I had the chance to attend a really good seminar recently with some of the smartest PIP lawyers in the state. After leaving the same, here are my thoughts on the BIGGEST changes that Accident Victims and the healthcare providers who treat the same are likely to see and feel, from current law.
1) Up to a 75% Reduction in Overall Benefits. Simply, if you are not diagnosed with an EMC , you will only get $2,500.00 in PIP benefits, and not $10,000.00, like you pay for;
2) An Examination Under Oath is now a Condition Precedent to getting benefits under the policy. The insurance company can and will make you give an extensive presuit deposition and your failure to do the same will preclude and void any obligation of the insurance company to pay for that accident;
3) IME’s – If you miss two doctor’s appointments with the Insurance Company doctor, there is a rebuttable presumption your no show was unreasonable. Bottom line, you are cut-off, and it will be very difficult to prove in Court why you shouldn’t be;
4) Definition of what is an ‘Emergent Medical Condition’ and what conditions satisfy this stringent, yet vague requirement. It is highly questionable what is enough here. Are restrictions in range of motion enough? Severe pain? The key wording that the determinations will likely come down to is “in the absence of immediate medical attention.” Thus, is the issue one in which the patient needs immediate medical attention?
The definition and statutory language also leaves open the question of whether you just must have an EMC or whether the EMC must be to a specific body party or for a specific injury. Referrals for follow up care must be consistent with the initial diagnosis. Coding and documentation of all initial visits to each provider, particularly those making the EMC diagnosis in the first 14 days of care, are critical and will be heavily scrutinized.
5) As of July 1stof 2012, additional Medicare fee schedule reductions will apply to doctor billing.
Knowledge Equals Power in Orlando Auto Accident Cases
Bottom line, don’t expect lower insurance premiums any time soon. This statute is so poorly drafted, our flooded courts are going to be swamped, as courts will be left to figure out what this statute really means.