PIP Reform: Blocking Timely Access to Care is No Solution

-by Paul Anderson, FJA Secretary & Tallahassee Attorney

There are certain rites of spring: paying your taxes, mowing the lawn for the first time, and of course, the annual Florida Legislature debate over auto insurance.  

For as long as I can remember, Florida has had an auto insurance 'crisis,' largely focused on a small piece of every person's insurance bill, known as Personal Injury Protection (PIP).  If you've never had a serious accident, you may not be familiar with PIP, which essentially ensures that you, the policy holder, can quickly get the medical care you need after an accident.  Generally, PIP covers the first $10,000 in health bills.

Insurance companies don't like PIP laws because they put the injured person in charge of their own care.  You can go to the ER and get checked out or go to your chiropractor and get care without the insurance company getting a chance to delay your care or deny it all together.  Imagine that.

Critics of PIP argue there is fraud in the system, and sadly, they are right. We need better fraud enforcement, and people who stage accidents to get money from the insurance companies should go to jail, period.

What insurance companies want to do is increase the hurdles required to receive care. But let's not kid ourselvesthese 'hurdles' aren't designed by the insurance companies to cut fraud. Their only interest is increasing their own profits, and like every other kind of insurance, their profit increases when fewer claims are paid.  When talking about PIP, fewer claims mean less health care coverage for the people who paid for it.

By adding hurdles to the process, insurance companies are essentially requiring consumers and medical providers to prove, under oath, that their claims are legitimate before the insurer will consider payment.  Might sound reasonable, but this is like asking your family doctor to undergo an intimidating deposition before receiving payment each time your visit the doctor’s office. Treating medical providers like criminals won't reduce fraud, but it will reduce care. Clearly that wasn't the intent of the original PIP laws.

Now there are areas where we can reduce fraud.  For example, some have proposed a longer accident report form to help identify real fraud, which is a proposal that makes sense.  Others have suggested tougher criminal penalties, which should be done immediately. Other efforts, such as the task force created in Miami, which partners prosecutors with insurance fraud agents to crack down on fraud, could become a model around the state.

Another option would be to scrap the PIP laws all together and enact a mandatory bodily injury provision for auto insurance, which is the step that has been taken in all but two states. This would provide better coverage for those insured in accidents, but unfortunately, there hasn't been the will in the Florida Legislature to make this change.

But the types of changes being sought by the insurance companies will make it more difficult for a medical provider to bill a PIP insurer, potentially making medical providers increasingly less likely to want to treat auto accident victims that have to rely on PIP coverage to pay for their medical expenses. If we end up with fewer medical providers willing to handle PIP claims and treat auto accident victims, it will mean that even more Floridians, without medical insurance, will be heading to the ER for care. Such an alternative would be costly to all taxpayers.

This is an important issue that must be approached in a responsible manner–a manner that protects against fraud, but does so without limiting the ability of Floridians to access the insurance that they have paid for, for the health care that they need after an accident.

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This story ran in the Daytona Beach News Journal on 3/13/2011.
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