Federal Court Affirms Florida’s 2012 Personal Injury Protection Reforms

Dec 30, 2015


Politico Florida’s Christine Sexton reported this afternoon, December 30, 2015, that a federal appeals court in Atlanta has upheld 2012 reforms to Florida’s Personal Injury Protection laws that limit the $10,000 medical benefit to $2,500 when emergency medical care isn’t required.

Today’s ruling comes two weeks before the start of Florida’s 2016 regular Legislative Session, when automobile insurance could be an issue. 

“The legislative history clearly shows that the Florida Legislature sought to reduce fraudulent claims by making the full $10,000 amount of benefits available only to those insureds who suffered severe injuries, a restriction defined into the term ’emergency medical condition,'”  the 12-page opinion reads.  “Allowing an insured to escape that restriction on the higher limit would defeat the legislative intent and policy.”

Florida law requires drivers to carry $10,000 in Personal Injury Protection–or PIP coverage (also known as “No-Fault”)–which covers 80 percent of reasonable medical expenses, 60 percent of loss of income, 100 percent of replacement services and a death benefit.  Florida drivers also are required to carry $10,000 of personal damage insurance, which covers the physical expenses caused by the insured to third parties in an accident.

The cases under appeal are  Sendy Enivert v. Progressive Select Insurance Company and Glenaan Robbins v. Garrison Property and Casualty Insurance Company.  The defendants were injured in 2013 in separate car crashes.  Enivert and Robbins each sought reimbursement from their insurers for $10,000 in medical expenses.  In both claims, the insurers limited their benefits to $2,500.

Enivert and Robbins each filed suits in the same district court seeking declaratory judgments that they were entitled to $10,000 in benefits because no determination was made that they did not have emergency medical conditions.

The cases were assigned to different judges, both of whom ruled that the $10,000 applied only in emergency medical conditions.

“The Florida Legislature’s purpose in amending the Motor Vehicle No Fault Law in 2012 was to reduce the payment of fraudulent claims in order to lower insurance premiums,” chief judge Ed Carnes wrote for the federal appeals court in Atlanta.  To achieve that purpose, the judge wrote, the Legislature revised PIP provisions, “making the amount of the medical benefit dependent upon the severity of the injury.” 

The ruling comes as Florida Senator Jeff Brandes and House Insurance and Banking Subcommittee Vice Chairman Bill Hager have filed bills to repeal the state’s current PIP mandate.

Senator Brandes told POLITICO Florida earlier this month that despite the 2012 changes, the No-Fault program is so riddled with insurance fraud that it is broken beyond repair.  He filed SB 1112, which would repeal PIP effective 2019.

Representative Hager filed an identical companion bill, HB 997.  

Florida Chief Financial Officer Jeff Atwater also supports repealing the PIP requirement.

A copy of the federal court ruling is here:  http://politi.co/1Oy0PfC



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