personal injury - employment law - commercial litigation
No Fault Insurance or "PIP"
Serving all of Pasco County including Bayonet Point, Crystal Springs, Dade City, Elfers, Holiday, Hudson, Land O' Lakes, New Port Richey, Odessa, Port Richey, Saint Leo, San Antonio, Shady Hills, Trilby, Trinity, Wesley Chapel & Zephyrhills.
Serving North Pinellas including Crystal Beach, Clearwater, Countryside, Dunedin, Oldsmar, Palm Harbor, Safety Harbor and Tarpon Springs.
Serving all of Hernando County including Brooksville, Masaryktown, Spring Hill, Timber Pines and Weeki Wachee.
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As you know, I represent not only hard working business owners but also those injured through no fault of their own in automobile and motorcycle accidents. Sometimes, they are one and the same. As an attorney who has tried more than my share of personal injury cases, I think I could make an argument that mandatory personal injury protection (PIP) insurance coverage should give way to mandatory bodily injury (BI) and uninsured motorist (UM) coverage.
PIP, also called “no fault” provides up to $10,000 in benefits. It pays up to 80% of covered medical expenses and 60% of lost wages. As one judge said in a recent decision, PIP from its inception has been a complicated piece of legislation and the successive years of constant amendment and revision have both added to its complexity and detracted from its clarity. The purpose was to provide for the prompt payment of benefits without the necessity of legal action; although just the opposite has occurred.
PIP does not provide benefits to those whom you, as a motorist, may have injured. Neither does it provide benefits, beyond the ten thousand dollars, should you be injured by an uninsured motorist or a motorist with insufficient insurance coverage. Bodily injury and uninsured motorist coverage addresses those two situations.
It has long been argued that the PIP statute is ripe with fraud committed by unscrupulous doctors, chiropractors and other health care providers. To address this problem, the PIP statute expressly provides that an insurer is not required to pay a claim or charges to any person who knowingly submits a false or misleading statement relating to a claim or charges.
In a 2012 appellate decision coming out of Orange County, a chiropractor who engaged in improper billing practices with regard to nineteen State Farm insureds sought payment for chiropractic services provided to those patients. State Farm refused to pay. The chiropractor argued that even if some of the charges were improper, State Farm should nevertheless pay those charges which were proper. The court disagreed, holding that as to each patient the fraudulent charges relieved the insurance company of having to pay any of the chiropractor’s charges with regard to each patient.
Under the PIP statute, the patient is also relieved of the obligation to pay the health care provider’s bill. The court would not go as far as State Farm wanted; which was to preclude payment to any health care provider who provided services to the insured since there was no evidence that the patients were aware of the fraudulent and improper charges by the chiropractor.
Eliminating PIP in favor of mandatory BI and UM coverage would, in the long run, both reduce the level of such improper billing practices and improve the quality of coverage provided to insureds. The BI and UM coverage should also be required at a level, say $50,000 per person and $100,000 per accident to permit compensation for serious injuries. The $10,000 PIP is simply insufficient to pay medical expenses for serious injuries.