Tag Archives: PIP fee schedules

Insurance Information Institute Comments on PIP Premium Changes and Significance of the January 1, 2013 Effective Date of 2012 PIP Law Changes

Tampa Bay Fox 13 recently featured a segment regarding the effect of House Bill 119, the 2012 PIP law change, on PIP premium rates.  Lynne McChristian of the Insurance Information Institute, shed some light what appears to be a lack of a premium decrease.  McChristian indicates that the recent insurer reports are not indicative of what could likely be the case after January 1, 2013, when all of HB119′s changes take effect.

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Filed under Fla. Stat. 627.736 (2012), Insurance Fraud, Licensing, The Statutory "Fee Schedules"

Trial Advocate Quarterly Features Article on 2012 Florida PIP Law Changes by Mark J. Rose

Trial Advocate Quarterly

Trial Advocate Quarterly, Summer 2012

The summer 2012 of the Trial Advocate Quarterly features an article by attorney and FLPIPGuide.com contributor Mark J. Rose on the recent changes to Florida’s PIP/No-Fault Law including: statutory fee schedules, the “emergency medical condition” limitation, PIP payment logs, exhaustion of benefits, explanations of benefits, examinations under oat (EUO), independent medical examinations, and fraudulent PIP claims.

The article will soon be available on the Florida Defense Lawyer Association (FDLA) website at http://www.FDLA.org.  Requests for full copies of the article or for more information on the recent Florida PIP law changes, please contact Mark Rose (mrose@roiglawyers.com) or Michael Rosenberg (mrosenberg@roiglawyers.com).

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Filed under Examinations Under Oath (EUO), Fla. Stat. 627.736 (2012), Independent Medical Examinations (IME), Insurance Fraud, Licensing, The Statutory "Fee Schedules"

Florida Office of Insurance Regulation Issues Informational Memorandum On New PIP Statute “Fee Schedules”

On the same day Florida’s new PIP statute was signed by Governor Rick Scott, Florida’s Office of Insurance Regulation (OIR), and Insurance Commissioner Kevin M. McCarty, released  Informational Memorandum OIR-12-02M to address the statutory “fee schedule” provision in the new PIP statute.

The Memorandum itself explains:

The purpose of this memorandum is to assist insurers with the filings necessary to implement the notice requirement in Section 627.736(5)(a)5., Florida Statutes, resulting from the passage of House Bill 119. Among the various provisions of this legislation is a new statutory requirement that insurers provide a notice of the schedule of medical charges or “fee schedule” to insureds if the insurer is limiting reimbursement. The Office of Insurance Regulation (Office) has analyzed the revisions and is sending the attached sample endorsement language for inclusion of the schedule of charges specified in Section 627.736(5)(a), Florida Statutes.

The OIR did explain that insurers are not required to used the proposed language that the OIR provided and will expedite the review of the proposed policy endorsements in attempt to obtain approval prior to the July 1, 2012 effective date.

The OIR similarly addressed the two effective dates in the amended PIP law:

It should be noted that the fee schedule in the sample language is the fee schedule that is effective at the time that the notice requirement is established in Florida Statutes (July 1, 2012). It does not include the revisions in House Bill 119 to the fee schedule that become effective on January 1, 2013.

The full press release, including the sample language, is available here.

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Filed under Fla. Stat. 627.736 (2012), The Statutory "Fee Schedules"

Florida Supreme Court to Decide Fee Schedule Issue

Yesterday the 3rd District Court of Appeal rendered its decision Geico v. Virtual Imaging (a/a/o Maria Tirado). While the Court ruled it was bound by its prior decision denying the use of the Fee Schedule as found in Florida Statute 627.736, the Court also certified the fee schedule to the Florida Supreme Court. In certifying the question as a matter of great public importance the court found that

The Legislature’s amendment to the PIP statute sought to address the enormous costs and inefficiencies of the law prior to amendment. Litigation and fee-shifting to determine “reasonable” costs of standardized medical procedures should be passé by now. An MRI, for example, is now a common procedure. The medical cost accounting and national metrics supporting the Medicare Part B reimbursement figures for MRIs and other standard medical services are widely used and understood. An alternative charge based essentially on whatever the market will bear, on the other hand, invites litigation. A prevailing provider or insured may also recover attorney’s fees and costs, and resolution of these disputes also requires judicial resources at the expense of all State taxpayers. All of these circumstances are contrary to the original, no-fault objectives of the PIP statute.

Finally, a court that understands the legislature’s intent. The certified question reads as follows

WITH RESPECT TO PIP POLICIES ISSUED AFTER JANUARY 1, 2008, MAY THE INSURER COMPUTE PROVIDER REIMBURSEMENTS BASED ON THE FEE SCHEDULES IDENTIFIED IN SECTION 627.736(5)(a), FLORIDA STATUTES, EVEN IF THE POLICY DOES NOT CONTAIN A PROVISION SPECIFICALLY ELECTING THOSE SCHEDULES RATHER THAN “REASONABLE MEDICAL EXPENSES” COVERAGE BASED ON SECTION 627.736(1)(a)?

To read the entire opinion click here.

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Filed under Fla. Stat. 627.736 (2008), The Statutory "Fee Schedules"