This article from the Sun Sentinel, http://articles.sun-sentinel.com/2012-04-17/business/fl-pip-fraudsters-already-searching-ways-around-ch-20120416_1_florida-insurers-fraud-unit-massage, is just further proof positive of something I have been saying for months now – the NEW FLORIDA PIP AUTO INSURANCE LAW WILL FAIL!
The article discusses a medical group based out of Tampa, which apparently was sending faxes to chiropractors, advising that they will have their M.D.’s see patients, and render an ‘Emergent Medical Condition’ diagnosis, as required by the new PIP law, so the chiropractor and patient qualify for a full $10,000.00 in PIP benefits. The new PIP law requires that a doctor, nurse practitioner, or dentist find that an injured person have an “Emergent Medical Condition,” in order for them to receive up to the full $10,000.00 in benefits. If a diagnosis of an Emergent Medical Condition is not made, then the injured accident victim is capped at only $2,500.00 in PIP treatment benefits.
This scheme of EMC vs. non-EMC conditions and diagnosis, which was drafted and created by insurance company lobbyists, creates this very ethical and practical problem for doctors and patients. Now, the legislature and the insurance lobby have decided that whether or not you get the full benefit of your insurance premium dollars comes down to a one-time call, where the insurance company has an unlimited number of medical specialist who can render the diagnosis of non-EMC versus the insured who only has 4 providers and a very tight window (14 days from the accident), who can say it is an EMC, which requires full benefits of treatment. The result, more medical and diagnostic testing by front-line providers to make sure they have evidence to support this decision in a deposition and a courtroom. The end result – greater medical costs and wait times for all accident victims, and greater out-of-pocket medical expenses for all accident victims, with likely very little to any premium relief.