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PIP Opinion Letters

Review

In 2012 the legislature passed significant changes to the laws governing the care and billing for patients injured in automobile accidents. This law, Chapter 2012-197, Laws of Florida, became effective on January 1, 2013 and provides limitations on the rendering of services by several health care practitioners, including physical therapists, when treating patients hurt in an automobile accident. The new law is extremely complex and the full extent of the law’s ramifications is still evolving. In fact, legal challenges to the PIP reform law are ongoing. On behalf of its members, the FPTA sought administrative clarification for certain elements of the PIP reforms that impact patient access to care provided by physical therapists. The FPTA pursued this matter by requesting an opinion from the general counsel of the Florida Office of Insurance Regulation (OIR). The OIR general counsel returned an opinion supporting the FPTA assessment that an individual licensed physical therapist may, upon receipt of a referral from one of the specified providers, treat and bill PIP carriers for services under their individual license. Members may access the FPTA letter to Belinda Miller, OIR General Counsel, and the OIR response acknowledging the accuracy of the FPTA interpretation through the Members Only Documents section below.

Update of 7/8/14

During the last few months several FPTA members contacted FPTA regarding denial of claims by some PIP carriers. It is our understanding that these carriers are relying upon a different section of the new PIP law to assert that physical therapists may only bill through their clinic license, and that the clinic must be licensed and accredited. Prior to passage of the PIP reforms, the law was clear that a large segment of physical therapy clinics were exempt from licensure. Moreover, the guidance provided by the OIR opinion letter does not speak to the issue of licensure of the PIP clinic, nor does the OIR have jurisdiction over health clinic licensure.

The FPTA is communicating this important notice to its members to ensure your ability to provide services to patients injured in an automobile accident, and bill for the limits of the coverage ($2,500) as indicated in the new PIP law. We recommend that individual providers contact your Personal Injury Protection carriers, as well as your own legal counsel, for further clarification regarding your specific administrative operations.

Complaint Process

The FPTA has provided information for members and their patients to use when a complaint may be appropriate against PIP insurance carriers. Please follow the instructions and procedures to file appropriate complaints to the Florida Office of Insurance Regulation. Patients and providers wishing to communicate complaints may call the numbers provided or submit a complaint on-line. When using either method please provide complete information as requested below.

  • Full name of the insurance company involved; 
  • Your policy number; 
  • Claim number (if any); 
  • A detailed explanation of your concerns. 

Please check your policy to ensure that you are providing the correct name of your insurance company when submitting your Service Request. If the company information you submit is incorrect, it may impact the timeliness of the company’s response to the Department of Financial Services. 

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Members Only Documents

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Files and documents generated by the FPTA for the benefit of FPTA members. Certain documents are intended for members only and can be accessed once the member has logged in.
Item Name Posted By Date Posted
Bylaws 2014 PDF (179.83 KB)  more ] Administration 12/1/2014
PT Watch Group Letter PDF (285.89 KB)  more ] L. Aperauch 10/27/2014
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