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Insurance Carriers Ignore Judge Lewis’ Florida PIP Injunction

Has your medical practice received a denial of Personal Injury Protection (PIP) payment for Massage Therapy, Acupuncture, or facing the $2,500.00 limit due to Emergency Medical Condition (EMC) determination, or a non-determination? Here’s a growing list of Florida insurance carriers disregarding Judge Lewis’ injunction pertaining to the 2013 amendment to the Florida PIP Statute; Myers v. McCarty, Case No.: 2013 CA 73 (2nd Circuit, Leon County):

  • Geico
  • USAA
  • Mercury
  • MetLife
  • Nationwide
  • Infinity

Interestingly, State Farm is acknowledging the injunction in their (Explanation of Benefits) EOB’s and complying with it; bravo State Farm! These carriers were compiled based on actual PIP demands performed by our firm.

To re-cap, Judge Lewis’ injunction applies “to those sections of the law which require a finding of emergency medical condition as a prerequisite for payment for PIP benefits or that prohibit payments of benefits for services provided by Acupuncturists, Chiropractors, and Massage Therapists.” All other sections of the Florida PIP statute are unaffected. However, the latest round of PIP demands concern complete non-payment for massage therapy and benefits being capped at $2,500.00. The above-described injunction was entered March 15, 2013 and remains in full force and effect; throughout the State of Florida. Judge Lewis later revisited the Myers decision in April, under pressure from regulators, and ultimately upheld his initial decision. Judge Lewis explained,

“The reason for issuing the injunction was to protect the constitutional right and prevent the potential harm to citizens injured in auto accidents who, under the present PIP statute, may not receive necessary medical care.”

The present Florida PIP statute is an interesting creature because on one hand it prevents access to the courts by injured Floridians, but on another it opens the floodgates of litigation to medical providers such as MRI companies, chiropractors, massage therapists, physiatrists, and the like, who find their bills denied and/or restricted. Specifically, Massage Therapists and Acupuncturists were specifically targeted with a blanket denial of all bills; sounds like an unfair restriction on trade.

Interestingly, one of the legislative purposes of the new PIP statute in Florida was to curb perceived PIP fraud and reduce litigation! If anything, the new statute has churned litigation. Medical providers are now put in the uncomfortable position of having to make an “emergency medical condition” as poorly defined by the statute. No provider wants to risk their reputation by making a bad call.

Consequently, if the carrier refutes the determination, then they are within their capacity to get an opinion that the patient does not have an emergency medical condition. Now what you have is a pseudo-trial pitting doctor vs. doctor or doctor vs. insurance company. How can this possibly curb litigation? And caught in the middle of this dispute, the injured Floridian…who ironically is denied access to the courts to redress her injuries.

Perhaps the greatest head scratcher in the new Florida PIP statute is the fact that a chiropractor cannot make the determination that an individual has sustained an emergency medical condition BUT they can make the determination that the individual does not have an emergency medical condition. In other words, you’re not qualified to say you have it but you can say you can’t have it.

Judge Lewis was right to stick to his initial decision and uphold the injunction. While I have no doubt that the injunction is being appealed and rushed through the First District Court of Appeals, until a decision is made the injunction remains in place.

Therefore, if you find your bills being denied, reduced, and facing EMC-related issues, contact Sibley Dolman Gipe Accident Injury Lawyers, PA concerning any issues related to the no-fault statute in Florida.

Sibley Dolman Gipe Accident Injury Lawyers, PA is a Clearwater personal injury law firm that represents injury victims throughout the State of Florida.