THE TOPIC
The term "no-fault" auto insurance is often used loosely to denote any auto insurance program that allows policyholders to recover financial losses from their own insurance company, regardless of fault. But in its strictest form no-fault applies only to state laws that both provide for the payment of no-fault first-party benefits and restrict the right to sue, the so-called “limited tort” option. The first party (policyholder) benefit coverage is known as personal injury protection (PIP).
Under current no-fault laws, motorists may sue for severe injuries and for pain and suffering only if the case meets certain conditions. These conditions, known as a threshold, relate to the severity of injury. They may be expressed in verbal terms (a descriptive or verbal threshold) or in dollar amounts of medical bills, a monetary threshold. Some laws also include minimum requirements for the days of disability incurred as a result of the accident. Because high threshold no-fault systems restrict litigation, they tend to reduce costs and delays in paying claims. Verbal thresholds eliminate the incentive to inflate claims that may exist when there is a dollar "target" for medical expenses. However, in some states the verbal threshold has been eroded over time by broad judicial interpretation of the verbal threshold language, and PIP coverage has become the target of abuse and fraud by dishonest doctors and clinics that bill for unnecessary and expensive medical procedures, pushing up costs.
Currently 12 states and Puerto Rico have no-fault auto insurance laws. Florida, Michigan, New Jersey, New York and Pennsylvania have verbal thresholds. The other seven states—Hawaii, Kansas, Kentucky, Massachusetts, Minnesota, North Dakota and Utah—use a monetary threshold. Three states have a "choice" no-fault law. In New Jersey, Pennsylvania and Kentucky, motorists may reject the lawsuit threshold and retain the right to sue for any auto-related injury.
RECENT DEVELOPMENTS
States
- Minnesota: A study by the Insurance Research Council (IRC) of the state’s no-fault system, using data from 500 personal injury protection (PIP) insurance claims settled in 2007, found that 58 percent of all medical care provider charges for treatment of no-fault auto insurance claimants were from chiropractors, compared with 11 percent for physical therapists and 19 percent for physicians (general practitioners, ER physicians and orthopedists combined). The 22 auto insurance companies participating in the study represented 61 percent of the Minnesota auto insurance market.
- The growing cost is mostly due to the rapid rise in fees. While the number of auto insurance claimants obtaining chiropractic treatment increased 5 percent over the five year period 2002 to 2007, the average charge rose 30 percent from $122 to $158 per visit. Minnesota had the third-highest chiropractor utilization rate (42 percent) among the 17 states in the study, those with either with a true no-fault or the add-on system, see chart below for a list of states in these categories. Only Washington (add-on) and Florida had higher rates. Utilization of and charges for MRIs also grew during the period.
- Colorado: Colorado repealed its no-fault law in 2003, but critics of the repeal have been working to reinstate some form of first-party medical coverage ever since. Legislation was signed into law in June 2008, which would add an optional $5,000 in coverage to auto insurance policies for medical payments. Critics argued that emergency care providers, such as trauma centers, are suffering financially under the current tort-based system, under which medical bills are paid by health insurers. In September 2008 there was an attempt to reinstate no-fault but it failed to garner support in committee.
- The root of the problem lies in the difference between reimbursement rates set by the no-fault auto insurance law and those negotiated by health insurers. No-fault insurers paid the bills in full whereas health insurers, which deal with a much larger volume of cases, not just auto injury cases, can negotiate a significantly lower rate. Under S.B. 11, for the first 30 days emergency care providers are paid under a priority of payment schedule. Policyholders who do not want the coverage may reject it when they purchase auto insurance or when they renew their policy.
- An independent research group has found that Colorado drivers pay 35 percent less for auto insurance than they did before the state changed its auto insurance system nearly five years ago. Hospital reimbursements were down by $85 million, in part because they are treating fewer auto accident victims. In 2002 acute care hospitals admitted almost 6,000 people after auto accidents, compared with close to 4,500 in 2006, a drop of almost 1,500 people. In two-thirds of crashes there are no injuries and the majority of injuries that do occur are minor strains and sprains, according to insurance data.
