must explain in detail its reasons for failing to achieve those savings. The Office of Insurance Regulation must order an insurer to stop writing new PIP policies if the insurer requests a rate in excess of the statutorily required rate reduction and fails to provide a detailed explanation for that failure. The Office of Insurance Regulation must perform a comprehensive PIP data call and publish the results by January 1, 2015. The data call will analyze the impact of the act’s reforms on the PIP insurance market.
If approved by the Governor, these provisions take effect July 1, 2012, except as otherwise provided.
Vote: Senate 22-17; House 80-34

Monday, January 21, 2013

Preventing Back Injuries.

Preventing Back Injuries

Dr. Alan Himmel

Other than car accident care, I see my share of patients who simply "pulled their back out."  The mechanism behind this type of injury is different than a whiplash, or a hyper-flexion / hyper-extension injury, where the persons body is quickly flung in the direction of the impact (Newton's Law) and the muscles and tissues are quickly stretched beyond their limits.  The result of course is pain, inflammation, disc injury, etc.

But a "pulled back" is different.  Generally a person calls me up and says that their back is killing them.  They cannot stand up straight and cant even get out bed, in many cases.  They tell me that they were just bending over to put on their shoes, or they simply turned to reach for something, and the pain started.  Very often they describe it like a rubber band that all of a sudden lost its tension, and just gave out.  At that moment, there was severe pain and the inability to move.  The medical treatments for this type of injury are anti-inflammatory medications, muscle relaxers, and pain meds.

But, the truth is that all the symptom relief remedies in the world will not offer anything in the way of prevention.  The deal with these patients that I quickly find out is that its not the first time the person has had this type of injury.  What I have found actually is that its a recurrent type injury and the patient has done this before.  One interesting thing that I have observed with these patients is that each time they pull their back out, its worse than the time before, or it happened much easier than the time before.  This is because the injured tissues are damaged and are weaker with each successive injury.

                                Watch Peter Griffin as he explains the "improper way" of lifting.

There is something that you can do however, which works pretty well to reduce the frequency of these injuries, and maybe prevent them from happening altogether.  It requires a little work on your behalf, but the alternative is continued back injuries.

This is what it requires:

First, it requires knowing how to properly lift and bend.  This alone can prevent most of your injuries from happening in the first place.

1. Never bend from your back to lift.
2. Always bend at your knees to lift.
3. Never reach forward to lift anything.

(Number three requires an explanation.)  Never reach forward to lift anything. Step up to the object you want to lift, and carry it close to your body.  Its all about leverage.  A one pound object held out in front of you too far is like lifting 10 times its actual weight.  The next time you pick up a hammer, you will see that its easier to swing if you choke up on the grip closer to the head and claw.  And, conversely, if you hold it at the very and of the handle you will see that it is much more work to swing that hammer.  Just this little fact right here, will help prevent back injuries.

Next, in order to prevent injuries is strengthening your back.  This can be done by doing a few specific exercises.  You need to work on stability and strengthening.  Its a fact that these low back injuries frequently occur because of an inherent weakness in the muscles that support your body.  Again, its all about leverage.  You put a lot of stress on the low back muscles because from a leverage standpoint, the low back is very far away from the end of your body, which is your torso and arms and head. Let me give you another analogy:  Its like holding that hammer on the end of the handle.  The injury happens when the handle breaks, or the muscles in the low back just "give out."

So, here are a few excersises that really help.

1.  The plank.

2.  Abdominal crunches.

3.  Weight loss.

4.  Walking, biking, running, and not sitting.  (all require muscles of balance.)

One of my favorite exercises involve doing the eliptical excercise machine, and doing it hands free.  In other words, do not grab the two handles that go up and back.  You will find that you have a difficult time at first balancing, but it gets better over time.  When you let go of the handles, your body is forced to work the intrinsic muscles of balance and posture.  These are the muscles that you have that you have no control over.  But I assure you that if you are standing on your feet right now, they are there and are keeping you upright without you even knowing it.

Friday, January 18, 2013

Do you think these new PIP revisions will save Floridians money?

Do you think these new PIP revisions will save Floridians money?
Create your own poll

Tuesday, January 15, 2013



Dr. Alan Himmel

If you are looking for a Florida PIP medical condition form, there isn't one.

At least, not yet.

 As of today, which actually is Jan 15, 2013, (the deadline if you had your accident on Jan 1 and have not seen a doctor yet), the Florida department of insurance or the department of financial services have not issued a standard form.  Also, they have not even recommended to the insurance carriers that there should be a standard form.  Therefore, if you are a doctor who treats auto injury trauma patients, you wouldn't have any idea where to make the statement of an emergency medical condition or not.  Common sense would say that there should be a standard form or something should be written in the notes.  I had one insurance adjuster for Allstate tell me that it should be put on the claim form.  When I asked him where, he told me he did not know.  There are no extra boxes to designate emergency on a HCFA 1500 form, and there certainly are no extra boxes to write in how the injury fits the EMC definition as we have been reading it.  You can put in your diagnosis codes there, but that's all.

Hypothetically, it would be more realistic for the doctor to write in his chart note something like:

"I have examined this patient and have given the diagnosis of "brain concussion", with the symptoms of loss of balance, inability to concentrate, nausea, severe headache, etc., and have determined that this condition may cause serious jeopardy to the patient's health.  Thus, this patient has a severe injury which is an emergency medical condition."

This is probably the best bet at this point since there has been no instruction to the doctors about how this should be done.

Of course, any insurance company can tell you that your "emergency medical condition" is not severe enough.  Those insurance companies will disregard your doctor's EMC and limit you to 25% of the coverage you paid for, but that's another story.

This is only my opinion, and not advice.    I hope it helps.

