Sunday, February 26, 2012

PIP renamed "MCC" in reform bill ready for full House following week 7, 2012

The House's controversial new coverage to reform PIP was renamed "Medical Care Coverage" (MCC), passed its final committee, and is ready for action in the full House.

The revised House bill, HB 119, retains the emergency care coverage that was part of the original bill and adds a carve-out of $1,500 for non-emergency care in a doctor's office within the first 72 hours of an accident.

Earlier this session, the House bill created "Emergency Care Coverage" (ECC) to replace personal injury protection (PIP) motor vehicle coverage. ECC would provide hospital emergency room treatment within the first 72 hours following an accident. After the emergency, covered treatment would be confined to a very limited group of health care providers (medical physicians, osteopathic physicians, dentists, physician assistants, and registered nurse practitioners). For more on the initial house measure, see Week 1 . . . rapid start for PIP).

In week 7, 2012 session action, the Economic Affairs Committee made the change to MCC (from ECC) to reduce some of the opposition from the medical community. Here is a summary of the revised House bill that is now ready for House floor action:
  • MCC medical benefits of up to $10,000 are available for a timely presented emergency medical condition (see ECC explanation above).
  • A carve-out of up to $1,500 in MCC benefits is available to individuals who either (i) timely present for treatment and are determined at a hospital not to have an emergency medical condition or (ii) who do not present at a hospital but timely seek treatment with a medical doctor, osteopathic physician, dentist, physician assistant, or advanced registered nurse practitioner. 
  • A rebuttable presumption is created that a diagnosis of emergency medical condition in a hospital is correct.
  • Compliance with all policy terms by the insured is a condition precedent to eligibility for benefits. 
  • The 30-day payment period is tolled for an additional 30 days when fraud is suspected. 
  • Persons who submit false statements or false information are barred from receiving MCC benefits.
  • In an insured fails to appear for two examinations (mental or physical), there is a rebuttable presumption of the insured's unreasonable refusal or failure to submit to examination. 
  • Attorney fee awards are capped, and the contingency risk multiplier is eliminated. 
  • The bill provides for a single motor vehicle crash report form.
  • Insurers must file new forms and rates by December 1, 2012.
  • MCC retains many aspects of the PIP system, and is identical to PIP with respect to persons covered, the maximum benefit available in certain circumstances, and the availability of lost wage and funeral benefits.
For more on the House's new MCC coverage, see House Staff Analysis (Feb. 23, 2012) and House offers concessions to doctors in no-fault auto insurance fix (Fla. Current Feb. 24, 2012).

A significantly different Senate bill is scheduled for another committee hearing during week 8. For the Senate's version after week 4, see PIP bill clears first Florida Senate hurdle in 2012.

This summary was prepared by Perry Cone and posted at

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