Florida “No Fault” law is a confusing beast made up of difficult-to-understand requirements and ever changing regulations. The Florida legislature has made many changes to the law over the years, particularly to the personal injury protection (“PIP”) statute, which directly affects the insured. A recent case out of Sarasota illustrates the nuances in PIP law and emphasizes why, if you have been injured in an automobile accident, you should hire an experienced personal injury attorney who can represent your best interests before the insurance company.
Geico Indemnity Co. v. Physicians Group, LLC is a recent 2nd District Court of Appeal case that addressed PIP insurance and evaluated a 2008 amendment to the PIP statute that limited the amount an insurer could reimburse medical providers for non-emergency, non-hospital medical services. Judge Morris authored the opinion and held that the 2008 amendment did not apply retroactively to insurance policies that were in effect and expired prior to the statute’s effective date of January 1, 2008.
The facts in the Geico case involved Paul Androski, who was hurt in a car accident on September 5, 2006. He was covered by GEICO insurance for PIP protection under a policy that ran from August 23, 2006 to February 23, 2007. Physicians Group began treating Androski for his injuries from the accident on January 24, 2007. Under the language of the policy, which was consistent with the prior 2006 version of the PIP statute, GEICO paid Physicians Group 80% of the total amount billed to Androwski for medical services he received in 2007.
The new Florida Motor Vehicle No-Fault Law, which included a new PIP statute, went into effect on January 1, 2008. The distinguishing factor about the new PIP statute was that, for non-emergency, non-hospital services (like those rendered from Physicians Group to Androwski), a PIP insurer could “limit reimbursement to 80[%] of . . . 200[%] of the allowable amount under the participating physicians schedule of Medicare Part B” or if the services are “not reimbursable under Medicare Part B, . . . 80[%] of the maximum reimbursable allowance under worker’s compensation.” Fla. Stat. § 627.736(5)(a)(2)(f) (2008).
After Androwski was treated for an arthroscopic procedure by Physicians Group on January 7, 2008, GEICO proceeded to pay only 80% of 200% of the billed amount, based on the requirement of the 2008 statute. Under the old version, GEICO would have been required to pay 80% of the billed amount.
Physicians Group filed a complaint seeking a declaratory judgment on the issue of whether GEICO was prohibited from retroactively applying the 2008 amendment to claims under an insurance policy that was effective before the amendment. The court agreed with Physicians Group’s position and GEICO appealed. The appellate court evaluated the legislature’s intent to determine whether the statute should be construed as retroactive and agreed that it should not be applied retroactively, affirming in favor of Physicians Group.