Thanks to sweeping reform measures passed by a divided Florida Legislature last month, the state’s Personal Injury Protection system will change dramatically – both for accident victims and those who dedicate their careers to seeing they get the help they need.Depending on your perspective, those changes are either good or bad. For hospitals, diagnostic centers and certain specialty doctors like orthopedic surgeons, the revamped PIP law will bring added business and comfort in knowing that fraudsters who have taken advantage of the system will be weeded out. Massage therapy and acupuncture, services many deemed unnecessary and a wasteful use of PIP claims, will no longer be covered. Chiropractic treatments, though, survived repeated attempts at elimination.
Hospitals and urgent care centers also won out in a final measure that puts a premium on emergency care over all other treatments. The legislation allows the full $10,000 in coverage, for example, only to Floridians seriously hurt in auto accidents. Once HB 119 takes effect, policies would cover up to 80 percent of the policy limits for reasonable medical expenses – but only if accident patients are diagnosed or treated within the first 14 days after a crash for what’s deemed “emergency medical conditions.”
Under the new law, those conditions would be met if, without immediate emergency attention, they would:
• Cause serious jeopardy to the patient’s health;
• Result in serious impairment to bodily functions; or
• Result in serious dysfunction of an organ or body part.
All other non-emergency injuries, especially those of the soft tissue – which accounted for the vast majority of increases in PIP claims – would only qualify for up to $2,500 in coverage, regardless of policy limits.
But not all the changes benefitted the medical community. The Senate held the line against caps on attorney fees sought during late-night compromises with the House, keeping medical professionals’ strongest advocates in business. But in a loss for all those who struggle to keep insurers accountable in paying valid claims, judges will now be barred from using multipliers to increase fee awards, an important deterrent to the delay and deny tactics insurers have long employed against hospitals, diagnostic centers and other medical providers seeking compensation for their work in treating accident victims. And while medical providers won’t have to abide by the onerous site inspections that the House bill once sought, they and their patients will be subjected to deposition-like questioning under oath whenever insurers say they suspect fraud – whether the fishing expedition is justified or not.
There are some good, strong anti-fraud provisions in the bill. Insurers that fail to pay valid PIP claims would be subject to new action for unfair and deceptive practice, and doctors convicted of fraud would lose their license for five years and be barred from submitting a PIP claim for 10 years. The measure also establishes an Automotive Insurance Fraud Strike Force for prevention, investigation and prosecution of insurance fraud, but here’s the rub: It comes unfunded and will have to rely on private donations to operate, a tough prospect in a down economy.
Another promising directive from the original Senate bill lost its punch in the late-night negotiations with the House in the waning hours of the 2012 legislative session. The law no longer requires that insurers pass on savings to consumers in the form of 25 percent rate reductions. Instead, it requests that those rates be cut by 10 percent by October and 25 percent by 2014. But insurers will be allowed to forgo the cuts if they can explain in detail why they can’t afford them.
It’s the first time since 2008, and after successive tries, that the Legislature was able to come together to reform Florida’s PIP system, and the measure nearly died multiple times amid dissention and rancor. Many of the changes are promising for the hospital, diagnostic and medical communities, others not so much. There are winners and there are losers in this reform, perhaps the strongest sign of true compromise. But it’s going to take about a year to determine whether this sweeping legislation is the real fraud-fighting effort its champions in the Legislature and Governor’s Mansion say it is.
