Under Florida’s 14-day accident law, car accident victims must seek medical evaluation and treatment within 14 days of their crash. Failing to do so will prevent their personal injury protection (PIP) insurance carrier from paying the medical care providers who handled these services. Sometimes, the insurance company will claim their policyholder failed to get treatment within 14 days of the accident and deny the claim, even if this is false.
Unfortunately, medical centers, clinics, and practices often run into hiccups when trying to get the money they need based on a patient’s PIP policy. If the insurer unfairly refuses to cooperate or there are additional concerns about getting invoices paid, a PIP lawyer from our firm may be able to help you.
What Is the Florida 14-Day Accident Law?
Lawmakers established the 14-day accident law under Florida Statutes § 627.736. This law outlines how the state’s recognized no-fault system works. This includes a mandatory 14-day period during which crash victims must seek medical care. When serious injuries occur, the victim often goes directly to the hospital in an ambulance or medevac helicopter. There is no concern about the 14-day period in cases like these.
However, when injuries are relatively minor, the victim only has two weeks to see a doctor for diagnosis and treatment. If they do not make their initial appointment by the 14th day following the crash, their no-fault auto insurance provider can deny the claim, refusing to pay for the visit and any future care related to car accident injuries.
How Does The 14-Day Accident Law Affect Health Care Providers?
Medical care providers who frequently see auto accident victims have to bill the patient’s personal injury protection (PIP) insurer to receive payment directly for their services. Healthcare facilities generally deal with both PIP and health insurance claims to receive payment for their billed services.
Under Florida Statutes § 627.736, the institution or individual rendering treatment should send an invoice and receive payment directly. This payment should cover a wide range of accident-related injury care, including:
- Emergency department treatment
- Ambulance transportation
- Surgery
- Hospitalization
- Rehabilitation
- Therapies
- Prescription medications
Insurers Could Refuse to Pay a PIP Claim
When a patient comes to a clinic or doctor’s office for care for auto accident injuries, they must ensure they are in this 14-day window or are covering their medical expenses in another way. Sometimes, the insurance carrier still alleges there is a problem. They might deny a claim because they say the policyholder did not see a doctor soon enough, among other reasons.
There are also numerous other reasons why a PIP insurer might refuse to pay a claim. These reasons could be valid, based on incorrect facts, or completely false. It could require investigating to determine what went wrong.
Some possible reasons why a PIP provider might refuse to pay a healthcare provider include:
- They believe the policyholder did not see a doctor in time
- They deem the services and charge unreasonable
- They based it on an independent medical examination
- The provider or policyholder refused an examination under oath
- They believe the policyholder or care provider lied or misrepresented their injuries
Sometimes, these insurance companies refuse to communicate about a claim. They may delay or ignore a claim entirely. This could support a bad faith insurance lawsuit from the policyholder and support action from the care provider, too.
Our Firm Can Help You if You Were Not Paid for Your Services
Florida Statutes § 627.736 sets a tight deadline for personal injury protection insurance carriers to pay medical bills quickly. They have up to 30 days to pay or deny the claim, in whole or in part. The policyholder or care provider submits a notice of a covered loss—the crash injury—and the billed amount for its diagnosis, treatment, and any necessary medication.
If the insurance company does not pay within 30 days of this written notice, the medical facility, clinic, or doctor can move forward with a lawsuit against them to recover the money owed.
Often, this process triggers the insurance company to take a closer look, and they uncover a mistake in their investigation or paperwork that caused an invalid denial. Sometimes, they offer to pay the bills to avoid a costly trial. Either way, the insurer pays the medical facility, and the crash victim receives the care they need.
What Is the Role of an Attorney in These Cases?
An attorney from a law firm familiar with this process will know how to navigate the steps necessary to seek the money to cover the bills in question. This process often begins with a demand letter. The attorney crafts a demand letter to the insurance carrier outlining your argument and the amount owed.
In most cases, a demand letter is necessary and serves as the required pre-trial notice before taking court action against an insurance company. If the lawyer does not get a satisfactory response to the demand letter, including a fair offer during negotiations, a lawsuit is likely the next step.
Our lawyers handle these cases on a contingency-fee basis. Your attorney does not charge anything upfront. Instead, they ask for a portion of the payout when the case closes.
Contact Us to Discuss Your Next Steps in Recovering the Money Owed
At Ged Lawyers, we represent healthcare providers struggling to get paid for the services they rendered. Our attorneys only represent medical providers and healthcare facilities in PIP cases. We will fight to help you receive compensation for your services.
We provide complimentary initial case consultations for our potential clients. We are here now to discuss your options and explain how we can help you. Contact us today to get started.
