Politics

PIP Reform Bill Drives Through House Panel Amid Opposition

By: Kenric Ward | Posted: January 26, 2012 3:55 AM
Car AccidentCredit: bayareainjurycenters.com
A personal injury protection bill patterned after Florida's workers' compensation program ran into a buzz saw of opposition at a jam-packed committee room Wednesday, but emerged relatively unscathed.

Soaring costs for mandatory motor vehicle PIP insurance are driving the demand for reform, said Rep. Jim Boyd, sponsor of House Bill 119.

"Florida has a billion-dollar [PIP] fraud industry," the Bradenton Republican said. "The number of drivers is flat and accidents are down, but claim values are up and PIP premiums are up 66 percent."

With some projections forecasting price increases of as much as 30 percent this year, the House Civil Justice Subcommittee approved Boyd's bill after more than two hours of testimony and debate.

To curb costs, HB 119 sidelines so-called PIP clinics by mandating that accident victims report to a hospital emergency room or a hospital-owned clinic within 72 hours for treatment.

A long-form crash report must be completed at accident scenes to ascertain exactly who was involved.

The bill expands insurers' authority to conduct wide-ranging examinations of physicians and staff under oath -- a provision that opponents branded a "fishing expedition."

Paul Lambert, of the Florida Chiropractic Association, labeled the 109-page HB 119 "an empty box that says minor injuries won't be covered and you can't select a doctor of your choice."

But Monte Stevens, of the state Office of Insurance Regulation, said more accountability is needed.

"Abuse and bad actors are driving up rates for everyone," Stevens said.

The Coalition for Auto-Insurance Reform reported that 28.4 cents of each PIP premium dollar go to attorneys while only 14.5 cents go toward medical bills, lost wages and other economic loss. The remainder goes to non-economic loss (16.9 cents) and "fraudulent and excessive claims" (12.6 cents), the coalition said.

Boyd cited other statistics showing that some Florida motorists are paying as much as $15,000 for the required minimum $10,000 PIP coverage.

"This bill puts dollars back in pockets of Floridians, not in the pockets of fraudsters," Boyd testified.

Stevens likened the proposed PIP overhaul to the state's workers' comp reforms, which have reduced costs by 60 percent over the past seven years. But Stevens said he could not estimate savings from HR 119, since no state has installed such a program.

Rep. Matt Gaetz, R-Shalimar, questioned the cost-benefit of funneling all PIP injury cases to emergency rooms, which he called "the most costly form of care."

Gaetz, an attorney, also complained that HB 119 "erodes" the right to pursue class-action suits against insurers for "systematic underpayment of claims."

In voting against the measure, another attorney, Rep. Darren Soto, D-Orlando, said, "We're driving blind with this bill."

While a parade of critics from the audience called his measure "anti-consumer, anti-doctor and pro-insurance," Boyd maintained that the goal is to "eliminate overbilling."

"We're not changing who's covered," he said.

Gov. Rick Scott calls PIP fraud a "billion-dollar tax" on motorists, and the Florida Chamber of Commerce supports Boyd's reform bill. (For video of Scott, Chief Financial Officer Jeff Atwater and business leaders discussing the bill, see here.)

But the Florida Medical Association opposes HB 119.

“Making illegal conduct more illegal and imposing burdensome new requirements on the legitimate physicians who treat auto accident patients is not the way to stop PIP fraud and abuse," said Rebecca O’Hara, FMA vice president of governmental affairs.

"The FMA believes that if we focus on more effectively targeting and punishing those who break the laws, we’ll restore order to the PIP system.”

