Insurance companies sometimes deny, delay, underpay, or incorrectly compensate personal injury protection (PIP) claims. When this happens, medical providers do not receive the money owed to them.
Our PIP guide for medical providers can help you understand the PIP insurance process, how claims and payments work, and how our firm can help you fight for denied or reduced payments.
What Is PIP and What Does It Cover?
According to the Insurance Information Institute (III), only 12 states follow some version of a no-fault automobile insurance system:
- Florida
- Massachusetts
- New York
- New Jersey
- Pennsylvania
- Michigan
- Minnesota
- North Dakota
- Utah
- Hawaii
- Kansas
- Kentucky
Under no-fault, drivers must carry PIP insurance to pay for medical care after a car accident, regardless of who is liable for the collision. Ideally, the advantage of a no-fault system is that it speeds up the insurance payment process by eliminating the need to establish legal liability before compensating the injured. Unfortunately, however, that is not the way claims always work out.
PIP pays for all or a portion of the policyholder or other covered individuals’ medical treatment up to the policy’s limit. Each state mandates its own PIP minimums. Covered care generally includes any necessary and reasonable medical care resulting from an accident, including:
- Emergency transportation and services
- Doctor and hospital bills
- Surgeries
- Diagnostic testing and imaging
- Rehabilitation and physical therapy
- Medications
- Medical devices, medical equipment, and prosthetics
- Dental care
Why Would an Insurance Company Deny PIP Payments to a Medical Provider?
Many issues could cause a delayed, denied, or reduced PIP payment to a medical provider, including:
- The medical provider is not properly licensed or has not met local licensing and registration requirements (for example, Miami-Dade County, FL requires that providers register with the county and meet specific financial guidelines to qualify for PIP payments).
- There is an issue with a provider’s patient logs.
- The insurance company has asked for an independent medical exam (IME).
- The insured refuses to submit to an IME, or the findings of the IME contradict the insured’s claim.
- The insured failed to appear at an examination under oath (EUO).
- The insurance company believes the insured made a false statement or erroneous claim.
- The insured did not seek medical treatment in a timely fashion (for example, Florida Statutes § 627.736 requires covered parties to receive care within 14 days of their accident).
- The insured has maxed out their policy’s PIP benefits.
- The insured failed to file their PIP claim per their policy’s deadlines.
- The insured has not complied with medical orders.
How Do You Know If There Is a Problem With Your PIP Payments?
The only way to ensure insurance adequately compensates you is to review all claims and explanations of benefits/reviews (EOB/EORs) that come through your office carefully. You may have grounds for contesting payments if:
- An “allowed amount” is listed as $0, or there is another indication the charge is not covered.
- Insurance “down codes” a service or procedure to a lesser charge.
- Claims are past due.
- A claim goes unpaid for an extended period, and the insurance company has not notified you why or sent an EOB/EOR.
- Insurance requests your patient submits to an IME or suspends their benefits.
A Jacksonville PIP lawyer with our firm can help you determine why you are not receiving PIP payments owed to you or your practice. We can then help you explore your legal options for getting the compensation you deserve.
How Long Do You Have to Pursue Denied PIP Payments?
In general, PIP insurance companies should remit payment to medical providers upon receiving a bill for services. Usually, claims not paid within 30 days are overdue. If you contest a denied or underpaid claim in civil court, your state’s statute of limitations for contract claims/breach of contract will dictate how long you have to file a lawsuit.
A lawyer with our firm can tell you more about applicable deadlines and help you get started before time runs out.
How Can a Lawyer Help You Recover Compensation for Denied PIP Claims?
You have the right to take legal action to recover denied PIP claims. You can attempt to do this yourself; however, hiring an attorney can send a message to the insurance company that you are serious about recovering what they owe you. Additionally, working with an attorney saves you time and energy and spares you the hassle of dealing with insurance providers and their lawyers.
An attorney with our firm can:
- Review unpaid claims and determine if you have grounds for legal action
- Calculate how much PIP coverage the insurance company owes you and your practice
- Draft a demand letter and notify involved parties of your intent to take action
- Represent you during negotiations and fight to secure an advantageous pre-trial settlement
- Handle paperwork, deadlines, and other “red tape”
- Handle case-related phone calls, emails, and meetings
- Accompany you to appearances and appear for you when possible
- File a lawsuit and represent you at trial if necessary
- Contact you with frequent and timely case updates
What Will It Cost to Engage Legal Help?
In some cases, hiring an attorney to represent you will cost you nothing. For example, per Florida Statutes § 627.428, in a case resulting in a judgment against an insurance company, the insurance company is responsible for the plaintiff’s legal fees in addition to other damages awarded.
Additionally, an attorney with our firm can take your case on contingency, meaning you pay nothing upfront. We only collect a fee if we obtain compensation for you.
Contact GED Lawyers for Help With Your PIP Payments Today
You deserve payment for the medical services you and your practice provide. Furthermore, you should not have to accept pennies on the dollar. Our PIP attorneys can relieve the stress of recovering denied or reduced payments and fight for fair financial recovery.
Contact us today for answers to questions we may not have addressed in our PIP guide for medical providers. We can tell you more about how an attorney with GED Lawyers can help you pursue compensation. A member of our team is available 24/7 to answer your questions and schedule a free consultation.
