“PIP” stands for Personal Injury Protection. PIP is governed by Florida’s No Fault law, statute 627.736, with a statute of limitations of 5 years. In “no-fault” states like Florida, PIP is required coverage for anyone that owns an automobile. PIP insurance obligates carriers to pay 80% of all covered medical bills, up to the limit of $10,000. This makes PIP a compelling opportunity to obtain revenue for the medical provider.
But PIP carriers scrutinize each and every claim. Insurance companies routinely deny or underpay legitimate bills. Many healthcare providers don’t bother to challenge the carrier’s decision. However, Florida’s No-Fault law provides attorney’s fees to the prevailing party, as a “check and balance” against insurance carriers that do not follow the law. Lubell Rosen makes it easy for providers to challenge denials and underpayments.
Denials and Underpayment
Insurance companies are constantly coming up with new ways to deny or underpay bills. The most common reasons that we have seen to date are as follows:
Often insurance company denials occur when there is a billing error. Even if the error is the fault of medical provider, we can still re-submit or supplement the documentation, and the carrier is required to pay. Insurance companies can be aggressive, using denials as a negotiating tactic or will defame the medical provider to its patients. Insurance carriers have accused providers of fraud, alleged unlicensed medical care and improper billing. In most cases however, the carrier is simply trying to avoid paying legitimate bills.
Insurance carriers often attempt to reduce the payment by a small amount, assuming most medical providers will not bother to file suit. This is precisely why the legislature awards prevailing party attorney’s fees. Multiply a few dollars times thousands, or tens of thousands, of claims, and the carriers are taking advantage of the system.
- Exhaustion of Benefits
One of the most common reasons why a carrier will deny a claim is exhaustion of benefits. In other words, once the carrier pays the full $10,000 in benefits to providers making claims, they close the book on all subsequent claims. However, you may still have a valid claim. The PIP statute contains a hierarchy of who should be paid and in what order, with many exceptions - and exceptions to the exceptions. PIP carriers are required to provide us a payout log upon request. This will often tell us if your bill was misapplied and we can demand payment.
- Fee Schedules
The Florida statute permits insurance carriers, in certain cases, to use fee schedules to pay medical bills. However, there are strict rules as to when a carrier may use a schedule and when they may not use one. If a carrier does not follow the rules precisely, they are responsible to pay the legitimate amount owed.
- Misapplication of the deductible
Most PIP policies contain a $250, $500, or $1,000 deductible. Some carriers chose to apply the deductible in a way to minimize their obligation to pay legitimate bills. These cases often require skilled attorneys with knowledge of appellate law. Lubell Rosen takes all of the risk, and if we prevail, the doctor’s bills are paid and we get our fees.
- Misrepresentations when taking out the policy
Certain insurance carriers deny claims on the basis that there were misrepresentations on the policy application. These are usually fact driven cases and the results vary from case to case. It is is a typical practice of nonstandard auto insurance carriers who sell policies to low income families. The carriers collect millions of premium dollars from these families and then accuse them of misrepresentation when it comes time to pay a claim. Lubell Rosen is not afraid to take these cases to a jury trial for resolution. If we lose, you owe us nothing. But if the jury rules in our favor, your bill and our fees get paid by the insurance carrier.
Types of providers we represent
Lubell Rosen represents any medical provider that treats patients following an accident. Most PIP firms focus only on chiropractors; Lubell Rosen accepts all medical providers. In fact, we have found that the best PIP suits involve providers that have either seen the patient in the hospital, or very soon after. Our most common specialties of clients include:
Attorney’s Fees & Costs
At Lubell Rosen, medical provider’s never pay our attorney’s fees or costs, and they never come out of the medical bill or settlement. Attorney’s fees and costs are only paid to us pursuant to Florida’s No-Fault law by the insurance carrier, either by settlement or judgment. If we are unable to obtain a settlement or judgment on the client’s behalf, we don’t get paid.
How the PIP collection process works
Lubell Rosen simplifies the entire process. From start to finish, we do almost all of the work, letting you focus on your practice. Here is a brief outline of how it works:
- Client signs contract with Lubell Rosen, agreeing to a contingency fee representation. For a copy of a sample contract, click here.
- An attorney from Lubell Rosen will meet with a representative from the medical provider and/or your medical billing company to obtain a list of your unpaid and underpaid medical bills over the past 5 years.
- We calculate the amount due on each unpaid and underpaid claim and send out a “Pre-Suit Demand Letter”, pursuant to Florida No-Fault law. The demand letter seeks the payment of the amount due, statutory interest, penalty and postage. Payment must be made within 30 days.
- If the claim is paid, the full amount of the claim is paid to the provider. Lubell Rosen only retains the interest, penalty and postage.
- If the claim is denied or not made within 30 days, we evaluate the case for possible suit. If we determine it’s a valid claim, we lay out all the court filing fees.
- We instruct the sheriff to serve proper summons on the carrier for each case. We lay out the summons fee.
- Following the initial hearing, we are often able to engage in settlement discussions with the carrier.
- If settlement cannot be achieved, we litigate the case, at our sole expense. We take depositions of the PIP adjuster and all relevant fact witnesses.
- If the carrier requests depositions of our clients, we prepare our clients for depositions and attend the deposition with them.
- If the case still hasn’t settled, we go to summary judgment and/or trial, depending on the facts and issues involved in the case.
If you would like a free consultation about our PIP recovery efforts and/or a confidential evaluation of your unpaid or underpaid medical bills, please contact us here.