Understanding Personal Injury Protection (PIP) Suits in Florida

PIP is a mandatory component of all Florida motor vehicle insurance policies. It typically provides for benefits of 80% of the injured party’s outstanding medicals up to a maximum of $10,000.00, paid directly from the insurance carrier to the treating medical provider. The auto insurance carrier is required to provide PIP benefits regardless of the motorist’s fault, and that is why Florida is sometimes referred to as a “no-fault” state. PIP was ultimately designed to reduce the delay of payment to medical providers and to aid in the immediate treatment of injured persons from motor vehicle crashes.
However, auto insurance companies are not always fair in their dealings with medical providers. In many cases, providers find their billings to be down-coded or find denials on PIP benefits for reasons such as no-EMC (emergency medical condition), untimely billing, etc. Medical providers are met with these denials and often are unsure on how to proceed. Most providers accept the nonpayment and move on for fear of creating a greater hassle than the payment is worth.
This is precisely where MANGAL, PLLC comes in. It is imperative that providers hire an experienced PIP law firm in Florida to receive compensation under the personal injury protection law. As you will learn in this article, our practice is efficient and handles all of your under/non-payments for you automatically. Whether you were underpaid by thousands of dollars or pennies, we will get you every last cent you deserve, and at no out-of-pocket expense to you!

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.

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 accommodate medical providers, MANGAL, PLLC, works as fast as possible to resolve these issues efficiently and allow for a quicker return to work.

What is the Discovery Process?

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

Do I necessarily Need to Hire a Personal Injury Protection Lawyer in Orlando?

Hiring a professional and experienced Orlando PIP attorney always helps in expediting the PIP process. When an insurance company has to deal with an experienced lawyer, they know delaying tactics won’t work. The process of a PIP demand moves much more efficiently and it also maximizes the amount of demand 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!

Is It Possible to Raise a Demand 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.

Should I Opt for Health Insurance?

The process of a health insurance claim is long and tedious. Also, the compensation is much lower and will take much longer than the PIP process.

What Are Important Documents for PIP Demand?

You must have Assignment of Benefits (AOB) and an itemized ledger to identify specific codes and charges.

How Long Should the Process Take?

The statutory limit for a reply to the demand is 30 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 personal injury protection purposes, it’s 5 years from the date that the claim is past-due; and not 5 years from the date of the loss incurred. (Read our blog article on Statutes of Limitations to learn more.)

What About Out-Of-State Insurance Policies?

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