PIP Legislation Passes in the FL House and Senate

The Florida House and Senate negotiated and passed personal injury protection(“PIP”) reform in the final hours of the legislative session. The final legislation, which can be found here, includes numerous reforms of the existing law and is hoped to reduce PIP fraud in Florida.

Although the legislation does not include attorneys’ fee caps, it contains an admonition of sorts that attorneys must “comply with prevailing professional standards,” that they “not overstate or inflate the number of hours reasonably necessary for a case of comparable skill or complexity,” and that their fees “represent legal services that are reasonable and necessary to achieve the result obtained. “The legislation eliminates fee risk multipliers in PIP cases. It also applies the offer of judgment statutory framework to PIP cases, allowing insurers to recover their fees when an insured recovers a statutorily specified percentage less than the insurer’s offer.

While the legislation preserves the $10,000 PIP benefit, this amount is available only for medical treatment of an emergency medical condition. Reimbursement for services for treatment of non-emergency conditions is limited to $2,500. An insured may still receive reimbursement for physical therapy, but only to the extent a doctor or chiropractor referred the insured for such treatment. The final legislation expressly excludes reimbursement for treatment by massage therapists and acupuncturists regardless of the provider and, with some exceptions, requires licensure of clinics seeking payment through PIP.

In a further attempt to eliminate PIP fraud, the legislation requires a long-form report to be used in all crashes where a party to the crash complains of any pain or discomfort. The legislation extends insurers’ fraud investigation period from 30 to 90 days. It also allows insurers to take an examination under oath of their PIP insureds. However, a business practice of unreasonable requests for examinations under oath may be deemed an unfair insurance practice by the Office of Insurance Regulation. The legislation imposes a 14-day timeframe within which an insured must seek medical treatment in order for such treatment to be covered under PIP. Through the course of such treatment, an insured may be asked to appear for an independent medical examination and may ultimately lose benefits based on a failure to do so.

The legislation includes other reforms including revisions to the PIP medical fee schedule, a requirement that a notice of the fee schedule be included in insurance policies, a requirement that insurers make Medicaid reimbursement payments within 30 days, the creation of a non-profit organization aimed at fighting motor vehicle insurance fraud, and the creation of a more user-friendly claim system.

Governor Rick Scott, a strong supporter of PIP reform, has called the passage of the PIP legislation “a triumphant moment for the residents of Florida.” Governor Scott is expected to sign the legislation into law.