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Insurance Consumer Advocate

Sha'Ron James


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Mailing: 200 East Gaines St.
Tallahassee, FL 32399-0308

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(850) 413-3089
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Randy Hansbrough: Florida's New Personal Injury Protection Reform Law a Bad Joke on Consumers

12/13/2012

TCPalm.com

Several months ago I wrote on the upcoming personal injury protection (PIP) law, due to take effect Jan 1. While the majority of my practice is in the field of functional neurology and metabolic therapy, I've been practicing for more than 30 years, so it is inevitable that I would see car crash-injured patients.

People should be treated fairly if they are hurt in an auto accident, and I share with many others, both doctors and lawyers, a strong concern for the obvious inequity in this insurance industry-sponsored law.

Insurers of all types seem to have this propensity to engage in unfair trade practices, such as what Robin Westcott, the state's consumer advocate described when she identified "a troubling new trend" with insurers taking premiums for years, then denying claims based on a person's credit history, according to an article in the Palm Beach Post Nov. 4. Numerous judges, attorneys and other patient advocates have scrutinized the details of what is about to be imposed upon us, and it comes down to these elements:

1) If you are hurt in a crash, you have only 14 days to go to a doctor or the emergency room for help. If you wait because you think the "minor" pain will resolve on its own, and then change your mind on the 15th day, you will have no coverage whatsoever. Therefore, be wise, protect yourself, and at least get looked at by a doctor of your choice. That way, if you develop more intense pain weeks later due to an underlying injury, you will be covered. It is common for injuries to produce delayed symptoms, due to slowly forming scar tissue at the damaged site. Ask any athlete or auto injury patient.

2) Although you are required by law to carry $10,000 in PIP, you are only entitled to $2,500 of it, unless the all-wise insurance adjuster elects to grace your care with more of what you were required to pay for. It's clearly another freebie for insurers, thanks to our manipulated Legislature and governor, who bought his own job.

If you need more care, you will have to plead past a smokescreen of hand-picked insurance doctors who get paid for denying care, unless they deem you worthy, defined vaguely as an "Emergency Medical Condition." An EMC is defined as "serious" jeopardy to your health, function or body part. The problem here is: someone other than you gets to decide if your continuing pain or loss of normal function is serious enough for their satisfaction.

In addition to the cost shifting over to your health insurance, Medicare or Medicaid, there is more in this law that is anti-consumer and will affect us all. Our lawmakers made sure there are more than enough big teeth enforcement provisions to boost insurers' profits, but toothless gums to ensure our rates will go down as promised.

This is no surprise from the ex-CEO of the Columbia HCA hospital chain, which was federally prosecuted for $1.3 billion in Medicare fraud, yet somehow Rick Scott got off unscathed, having pleaded the Fifth Amendment numerous times. This is yet another example of our governor's love affair with corporate greed, while betraying the people he claims to serve.