Senator Bill Posey Proposes PIP Legislation

The Specialty Agents Association (“Association”) released a summary of the proposed legislation that Senator Bill Posey (R- Rockledge) is drafting regarding Personal Injury Protection (“PIP”) coverage.  The proposed legislation is expected to be very similar to Senate Bill 1880 from the 2007 Regular Legislative Session.  Below please find the summary released by the Association.

Reenacts No-Fault Law and PIP Requirement

•     Re-enacts the No-Fault Law on October 1, 2007 (no period of repeal).
•     Maintains requirement for motor vehicle owners to maintain PIP coverage that pays 80% of medical expenses up to $10,000.
•     Provides procedures for insurers to send revised premium and coverage changes to policyholders who have renewed coverage without PIP.

Medical Fee Limits for PIP – Allows PIP insurers to limit reimbursement to the following schedule of maximum charges:

•     For emergency transport and treatment (ambulance, emergency medical technicians), 200% of Medicare;
•     For emergency services and care provided by a hospital, 75% of billed charges;
•     For emergency services and care and related hospital inpatient services rendered by a physician, the physician’s usual and customary charges;
•     For hospital inpatient services, 200% of Medicare Part A;
•     For hospital outpatient services, 200% of Medicare Part A;
•     For all other medical services, 200% of Medicare Part B.
•     If medical care is not reimbursable under Medicare, the insurer may apply the workers’ compensation fee schedule. If the medical care is not reimbursable under either Medicare or workers’ compensation, the insurer is not required to pay for the care.
•     The insurer may not apply any utilization limits that apply under Medicare or workers’ compensation.
•     If an insurer limits payment as authorized, the medical provider may not bill the insured for any excess amount, except for amounts that are not covered due to the deductible, coinsurance amount, or maximum policy limits.

Health Care Clinics – PIP would not reimburse treatment by a licensed health care clinic unless the clinic:

•     Has a medical director that is a Florida licensed physician, osteopath, or chiropractor;
•     Has either been continuously licensed for more than 3 years or is a publicly traded corporation; and
•     Provides at least four of the following medical specialties: 1) general medicine; 2) radiography; 3) orthopedic medicine; 4) physical medicine;
5) physical therapy; 6) physical rehabilitation; 7) prescribing or dispensing outpatient prescription medication; 8) laboratory services.

Demand Letter

•     Increases from 15 days to 30 days for an insurer to pay a claim (with interest and penalty) after a provider has sent a “demand letter” for payment. (A demand letter must be sent as a precondition to filing suit and collecting attorney fees.)

 

In our opinion, this proposal is likely a non-starter in the House of Representatives. 

Should you have any questions or comments regarding this information, please feel free to contact this office.