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We need to make sure that we get what we pay for. You’ve been involved in an accident that’s not your fault and have a stiff neck and various aches and pains. You present to your primary care physician with the complaints of pain you are experiencing. Who pays the bill? First, you need to realize that Florida is a no fault state. What this means is regardless of who caused the accident, state law requires you to carry Personal Injury Protection (PIP) coverage for up to $10,000.00. See Fla. Stat. 627.736(1). This means that your physician can submit your bills for treatment to your motor vehicle insurance company. Your insurance company is obligated to pay 80% of your reasonable medical expenses up to the $10,000.00 limit. However, don’t think that the $10,000.00 limit is automatic because it isn’t. The insurance lobbyists convinced the state legislature to change the PIP statute to include a requirement that to receive the entire $10,000.00 in PIP benefits that you pay for by way of insurance premiums, your physician or medical provider now must find or determine that you had or have an “emergency medical condition”. See Fla. Stat. 627.736(1)(a)(4). This statutory change resulted in the insurance companies putting even more money in their pockets at the expense of the consumer who wound up receiving less coverage for the same amount of money. The new PIP statute defines “emergency medical condition” as any of the following: (a) serious jeopardy to patient’s health; (b) serious impairment to bodily functions; or(c) serious dysfunction of a bodily organ or part. If any of the three conditions aren’t referenced in your physician’s or provider’s initial treatment notes, then your PIP benefits or coverage will be limited to $2,500.00 covering only your initial treatment visits. You then, or the individual who is at fault for the accident, are responsible or liable for the balance of your bills over the $2,500.00 which often times requires legal intervention to encourage the wrongdoer and their insurance company to do the right thing. You need to discuss this issue with your treating provider to insure that he or she establishes that you have an “emergency medical condition” such that the absence of immediate medical attention could reasonably be expected to result in any of the 3 previously described conditions. You need to look out for your own interests because the politicians and insurance companies certainly won’t.  You need aggressive legal representation with a firm that understands the issues of today.

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