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Why Should A Florida Doctor Hire A PIP Lawyer?

Aug 01, 2014
Shamis & Gentile, P.A.
personal injury protection

Why Should A Florida Doctor Hire A Personal Injury Protection Attorney?

A number of medical providers are being ripped off by their patients’ personal injury protection (PIP) insurers. For instance, some insurance companies are underpaying, paying incorrectly, or completely refusing to make payment altogether. Not only are the insurers not making payments, they’re refusing the payment for all of the wrong reasons. It is vital to have a PIP litigator in place to do your dirty work for you and to ensure that the insurance carrier, in fact, makes all valid payments.

Common reasons for underpaying or paying the incorrect benefit amount:

  • On several occasions, the insurance company will misapply the deductible. Instead of applying the deductible to the total billed, as they should, the insurance company will apply the deductible to the amount that they reduce the bill by. In other words, the insurance company will reduce the bill by 80% of the reasonable amount and then apply the deductible. When doing the correct process of application, the insurance carrier will apply the deductible after the total amount billed, prior to the reduction.
  • The updated 2013 PIP amended Medicare coding policies must be correctly applied by insurance carriers. The insurer isn’t supposed to reduce bills based on National Correct Coding Initiative’s Medicare Reduction Policies, Hospital Outpatient Payment System, etc. Therefore, if committed these are incorrect reductions. For instance, in Socc v. State Farm, the 5th DCA held that the Florida Statutes do not support a finding that the Legislature intended to incorporate all of Medicare into the PIP statute.
  • “The insurer believes that they paid a reasonable amount.” Another incorrect method, the insurer will defend as per Florida Statutes 627.736(5)(a)(2) indicating that they’ve included a permissive fee schedule into their policy, but really they have yet to amend their policies. Be aware that the insurer has to give notice to the insured before using Medicare fee schedules to limit reimbursements for medical services. This precise notice has to be found in the insurance policy, specifying that the insurer is taking advantage of the Medicare fee schedule, Workers Compensation Fee Schedules, etc.
  • The insured fails to attend an examination under oath (EUO). Missing a EUO does not and should not result in non-payment to the medical provider. It is not a condition precedent, meaning an event that must take place prior to obtaining PIP benefits.
  • Assignment of benefits is a mere direction to pay and is invalid. An assignment of benefits is valid, even if it appears in the form of a direction to pay. There is no legal division between an assignment and a direction to pay.

Listed above are a few “excuses” of the mass of defenses raised by Florida PIP insurance carriers. So it is critical to contact a knowledgeable PIP litigator to guarantee that the insurance company doesn’t incorrectly pay or omit to pay a medical provider for the medical services rendered. Insurers frequently apply the incorrect payment methodology and incorrectly apply current case law. Do not give up on yourself! Contact an experienced Personal Injury Protection lawyer to fight for you and retrieve what you are entitled to.



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