- Florida: The state’s no-fault law expired on October 1, 2007 after lawmakers had failed to agree on how to reform the law. However, shortly after the expiration date, under pressure from the Governor, lawmakers reenacted the no-fault law which became effective in January 2008, with significant reforms designed to curb fraud. One provision limits the type of health care providers that can be reimbursed to help eliminate claims from fraudulent medical clinics. Payments for medical care under the personal injury protection (PIP) part of the policy can only be made when provided, ordered or prescribed by authorized medical care providers. The legislation also sets limits on fees for medical care provided under the law. Hospitals feared that unreimbursed costs would soar under a tort system. About 40 percent of the patients treated at hospitals and trauma centers for injuries related to auto accidents rely on PIP because they have no health insurance, hospitals say. Under the old system, the state’s no-fault PIP benefits had been subject to fraud and abuse.
- New Jersey: New Jersey is one of the five states with a verbal threshold and one of three with a law that allows people to choose a no-fault or tort-based liability policy. The key to the success of a verbal threshold is to preserve the strict limit on filing of lawsuits. Since the law was rewritten in 1998, the state Supreme Court has ruled on several verbal threshold cases. The most recent involves emotional distress, which is not specifically mentioned in the law as an injury that meets the threshold. In June 2008, in Jablonowska v. Suther, the New Jersey Supreme Court ruled in a 4-3 decision that a plaintiff may recover claims for severe emotional harm that may be expected from having perceived the death of or serious injury to a spouse or an intimate family relative. Jablonowska was driving with her mother when her car was hit in the rear, causing it to crash into the concrete divider. When she regained consciousness, she saw that her mother was seriously injured. At the hospital she was pronounced dead. Voting against recovery of damages for emotional distress, dissenting justices said that the decision opened the way for distinctions regarding the severity of accidents that the legislature never considered when they adopted the verbal threshold in 1998.
- Insurers have been monitoring case filings to determine whether a June 2005 New Jersey Supreme Court ruling in what is known as the DiProspero case has had a significant effect on the number of court filings. Initially, it was feared that the decision would allow many more people to sue for pain and suffering, effectively negating the cost advantages of choosing no-fault coverage. However, so far, there has been no appreciable change. The DiProspero ruling weakened the verbal threshold that is designed to keep all but the most seriously injured drivers from suing for noneconomic damages.
- The language defining the threshold was modified by the legislature in 1998 when the state auto insurance law was completely revamped. In the DiProspero case the high court said that if the legislature had intended to make it more difficult for accident victims to obtain an award through the courts, then it should have written the new statute accordingly.
- A lawsuit has been filed by the state’s Medical Society and others seeking to modify a PIP medical fee schedule. The fee schedule, which was to take effect in October 2007, is a list of maximum charges for certain common treatments and procedures. It was adopted by the state’s Insurance Department in an attempt to control soaring medical care fees paid by insurers for treatment related to auto accidents. The Insurance Department said that it will consider at a later time whether a fee schedule for hospitals is needed. A ruling by the court is expected soon.
STATE AUTO INSURANCE LAWS GOVERNING LIABILITY COVERAGE![]()
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BACKGROUND
Currently, state auto liability insurance laws fall into four broad categories: no-fault, choice no-fault, tort liability and add-on. The major differences are whether there are restrictions on the right to sue and whether the policyholder’s own insurer pays first-party benefits, up to the state maximum amount, regardless of who is at fault in the accident. These alternative systems have evolved over time as consumers, regulators and insurers have sought ways to lower the cost and speed up the delivery of compensation for auto accidents.
The Different Auto Insurance Systems
No-fault: The no-fault system is intended to lower the cost of auto insurance by taking small claims out of the courts. Each insurance company compensates its own policyholders for the cost of minor injuries, regardless of who was at fault in the accident.