Personal Injury Protection And Fraud

People in Weatherford, Mineral Wells, Aledo, Azle, Springtown, Millsap, Willow Park, Hudson Oaks, Brock, Cool, and other places in Parker County need to be aware of the Personal Injury Protection (PIP) benefits in their auto policy.
Most people have have these benefits do not even know how they work. All they know is that when they talked with their insurance agent they told the agent they wanted “full coverage” and as a result of that directive they ended up with PIP. It is a good coverage to have and there are laws regulating this coverage in the Texas Insurance Code.
These PIP laws are found in Sections 1952.151 thru 1952.161.
In Florida, there is an attempt underway to regulate PIP in such a way as to hopefully reduce fraud and as a result to hopefully reduce premiums for this coverage.
The Miami Herald ran a story on April 1, 2012, titled “Time Will Tell If New Law Fixes Rampant Car Insurance Fraud.” The story is authored by Tia Mitchell and deals specifically with PIP.
The Florida division of Insurance Fraud reports people committing fraud in staging accidents and collecting thousands of dollars in insurance money. In response to this fraud the story tells us that the Florida legislature has passed a law that is intended to reduce this fraud and reduce insurance rates. The relevance of this Florida law to Texans is that if the law proves to be effective in Florida, it is likely something that will eventually be passed and enacted in Texas also.
The measure includes a requirement that insurance companies reduce PIP premiums at least 10% by Oct. 1 and 25% by 2014.
One of the stated goals of this legislation is to put PIP back into its original character as emergency treatment to get a person back on their feet. As part of that effort, the new law bars massage therapists and acupuncturists from treating patients under PIP. Those services have been contributing to rising costs, and are deemed less necessary than other treatments.
Beginning in 2013, people injured in auto accidents will have 14 days to seek initial treatment – under current law there is no cutoff – and that first visit will carry more weight.
Only people diagnosed with an “emergency medical condition” will be eligible for the full $10,000 PIP benefit. Medical doctors, osteopathic physicians, dentists, physician assistants or advanced registered nurse practitioners will be authorized to make the determination.
Those with less severe injuries will receive only $2,500. Soft tissue injuries that are common in car accidents, such as soreness, swelling and bruising, are not expected to be considered emergencies.
Supporters of this new law say that this is how the system is supposed to work because PIP was intended to help people only with their immediate needs after an accident. Letting other types of insurance such as the at fault drivers liability coverage or private health policies take care of the rest, is the goal.
Another change in current law is clearing up ongoing disputes about how costs should be calculated by factoring in the fee schedule under Medicare. It also clarifies that insurance companies can examine patients under oath when investigating possible fraud, and eliminates a provision that allowed Judges to drastically increase the amount of fees awarded to the attorneys of injured people.
It is worth noting that this Medicare fee schedule fix was tried in 2007 and resulted in a drastic increase in disputes that ended up in court.
The Florida Justice Association, which represents trial lawyers, says there is no question but that the number of PIP lawsuits will increase. This is because the “emergency medical condition” definition will be an issue. Two examples of this are (1) is it going to be up to a court to determine whether a certain kind of sprain is an EMC, or (2) a bulged disc in the spine is an EMC.
Texas has often followed Florida in tort reform laws. That is essentially what this law is. So, that means this law may very well be coming to Texas in its next legislative session.