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An Analysis of PIP Suits and Florida PIP Law

What is a PIP suit?

First, most people do not readily understand what a “PIP suit” is. Often, it gets confused with personal injury cases that most are familiar with. In a typical personal injury case an injured party sues another party for damages caused by the negligence of another party. Typically this is referred to as tort law.

“PIP” suits are governed under Florida statute 627.736 with a statute of limitations of 5 years. “PIP” stands for personal injury protection and in “no-fault states” like Florida; it is required insurance coverage through your personal auto insurance company.

Essentially, when you are involved in a car accident, PIP pays 80% of your medical expenses, lost wages and other incidentals up to the required $10,000.00. The legislative purpose behind the “no fault” statute is to allow for expeditious medical treatment regardless of who was at fault. In other words, if not for the “no fault provision,” an injured party would have to wait for a Court of Law to determine and opine on liability before an insurance carrier would tender payment for medical services rendered. In such a scenario, physicians would be hesitant to evaluate and offer treatment to an individual injured as a result of an automobile accident due to the inordinate wait to receive payment for services rendered. Additionally, such a scenario would create a serious logjam and delay in cases reaching trial. In turn, this would create an impermissible burden for consumers seeking recourse if physically injured.

What is the need for PIP suits?

So, why the need for PIP suits? In theory, an insured party would be involved in a car accident and seek treatment for his injuries. The medical provider in turn bills the insurance company to pay off the medical bills incurred under “PIP”. Again in theory, the insurance company will reimburse the medical provider after receiving the bills and everyone is happy. Not so fast. Why are there thousands of PIP claims filed in our courts every year? Easy. In some cases the insurance carriers delay or deny payment of the bills for valid reasons such as falsehoods contained in an insurance application or due to the insured failing to comply with their insurance policy (i.e., submitting to an independent medical examination with a physician selected by the insurance carrier following an automobile accident). When this occurs, a medical provider has the right to go after the insurance company to pay such bills in order to be properly reimbursed for services rendered.

Claims range from a few hundred dollars to as much as several thousand dollars. The legislature allows medical providers a cause of action in this case under FL. STAT 627.736. In a situation as described, a medical provider may retain the services of competent legal counsel to handle the matter and collect what is due and owing. In many cases, medical providers are not aware that they may seek action against these insurance companies. It is common for these medical providers to have hundreds of bills that were either partially paid by the insurance companies or not paid at all. Essentially, this adds up to thousands of dollars sitting unpaid within their files.

PIP suits have come under fire by insurance carriers who tend to focus on cases wherein a plaintiff lawyer has filed a lawsuit on what they may deem is a nominal amount (an example would be a lawsuit filed over a reduction of a few dollars). Florida insurance carriers such as United Automobile Insurance; will cry foul and characterize the PIP suit lawyers as greedy. They have attempted to portray plaintiff lawyers as the reason why insurance premiums continue to rise. This is a complete fallacy. What these same insurance carriers fail to state, is that they many reductions are for far greater sums that a dollar. It is much easier to focus on the most egregious cases, and then paint all attorneys with one brush. Further, they also fail to explain that a small reduction of even a few cents multiplied by thousands upon thousands of claims results in a big savings for the insurance carrier. There is a reason behind every decision the insurance carrier makes. Their sole purpose is to maintain and increase profitability for their shareholders.

How we can help

Hiring competent legal counsel to handle your PIP claims is effortless. Since statute of limitations on these cases are 5 years, we can go back and demand that the insurance companies pay the bills that they were contracted to pay through PIP. The legislature did even better by providing that attorney fees be paid to the prevailing party. This allows a medical provider to not invest money into their accounts receivable to get money that is OWED to them. We do all the work and the insurance carrier pays our legal fees should we prevail. Every medical provider that submits payment under PIP should have a competent legal office with PIP experience ready to demand payments from the insurance carriers.

We will happily come to your office and audit all paperwork and billing records to locate potential PIP claims. Our audit is free of charge and we will handle the entire process from demand all the way through lawsuit, if necessary. Further, we do not charge the medical provider for our services at any point. Many law firms charge the medical provider a percentage of the benefits aside from the statutory attorney fee earned.  At Sibley Dolman Gipe Accident Injury Lawyers, PA, we agree to only accept the attorney fees provided under Florida Statute. We have no interest in taking your piece of the pay. In fact, our firm refuses to take even a penny of the benefits owed to the medical provider.

The types of PIP cases we handle

Sibley Dolman Gipe Accident Injury Lawyers, PA represents medical providers such as Chiropractors, Orthopedic Surgeons, Physiatrists, TMJ specialists, and MRI facilities throughout the State of Florida.

In accordance with the amended Florida PIP statute, we handle any and all cases wherein an insurance carrier caps no-fault benefits at $2500 due to their determination that an emergency medical condition (EMC) does not in fact exist. EMC is a term of art created by the Florida legislature in 2013. EMC had been extensively analyzed in previous Sibley Dolman Gipe Accident Injury Lawyers, PA articles. If an insurance carrier has capped benefits at $2500 due to a determination of a lack of an EMC, we will happily review the file. Several Florida insurance carriers, including Progressive have retained Florida physicians to perform a peer review of medical records. A peer review (in the context of PIP billing) is a process in which a physician retained by the insurance carrier simply reviews the records and generally rubber-stamps a determination that an EMC does not exist. We have yet to see a peer review end in a favorable outcome for a claimant. Further, the peer review physician retained by the insurance carrier never physically examines the claimant.

We also routinely handle IME (independent medical examination) suspension of benefits, as well as improper reductions in accordance with the Florida PIP statute.