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Florida’s PIP/No-Fault Law

On behalf of Terence Gross of Gross & Schuster, P.A. posted in Car Accidents and Legal Questions on Monday, September 28, 2015.

On January 1, 2013 Florida’s No-Fault Statute was subject to many significant changes.  One major change was that the legislature decided that if a person did not treat within 14 days of an accident with any type of medical or chiropractic facility, that individual would forfeit any potential PIP or no-fault coverage through their own personal policy.  Therefore, it is incumbent upon the injured party to at least seek out the services of any type of physician within that time period in order to preserve the benefits that they paid for.

Another major change in the law is that the legislature chose to discriminate against massage therapists and acupuncturists, in that bills for those services would no longer have to be paid by no-fault.  These particular provisions of that statute are currently being challenged in our court system on several bases.  I think the best argument would be the equal protection clause, since it discriminates against massage therapists and acupuncturists without any underlying scientific data supporting their deletion from no-fault coverage.

The legislature also continued to mandate mandatory fee schedules for physicians, chiropractors, MRI facilities and like in relation to what actually would be owed by a no-fault carrier, once bills have been submitted.  This new provision mandates write-offs if the health care provider accepts PIP or no-fault payments.

Last, but certainly not least, is a provision that was added to the 2013 statute regarding the necessity of an emergency medical condition (EMC) before a no fault carrier would be responsible for paying 80% of the bills up to $10,000.  Specifically, without an EMC certification by a medical doctor, a physician’s assistant or a dentist, the no-fault carrier would only be responsible to pay 80% of bills up to $2,500.  The essence of this law means that a chiropractor cannot EMC certify a patient and without an opinion from a medical doctor or a PA, most chiropractic bills would be left unpaid and ultimately the client’s responsibility, even though the client may have paid a premium for years for $10,000 in no-fault coverage.

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