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PATIENTS MUST UNDERSTAND THESE RULES TO AVOID LOOSING MEDICAL BENEFITS

The Florida legislature has made changes to the law. The changes allowed insurance companies to change the way that personal injury protection (PIP) are administered to their policy holders. PIP benefits are mandated for every car insurance policy holder in Florida and many other states. The goal behind this requirement is to ensure that those receiving medical treatment for injuries sustained in vehicle accidents are able to pay for their treatment quickly. PIP benefits are intended to cover the cost of treatment regardless of whose fault the accident was. However, changes to the law have made it more difficult for policy holders to avoid losing PIP benefits. Of the changes that have been made to the law, there are a few that must be understood by medical providers and policy holders alike. A good understanding can help car accident victims to avoid losing PIP benefits out on benefits that they are entitled to.

First, the law requires that patients receive their initial medical treatment within 14 days from the date that the accident occurred. The reasoning supporting this rule is that anyone involved in an accident that truly feels pain or discomfort will seek treatment within this time period. However, common sense reality tells us that many people experiencing health issues that result from a car accident will wait longer for fear of visiting a doctor and incurring costs that may not be need if they just wait it out. For any one that chooses to go this route and wait more than 14 days will lose out on their PIP benefits. After those 14 days, none PIP benefits will not be available regardless of how severe the injury is. To avoid losing out on PIP benefits, policy holders must understand that they need to seek treatment quickly after an accident even if they do not feel like they have been injured.

Second, the law limits the $10,000 of PIP benefits to just $2,500 unless the patient has an Emergency Medical Condition. The full amount of PIP benefits were formerly available for all medical treatment that was needed due to a car accident. Now, to avoid losing PIP benefits, a patient must now show that their condition involves “serious jeopardy to patient health”. It is important to know that chiropractors are not included in the list of medical providers that can determine an EMC. The list includes only MDs, osteopaths, dentists, physician’s assistants, or nurse administrators. Patients that mistakenly receive treatment from only a chiropractor where an EMC may be present will not be allowed to collect benefits that they are entitled to. Patients must be aware that despite following the letter of the law and being diagnosed with an EMC, insurance companies have still underpaid or denied treatment for benefits all together.

Third, Florida law allows insurance companies to demand a patient to appear for an examination under oath without any time restrictions. To avoid losing PIP benefits, patients must be prepared for these examinations. It is not uncommon for insurance companies to come up with a very specific and detailed list of questions that thoroughly dissect a patient’s medical history. They are allowed to do this because any question related to medical history may be relevant to the patient’s health. It is important to know that insurance companies are able to deny benefits to patients that do not show up or do not complete the examination.

The above mentioned are just some of the more common ways that patients can avoid losing PIP benefits. There are many other ways that patients can better understand their insurance policies to make sure they receive the benefits they are entitled to after a car accident. Consulting with one of the attorneys at Florida Litigators, PLLC can give you piece of mind when undergoing treatment that should be paid for by your PIP benefits.