Revised Florida Personal Injury Protection Insurance Forms Effective March 25, 2013 Under HB 119

Apr 15, 2013


Statutory revisions to two forms relating to Personal Injury Protection (“PIP”) insurance were finalized on March 25, 2013 pursuant to HB 119, which overhauled Florida’s No-Fault law last year.

Revisions to Rule 69O-176.013, entitled “Notification of Insured’s Rights and Standard Disclosure Form; Personal Injury Protection Benefits,” finalized previous Emergency Rule changes to Form OIR-B1-1149 (Notification of Personal Injury Protection Benefits).  The Emergency Rule had been adopted during late 2012 to ensure sufficient time to finalize a permanent Rule.

Form OIR-B1-1149 explains the rights and benefits to which claimants are entitled under No-Fault.  It was revised to reflect that PIP benefits are allocated for emergency medical treatment and a flat $5,000 death benefit.  Under the new law, disability benefits combined with medical benefits cannot exceed $10,000.

The revised Form now also specifies the $2,500 per person minimum limit for loss resulting from bodily injury, sickness or disease arising from a non-emergency medical condition as determined by certain medical providers.  Technical edits relating to fraud reporting and billing disclosures are also incorporated.

Under Rule 69O-176.013, each insurer issuing a PIP policy in Florida shall mail or deliver Form OIR-B1-1149 to an insured within 21 days after receiving notice of an automobile accident or claim involving personal injury to an insured who is covered under the policy. 

In addition, Rule 69O-176.013 provides that Form OIR-B1-1571 (also known as the “Standard Disclosure and Acknowledgement Form – Personal Injury Protection – Initial Treatment or Service Provided”) shall be utilized by providers as described in Section 627.736(5)(e), F.S.   Among other requirements, the law provides that, at the initial treatment or service provided, each physician, other licensed professional, clinic, or other medical institution providing medical services upon which a claim for PIP benefits is based shall require an insured, or his or her guardian, to execute a disclosure and acknowledgment form reflecting that services were rendered, and that no solicitation by an outside party occurred.

Also effective on March 25 to comply with HB 119, technical edits to Form OIR-B1-1809 (Health Care Provider Certification of Eligibility) were finalized under Rule 69O-170.0155.  The Rule, entitled “Forms,” also references forms relating to other lines of insurance.


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