627.736 Required personal injury protection benefits; exclusions; priority; claims.—
(1) REQUIRED BENEFITS.—An insurance policy complying with the security requirements of s.627.733 must provide personal injury protection to the named insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in the motor vehicle, and other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle, subject to subsection (2) and paragraph (4)(e), to a limit of $10,000 in medical and disability benefits and $5,000 in death benefits resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle as follows:
(a) Medical benefits.—Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital, and nursing services if the individual receives initial services and care pursuant to subparagraph 1. within 14 days after the motor vehicle accident. The medical benefits provide reimbursement only for:
1. Initial services and care that are lawfully provided, supervised, ordered, or prescribed by a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, or a chiropractic physician licensed under chapter 460 or that are provided in a hospital or in a facility that owns, or is wholly owned by, a hospital. Initial services and care may also be provided by a person or entity licensed under part III of chapter 401 which provides emergency transportation and treatment.
And a little further down in the statute:
3. Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. up to $10,000 if a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced registered nurse practitioner licensed under chapter 464 has determined that the injured person had an emergency medical condition.
4. Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. is limited to $2,500 if a provider listed in subparagraph 1. or subparagraph 2. determines that the injured person did not have an emergency medical condition.
So we see that the injured person must be treated within 14 days of the accident to receive any coverage from PIP. While this requirement can prevent fraudulent claims, some argue it also adds insult to injury because some injuries or symptoms caused by an auto accident may take longer than 14 days to present themselves. Another thing people need to understand with this new restriction is it only blocks PIP benefits, it does not prevent the injured person from submitting a claim to the at-fault person's insurance company. The downside is that there may be more out-of-pocket expenses while submitting that claim.
Next, as stated above, the usual PIP limit for a person's policy is $10,000. A new restriction was added that now could limit the PIP benefits to $2,500. Again, this was added as a way to fight fraudulent claims. However, many disagree with this because they believe if they are paying an insurance premium for $10,000 in benefits, that is what they should receive. On the other side, lawmakers argue that this change will actually save people money on their insurance because people will not be receiving unnecessary, costly treatments.
It is important to understand what benefits your policy provides and how your policy syncs up to Florida's statute regarding auto insurance.
What do you think about the changes?
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