MANUAL THERAPY DENIALSIn 2012, the Florida Legislature reformed the PIP statute and made several sweeping changes. One of the most significant changes was excluding Massage Therapy from the list of reimbursable services. Under the revised statute, massage therapy (CPT 97124) cannot be paid for by your PIP policy. Progressive and other insurance companies, however, are denying Manuel Therapy services (CPT 97140) since this is a procedure that is routinely performed by massage therapists. Chiropractors, Physical therapists and some Physicians also perform Manual Therapy. This is just another example of insurance companies circumventing the law. They are denying these claims, alleging that they are not reimbursable under the PIP statute. Manuel Therapy and Massage Therapy are two separate, distinct services and charges, with the latter not being reimbursable. If your Manuel Therapy code has been denied, please contact the Dolman Law Group Accident Injury Lawyers, PA. We have been very successful in getting these services properly paid.
EMERGENCY MEDICAL CONDITION DENIALSProgressive has been denying payment of claims in excess of $2,500 in PIP benefits by way of challenging an already determined Emergency Medical Condition. Under Florida's no-fault law, a qualified physician under the statute must determine that the patient has an Emergency Medical Condition. Without such determination, the insured is limited to $2,500 in benefits. What is an Emergency Medical Condition (EMC)? In accordance with the applicable Florida PIP statutes (F.S. 627.730 – 627.7405), an EMC is a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate attention would be reasonably expected to result in any of the following:
- Serious jeopardy to the patient's health
- Serious impairment to bodily function
- Serious dysfunction of any bodily organ or part.
CONTACT FLORIDA PIP SUIT ATTORNEYS DOLMAN LAW GROUPWe have been successful in challenging these types of denials. If an insurance company has denied your claim by attempting to challenge your EMC, contact our PIP attorneys at Dolman Law Group Accident Injury Lawyers, PA today at 727-451-6900 for a free consultation. We will not collect payment until we have earned our client the compensation they deserve. Dolman Law Group Accident Injury Lawyers, PA 800 North Belcher Road Clearwater, FL 33765 727-451-6900