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PIP Lawsuits for Medical Providers

Clermont, FL
PIP-Lawsuits-for-Medical-Providers

When Can You File a Claim Under the Florida PIP Law?

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.

Personal Injury Protection (PIP) Suits Clermont Florida - MANGAL, PLLC

Things to Consider Before Filing PIP Litigation in Florida

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. 

Where to File the Lawsuit

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.

What is the Discovery Process?

Discovery is a process where both parties can obtain evidence from one another in the form of interrogatories, requests for production and depositions. To accomodate medical providers, MANGAL, PLLC, works as fast as possible to resolve these issues efficiently and allow for a quicker return to work.

What About Fees and Settlements?

We do NOT touch the principal amount due to the providers!

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.

Other Things You Should Consider

Medical providers review every patient forms and thoroughly check all explanations of Benefits/Reviews. It’s a red flag when there’s $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 You Should File a PIP Lawsuit in Florida

 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 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.

Why Do You Need to Hire a Personal Injury Protection Law Firm to File a PIP Lawsuit?  

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 5 years.

Frequently Asked Florida PIP Questions

Why hire an attorney to handle PIP? Why not do it myself?

The help of experienced attorneys allows the process of a PIP demand to happen much more efficiently as well as maximizing the amount of demands made. The advantage of an attorney is that the insurance company will want to end negotiation quickly as there is more immediate potential for litigation. It is possible to file a claim on your own for yourself; however, fighting to make sure you get what you deserve can and should be trusted in the hands of our firm.

How do you review our files? Do we need to do any "heavy lifting"?

No heavy lifting required. Contact us today so we can get a specialized plan in place just for your medical practice. We will come to you, pick up the files, scan them into our systems, and drop them off! For free!

Can a demand be done for Medical Payments benefits?

No. These benefits do not include PIP as they are contractual coverage and not a part of <a href=”http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&amp;URL=0600-0699/0627/Sections/0627.736.html” target=”_blank” rel=”noopener noreferrer”>Fla. Stat. 627.736</a>, which governs PIP.

What about health insurance?

The process of a health insurance claim is long and made more difficult by the appeals process. If the health insurance even exists on a claim the payment is much lower and will take much longer than the PIP process.

What documents do you need for a PIP demand?

Before anything can get started an Assignment of Benefits (AOB) and an itemized ledger that identifies specific codes and charges are needed.

How long should the process take?

The limit for a reply to the demand is thirty days. Anything more than that is due to litigation in which the amount of time needed may vary.

How will I know what’s going on in our cases?

Our firm works hard to build a relationship with the client and provide complete satisfaction of our services, being readily available at any given request.

What is the Statute of Limitations on a PIP claim?

For PIP purposes, it is 5 years from the date that the claim is past-due; not 5 years from the date of loss.

What about out-of-state insurance policies?

Policies can be made outside of Florida that is in accordance to another state’s laws but not necessarily Florida’s. If an insurance company is not authorized to write policies in Florida, the company’s state’s insurance laws are enforced and used. The other state would hold custody of those claims and all litigation would be under the rules present there.