Florida is trying to stop the rampant auto insurance fraud that has taken place under the no-fault system.  In recent years the amount of auto vehicle accidents has remained relatively the same, yet Florida PIP claims have skyrocketed.  Nearly half of all FL auto insurance fraud investigations are in regards to PIP. Starting January 1st, 2013 there are changes in Florida’s PIP (aka no fault insurance).  Car owners here are still required to purchase $10,000 worth of personal injury protection (PIP) coverage and PIP will continue to pay out 80 percent of medical expenses that are found to be necessary and reasonable, regardless of fault.

However, there are a few new changes starting that took effect on January 1, 2013 concerning how quickly you just receive said medical treatment for your injuries and who can treat them.  If your injury isn’t declared “serious”, then you can only receive up to $2,500 in PIP benefits. There were also some timing restrictions added to the PIP Florida no-dault law (FL Statute 627.736).  You must begin medical services and care within tw0 weeks (14-days) of the accident in order to be eligible for PIP benefits.  The law is now also a little more stringent about who you can visit for your initial medical treatment. Starting with the Florida 2013 PIP Change, your initial medical care must be by:

  • Emergency medical services personnel
  • Hospital
  • Facility that owns or is wholly owned by a hospital
  • Medical doctor, dentist, chiropractor or osteopath.

For follow-up medical treatment to be covered under Florida 2013 PIP, it must be based on a referral from an approved healthcare professional that provided the initial medical care.  Follow up services may be provided by a hospital, surgery center, medical doctor, osteopath, dentist, chiropractor, physician’s assistant, nurse practitioner, physical therapist or certain health care clinics. Massage therapy and acupuncture will no longer be covered, even if an authorized physician prescribes it.  If the appropriate health-care professional determines that you suffered from an emergency medical condition, then you can receive reimbursement for all medical services and care up to your $10,000 PIP limit.  If, instead, you're found to have a non-emergency medical condition, then your PIP benefits are limited to only $2,500. PIP will continue to pay 100 percent for necessary for reasonable replacement services that may be required due to your injuries and 60 percent of work loss -- up to your limit.  Death benefits are capped at $5,000 but are in addition your $10,000 medical and work loss benefits.

All portions of your Florida PIP, except the death benefit, will continue to be subjected to the deductible you selected.