Governor’s Office Holds Interested Party Meetings On PIP/No-Fault Reform

Recently, Governor Crist’s office has held three “interested parties” meetings to discuss various PIP/No-Fault reform mechanisms prior to the statute’s imminent October 1, 2007 sunset.  This office has attended the meetings and maintained advocacy for a PIP sunset, absent meaningful reform. 

In an effort to reach “meaningful reform” several ideas have been discussed, although none have been universally agreed upon at this time.  Many of these ideas are conceptual in nature, and no drafts or portions of a potential bill have been proposed at this time.  If these ideas become more concrete, we will provide information as it becomes available.
 
The first reform component discussed was a proposed medical fee schedule.  So far, the discussion has revolved around a schedule that would authorize 200% of Medicare allowances for all services other than those rendered in an Emergency Room.  At this time, no concept has come to fruition regarding a fee schedule for Emergency Room treatment. 
 
The second reform component discussed has been a sub-limit of $5,000.00 for all treatment rendered outside of a hospital.  Further discussion of other forms of utilization controls is expected.
 
The third and final component discussed was attorneys’ fee reform. Several ideas were circulated for discussion purposes, but the idea gaining the most support is an Alternative Dispute Resolution (“ADR”) mechanism that must be utilized before a lawsuit can be filed on a disputed claim. 

In summary, the proposal would require disputed claims to go before a “neutral evaluator” who would render an opinion regarding the reasonableness, the causation and the necessity of the procedure. 

The Florida Office of Insurance Regulation or the Department of Financial Services would compile a list of persons eligible to participate as “neutral evaluators” from a pool of applicants, but the “neutral evaluators” would have to meet certain criteria to become eligible. 

The proceeding would be non-binding, but if the “neutral evaluator” determines that a claim is invalid for whatever reason the Plaintiff would then be responsible for his own attorneys’ fees in future litigation regarding that claim in certain circumstances. 

If an insurer refuses to participate in the evaluation, or if an insurer contests the “neutral evaluator’s” findings the insurer would be subject to the one-way attorneys’ fees provision provided in the current PIP/No-Fault law. 

Attached you will find a proposal that was drafted several years ago attempting to establish such an ADR system.  

Please keep in mind that this report is for discussion purposes only, and in no way is the information herein meant to imply that an agreement has been reached on any of these matters. 

Another meeting is scheduled for Friday morning to discuss these matters further. 

Should you have any comments regarding these proposals, please provide them to us prior to Friday’s meeting.