As South Florida PIP lawyers we understand the concerns chiropractors have about the recent laws passed by the legislature. We have received numerous calls asking for a breakdown of the new standards. Here we will address the new standards as it pertains particularly to chiropractors. In order to analyze the effect of the new pip law on chiropractors it we look to the pertinent language;
“Reimbursement for services and care…up to $10,000 if a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or 459, or an advanced registered nurse practitioner licensed under chapter 464 has determined that the injured person had an emergency medical condition. Reimbursement for services and care…is limited to $2,500 if any provider…determines that the injured person did not have an emergency medical condition.”
It is very clear from the above language that a chiropractor cannot diagnose an emergency medical condition and thus will be limited to $2,500 in reimbursements for services provided. It is hard to see what the rationale is or why chiropractors are being affected disproportionately. After all, a chiropractor is just as able to diagnose an emergency medical condition as a medical doctor, physician assistant, or advanced nurse practitioner.
The effect of this new Florida pip law is that many chiropractors will downsize their practices or close them altogether. Many jobs will be lost as a result of this law. Whether any benefit will come to citizens of Florida remains to be seen. This new PIP law was passed with the condition that insurance companies first reduce their rates by 10% and then 25%. However, insurance companies will not be obligated to reduce rates if they can show that it is not financially feasible. Thus, the result will most likely be that Florida citizens lose jobs and their insurance rates will remain the same or even rise.
There are ways in which chiropractors may be able to charge up to $10,000 through their practice. We are endeavoring toward perfecting these mechanisms and will provide services along those lines for chiropractors. We are also endeavoring along with physicians to provide appropriate forms and protocols for the new emergency medical condition (emc) standard. These will be available shortly.
As Miami pip attorneys we understand that things may seem dire for a chiropractor reading this blog. In fact, we have seen a few chiropractic offices close altogether. It is our impression that such rapid actions are not wise. As mentioned above there are still possibilities by which a chiropractor can bill up to $10,000. Furthermore, the validity of these new PIP standards may be in question and will surely be tested in court. In fact, there may be constitutional issues in question.
Equal protection under the law is guaranteed under the Florida and Federal constitution. Section 2 of the Dan Ray Warren v. Statefarm Mutual Automobile Insurance company, a chiropractor alleged that Florida Statute 627.736(5)(b) denied, “‘equal protection under the Florida Constitution to [chiropractors and other health care providers] by differentiating [their] bills from hospital and ambulance bills.” 899 So.2d 1090 (Fla. Supreme Court, 2005). To clarify, Florida Statute 627.736(5)(b) states that providers have no duty to pay for treatments that were rendered more than 30 days after postmark date. This same requirement was not applied to hospitals or ambulances.
Here the Supreme Court of Florida determined that different billing standards and deadlines did not constitute a fundamental right and chiropractors and other health care providers did no fall into a suspect class. By suspect class one refers to race, nationally, gender, etc. In other words, it did not seem to be law aimed at a particular group of people. This is a law that appears neutral on its face. The Court then reasoned that,
“[a] constitutional equal protection challenge to a statute that does not involve a fundamental right or suspect classification is evaluated by the rational relationship test…Under this test, a court must uphold a statute if the classification bears a rational relationship to a legitimate governmental objective. Our analysis in this case is governed by the rational relationship test because section 627.736(5)(b) does not implicate a fundamental right, nor do the petitioners claim to constitute a suspect class or claim that a fundamental right is at stake.” Id at 1095.
Here the Florida Supreme Court came to the conclusion that billing standards did not entail any sort of fundamental right or issue triggering a higher scrutiny. Thus, the Florida Supreme Court upheld the law.
However, the current situation seems to be different. There is an argument that caps imposed on chiropractors may indeed entail an issue relating to a fundamental right. We are referring to the right “to be rewarded for industry.” Why should a chiropractor or health care facility be limited as to the amount they may be able to bill an insurance company? On its face, the counter argument is that one is not prejudicing chiropractors or distinguishing between anybody. The new pip standard places caps based on whether an emergency medical condition is present. Nonetheless, one has to look at who can make this determination and it is quite apparent that chiropractors have been left out of the list.
If the courts determine that there is fundamental right in question they will apply a strict scrutiny standard. This would mean that the government would have to show that a compelling interest exists to justify the policy. This standard is very hard to meet and in many cases leads to the nullity of laws and standards passed by governments.
Our view is that a fundamental right is a stake here. This relates to ability of chiropractors and their employees to make a living and enjoy the fruits of their labor. Few things are more fundamental than that.