Florida is a no-fault state, and as such, all drivers must maintain a minimum personal injury protection policy (PIP). Of the benefits it provides, PIP insurance coverage is designed to ensure that injured individuals can access necessary medical care quickly, regardless of fault. However, healthcare providers may find difficulties securing payment for the services they provide.
If an insurance company is denying or undervaluing an accident claim you have filed, a Florida personal injury lawyer can help secure the compensation your practice is owed. Read on to learn more about what PIP coverage pays for in Florida.
What Is Personal Injury Protection?
Florida personal injury protection (PIP) is often referred to as no-fault insurance because PIP does not require that the policyholder prove fault in order to receive the benefits of the policy. Coverage is provided regardless of who is deemed legally responsible in the car accident.
Florida Statutes § 627.736 requires all Florida motorists to carry a minimum of $10,000 in medical and disability benefits. However, the law further states that PIP will only cover 80% of all “reasonable” medical expenses. The other 20% is the responsibility of the policyholder. Additionally, non-emergency medical bills are limited to $2,500.
The medical services covered are often limited to what is deemed necessary, such as:
- Medication, including pain management
- Emergency surgery
- Diagnostic testing, such as X-rays
- Hospitalization
- Ambulance
- Rehabilitation and therapy
There are certain medical treatments that are specifically denied. For example, the patient’s PIP policy will not cover the medical costs of massage or acupuncture.
Deadlines That Apply to PIP Claims
There are also deadlines that could affect your insurance claim for PIP compensation. For one, the patient needs to receive treatment for their medical condition within 14 days of the motor vehicle accident. The insurer must pay the claim within 30 days. However, they have 60 days to investigate the auto accident for fraud.
What a Doctor Can Do if the Insurance Company Denies a PIP Claim
Insurance companies often deny PIP claims for various reasons, leaving doctors without reimbursement for the care they provide to accident victims. Common reasons for denials include:
- Disputes over medical necessity
- Procedural errors in claim submission
- Questioning whether the treatment was related to the accident
When this happens, doctors are not without options:
Review the Reasons in the Denial Letter
The insurance company must provide you with a written explanation of the denial. Carefully review this document to identify the specific reason for the denial.
Verify That All Documentation Was Properly Submitted
Ensure that all medical records, billing codes, and claim forms were submitted correctly and in compliance with Florida PIP statutes. Missing or incomplete documentation is a frequent cause of denials.
Submit Your Appeal
If the denial was based on an error or misunderstanding, you can appeal the decision. Provide additional supporting documentation or corrected claims to strengthen your case.
Consult a Personal Injury Lawyer
If the insurance company continues to deny a valid claim, a lawyer can take legal action to enforce payment. Attorneys can identify bad faith practices, pursue litigation, and negotiate on behalf of your practice to recover the compensation you’re owed.
Working with a personal injury attorney ensures that your rights as a medical provider are protected and could help minimize financial losses due to denied claims.
Does PIP Pay for Anything Else?
The patient’s PIP insurance policy does provide coverage for several other benefits:
- Disability Benefits: PIP will pay for 60% of the patient’s lost wages while they recover from their injuries.
- Replacement Services: PIP will also reimburse the patient for any necessary household services they paid another to perform.
- Death Benefits: Families who have lost a loved one may receive $5,000 to cover funeral costs and burial expenses.
Drivers should be aware that the compensation received for these benefits is subject to policy coverage limits.
Our PIP Lawyers Can Take on the Insurance Company
At GED Lawyers, our personal injury protection (PIP) team specializes in handling PIP claims for Florida medical providers. Our lawyers have in-depth knowledge and stay abreast of changes in insurance law, fighting tirelessly for our clients for the compensation they deserve.
When the insurance company stalls, disputes, or denies a PIP claim, our legal team takes them on. If you have accepted an assignment of a patient’s PIP benefits and those benefits have been denied, let us help. Contact us today.
