If a provider properly bills an auto insurance company where PIP benefits are still available and all other prerequisites have been met, typically a provider may file a claim against the insurer at the earliest sign of an underpayment or nonpayment. Our office works through providers’ billings to determine which billings were erroneously paid. We then send a demand letter to the insurance company per Florida Statutes, Fla. Stat. 627.736(10). Through this demand letter, the law firm notifies the insurance company of the dispute created because of the denial of the claim and provides 30 days to settle the claim. If they still don’t pay the claim, you can file a lawsuit. This may sound simple, but the reality is the insurance company will not settle if there is no PIP insurance litigation attorney to represent on your behalf.
Having sufficient evidence always helps when you proceed to file a PIP lawsuit. Therefore, gather your necessary documents from doctors, specialists, or anyone else who has provided you with treatment. Collecting statements from witnesses and past records of all interactions with the insurance company will also help. You should be ready to produce all records of the financial losses you suffered because of the accident.
The lawsuit is filed most likely to a small claims division of county court where the clerk immediately sets a pre-trial conference date. In general, most cases get settled on this date or before this date. If this is the case then the medical providers will receive payment quickly but if the case continues past the pre-trial conference, discovery commences.
Discovery is a process where both parties can obtain evidence from one another in the form of interrogatories, requests for production and depositions. To accommodate medical providers, MANGAL, PLLC, works as fast as possible to resolve these issues efficiently and allow for a quicker return to work.
A key distinguishing factor of our PIP practice is that we do not touch the principal amount owed to providers. Instead, we collect “interest, fees, and costs.” This means that we collect whatever interest may have accrued on the principal owed to the provider (typically a nominal amount), the fees we collect directly from the auto insurer (and is limited to $250.00 anyway), and costs are mailing costs typically under $10.00 per file, also paid by the insurer and not the provider.
In the event we file a lawsuit, however, the fees change. For the provider, they remain the same, but for the auto insurer, they go up significantly. This is why most insurers try to avoid PIP lawsuits. But if they do ever give us a hard time, we file lawsuits instantly.
Medical providers review every patient forms and thoroughly check all explanations of Benefits/Reviews. It’s a red flag when there are $0 dollars listed in ‘allowed amount,’ because any indication that this section will remain unpaid should be marked on the form to be reviewed. If an office is being down-coded (for example 99205 to 99203), the claim is potentially filled with reasons to demand an increased amount for damages.
When a patient is sent to an independent medical examination by the insurer and their benefits are suspended by the results, you can file a PIP lawsuit with the increased amount for damages. Basically anytime the EOB shows no money as payment there is more than likely an issue present for a PIP demand, as only a small percentage of people legitimately have no coverage.
The primary nature of a PIP lawsuit is a breach of contract lawsuit. This is different from a typical personal injury lawsuit. Here it’s important to know that the statute of limitations for a PIP lawsuit is maximum of 5 years.