PIP Suits for Medical Providers

Florida PIP law is constantly changing, and has undergone many updates within recent years. PIP stands for Personal Injury Protection, a type of no-fault insurance coverage that pays medical bills and potential lost wages in the event of an accident within the state of Florida. This firm hopes to explain and update this material in order to create a more cohesive relationship between medical providers, the injured, and our law firm. Medical providers will find this information useful in determining if the PIP claim or lawsuit is valid and whether a demand can be sent or not. Florida PIP law mandates that bills are overdue if not paid within thirty days, unless there is a lack of reasonable proof that the party is not responsible for paying the claim. Once a claim is filed a document called the Explanation of Benefits (EOB) statement is generated. This statement is sent to the subscriber by the insurance company explaining the action of what medical treatment or services were provided, amount to be billed, and payments made on each claim. If your bills have been denied or reduced, as reflected on an Explanation of Benefits statement, or are simply unpaid with no explanation then you have a potential PIP claim.

Demand Letter

In accordance to Florida Statutes, Fla. Stat. 627.736(10), which explains the pre-suit process, our law firm will send a demand letter to the insurance company notifying them of the dispute and allowing thirty days for them to pay the claim (along with interest, penalty, and postage). If the claim is not paid within the first thirty days we will proceed to file a lawsuit. A lawsuit could potentially expose the insurance company to pay the attorney fees, but if the claim is met within the first thirty days and a lawsuit is not needed, those fees are not recoverable through the insurance company.

PIP Litigation

The lawsuit will be filed, most likely to a small claims division of county court where the clerk will immediately set a pre-trial conference date. The insurance company’s attorney must appear at this pre trial conference, so most cases will settle at 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. In order to accomodate for medical providers, our firm works as fast as possible to resolve these issues efficiently and allow for a quicker return to work.

Fees and Settlements

The most important fact here is that our law firm’s fees never come out of the PIP benefits originally owed to the medical provider. For cases that are settled before a lawsuit is necessary, our fees are the statutory 10% penalty (limited to $250.00), interest on the fees owed, and postage. In cases that settle after a lawsuit is filed, the firm’s fees are paid directly to us by the insurance company per Fla. Stat. 627.428. Due to this statute, insurance companies have a desire to close cases within the first thirty day period of the claim in order to avoid additional charges.

What to Look For

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. If the patient is sent to an independent medical examination by the insurer and their benefits are suspended by the results, the claim is potentially filled with reasons to demand an 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.

Frequently Asked Florida PIP Questions

  1. 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.
  2. 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!
  3. 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 Fla. Stat. 627.736, which governs PIP.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. What is the Statute of Limitations on a PIP claim?

  9. What about out-of-state insurance policies?

    • Policy can be made outside of Florida that is in accordance to another state’s laws but not necessarily Floridas. 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.

Author: Prachi Gupta