Pembroke Pines Chiropractic

Monday, January 14, 2013

Lawsuit Against Florida PIP No-Fault Law 2013

Lawsuit Against Florida PIP No-Fault Law 2013

Are you thinking about filing a law suit against your PIP insurance carrier for not covering you for injuries that you sustained in a car accident?  Well, get in line.  This year, it is expected that there will be many more PIP lawsuits than in previous years.  Why?  Because the insurance companies now have more opportunity to deny claims, and they will use the new Florida No-Fault law as support for their denials.

Don't worry.  Let us handle it.  We are doctors.  The most important thing is that you get the care that you need for your injuries.  Schedule an appointment and let us help.

We will accept assignment with your insurance carrier, and if they don't pay your medical bills, WE will file a lawsuit with an attorney, and WE will fight to get your medical bills paid.  Let US fight for your insurance benefits.

We have two convenient locations in Broward County, in Miramar and Sunrise/Tamarac.  We also will come out to you to see you for your accident.  We will bring a treatment table and the necessary therapies.  Yes, we are among a select few doctors that still do house calls!

Call today.

Dr. Rapp in practice for 19 Years.
Dr. Himmel  in practice for 17 Years.

Sunday, January 13, 2013

24/7 Chiropractic Care for Car accident injuruies, if the 14 days are running out!

24/7 Chiropractic Care if you have had a car accident injury and the 14 days are running out!  (new Florida rule)

If you are one of those people who like to wait until the last minute to do things, be advised that our office can see you at a moment's notice for any car accident related injury.  Why is this critical?  Because if you wait one extra second after 14 days, your insurance company will DENY your claim.  Don't let them get away with ripping you off.  You paid for this coverage and if you procrastinate and you wait more than 14 days, you are entitled to NOTHING!

We are available 24 hours a day and 7 days a week to make sure that you initiate treatment within the first 14 days following an accident.

This means:

1. We will come to your home at ANY time of the day, even 3am if necessary, to make sure that you get your first treatment within the new 14 day restriction..

2.  We can see you in Broward, Dade, Palm Beach County the same day you call.

3.  We have convenient offices if you would rather come in.  Just call us.

14 Day Auto Accident Emergency Care.

Call right now!

Alan Himmel, DC.


In 2013, Chiropractic Care in the State of Florida is STILL covered under PIP.


In 2013, Chiropractic Care in the State of Florida is STILL covered under PIP or the Florida No-Fault Law.  There is no need to worry about being covered, because chiropractic care has NOT been eliminated. You are still entitled to treatment.  Eliminated from reimbursement is massage and acupuncture, and also podiatrists.

The main thing you need to know is that you now have only 14 days to initiate treatment if you have been injured in a car accident.  This goes for passengers in a car, drivers, pedestrians, and even injuries that you may get while being inside, around, under a car repairing the car, etc.  If you injure yourself while changing your oil, or changing a tire, you are covered.  If you slip and fall while you are exiting or entering your car, you are covered.

My office handles all of these injuries.  I am conveniently located in Miramar and Pembroke Pines, but see patients all over South Florida.

Dr. Alan Himmel

Friday, January 11, 2013

How a Crap Insurance Company Treats its Customers

How a Crap Insurance Company Treats its Customers.

Alan Himmel

 Over the years I have had the misfortune to have to deal with certain insurance companies that, for the most part are existing for the purpose of ripping policy holder's off.  I am not going to mention any names, but if you google the three words, "Deny, Delay, Dont pay," you will be able to track down the name of this insurance carrier.

Luckily I have not had to deal with this company in several years, ever since I picked up my practice and moved 60 miles north.  Better for me anyway, because I was commuting down to this rancid insurance area just to try to help injured people, and oh yeah, actually be compensated for my work.  Some insurance carriers specifically target poor people who could hardly read or understand English.  Its very easy to rip off people who are uneducated.

So, as I was sitting here and had a few minutes, I was just reminiscing about a situation that a patient had a number of years ago with this insurance company.

What happened was a patient of mine was in an accident with his new pickup truck.  It seems he was crossing an intersection and ran a red light.  The accident caused substantial damage to his car and his car had to be towed.  Since it was a brand new Toyota, he told the tow truck driver to bring it to the local Toyota dealership for repair, which is where he just bought it.  He reported the claim to his insurance company and they sent an adjuster out to the body shop and estimated the damage to be about $2200.  The body shop on the other hand told the insurance company that the damages were closer to $8000, and there was no way that any body shop could repair the truck for the amount the insurance company was willing to pay.  So, since the body shop would not start the work, and the insurance company would not allow the correct amount to make the repairs, my patient's pickup truck remained at the body shop for several months.  My patient was adamant that the repairs be done correctly and at the Toyota dealership since the truck was only 2 months old.  The insurance company stated that they have no problem with him doing the repairs there, but they will not pay any more than $2200 to do the job.

Long and short of it, was that after several months at the Toyota body shop, the dealership called my patient and told him that he had to remove his vehicle, and he now had several thousand dollars in storage fees that must be paid to the dealership in order for the dealership to release his car  He has been paying the loan on his new truck the whole time the car was at the shop.  He was also paying for his insurance.  At this point, since he did not have the money to release his truck from the dealership, he decided to just abandon the truck.  He lost his truck, all the payments toward it, and his down payment. Not to mention, he also lost all the insurance premiums he paid.  Oh, and his PIP was paid at about 10 cents on the dollar to me.  I had to file a law suit to get the PIP paid, which took almost three years.

I would like to hear some other people who have had disasters dealing with insurance companies.  It can be any insurance company.  Anywhere in any state.  If you have an interesting story, lets hear it.

Friday, January 4, 2013




There has been some confusion regarding the New Revised Florida No-Fault PIP law.




Dr. Alan Himmel