Comments (7)

sendy
2:25PM FEB 2ND 2012
this is exactly what i was thinking about. punish the frauds and let the honest keep a job.why punish everyone over someone's stupidity?doesn't make any sense
Vicky
3:27PM JAN 30TH 2012
Hi Dave: PIP should be simple, yet is a complex issue. When PIP is billed, the practitioners are not paid under any circumstance what they bill. There is a medicare fee schedule that carriers pay by, and the patient usually has a 1000 deductible and the PIP is an 80/20. The deductibles and co-pays are very difficult to recover from the patients. Basically, the practitioner is getting paid by an established fee schedule. Like in every industry, there are unscrupulous individuals, but they are slowly diminishing. Something to look at in Florida: AHCA not only exempts physicians, but also exempts physical therapists, allowing them to set up establishments and never be checked or follow guidelines as physicians or establishments that are regulated by AHCA. That is something seriously overlooked and maybe there would not be so much fraud.
LDouglas
8:08PM JAN 26TH 2012
No comment other than I thought you might be interested to know PIP fraud was featured on the CBS News tonight.
Dave C
3:55PM JAN 26TH 2012
There is much frustration with everything PIP. Although the product was intended for good purposes, nefarious individuals and groups have hijacked PIP. Both sides cry foul at each other for trying to seek the best remedy fo their side. I agree that attorney's representing insureds should not be capped I do agree that there should be agreeable limits on what the medical providers get. Most of us that have insurance, have managed care plans where the providers agree to a certain fee for their services to participate in a plan where the insurance company insureds will seek service. Why is that such a difficult item to agree upon? Most accidents are legitimate and run smoothly through the claims pocess. Unfortunately, we see so much over-treatment or unnecessary treatment of individuals fo minor losses. Before PIP enactment, we did not see agressive medical treatment for soft tissue injuries. Professionals would check for broken bones and then request a period of relaxation or rest to aid our bruised bodies. However today, there is a template to "treat" a soft tissue aggressively from day one at 4-5 times a week with so many modalities. How can a body recover under normal circumstances let alone after a trauma? Why do we need PIP? Political representatives and parties in this state are forcefully challenging the federal government from making all Americans to purchase health insurance, yet we Floridians merely accept the state making us pay for health insurance from our auto insurers without response. As for the examinations under oath response above, the case cited was a unusual event. There is a need for insurance companies to have insureds obligated to provide sworn statements.
Dicky Parillo
9:55AM JAN 26TH 2012
The examination under oath (EUO) requirement does nothing to protect fraud. It is a harassment tool designed to deter medical providers from treating accidnet victims. Take a look at DeLeon v Great American ins Co where the insurance company attorney too SEVEN HOURS in an EUO.
Regarding staged accidents, take a look at Barreau v Peachtree which says mere suspicion is not enough. There is no doubt that there are staged accidents, and the insurers have the resources to discovery the fraud, but suspicion is not enough. Insurers yell fraud at every instance they can to avoid paying legitimate claims.
The limits on Plaintiff's attorneys fees creates an unfair business advantage. Insurers are billion dollar companies and they have no limits in the proposal; why should the law permit one insurance companies to pay whatever it choses and limit what the other side can seek.
Excluding chiropractors and massage therapy from PIP just flies in the face of being able to chose your own doctor or medical provider. In my two accidents, the massage therapy I received enhanced the chiropractic treatment. I did not break any bones; I did not suffer any lacerations, but I was hurting so badly I could not sleep.
Those that stage accidents or bill for treatment not rendered should do hard time in the county jail. The water shoudl be cleaned with harsher penalties for fraud, but do not throw out the baby with the dirty bathwater.
Jim B.
9:42AM JAN 26TH 2012
If they pass this mess and it is mirrored after the workers comp law it will be a disaster for the citizens of Florida. Sounds like to me the insurance companies are opening their wallets for "good government".
joe
7:46AM JAN 26TH 2012
I had a serious well documented job related accident and was totally jerked around by the insurance provider until I retained an attorney. If the insurer would have willingly paid to for my operation and rehabilitation instead of trying to treat my broken bones with pain killers and physical therapy I never would have considered retaining legal counsel. After everything was said and done I am now as good as new. I received the needed operation and rehabilitation and in addition to that I received a huge settlement that I would not have known about if the insurance provider had of acted in good faith. Since te real fraud is being commited by insurerance companies who offer and advertise sevices they don't intend to provide without a fight while charging exhobitant fees you are mandated to pay. I would suggest that you would be crazy to give up any of your rights on an insurance companies promise or on the promise of politicians that take campaign contributions from insurance companies.