Personal Injury Protection Lawyer

Do you treat and provide services to patients with PIP (or “personal injury protection”) benefits? Personal Injury Protection (PIP) is mandatory no-fault car insurance that provides up to $10,000.00 in medical coverage that individuals can use to pay their medical bills incurred from a car accident injury, under Florida automobile insurance policies.

Insurance carriers constantly reduce, underpay, or completely deny bills that are submitted to them. The Florida PIP statute is a complicated and ever-changing landscape that is seemingly impossible to traverse to those unfamiliar with it. Don’t be taken advantage of by these giant insurance carriers like Progressive, State Farm, Allstate and Geico (among others), but rather get the amount of money that you are owed. Shamis & Gentile P.A. has extensive personal injury protection experience in getting you the money you deserve.

If you are a doctor, do you know how much you bill for each individual CPT code? Did you know that each insurance company has its own method of analyzing each CPT code and potentially reducing or refusing payment? This is where our expertise comes into play. Shamis & Gentile P.A. knows how much those CPT codes should be paid, what each reduction or denial means, and can fight to get you paid the amount that you deserve.

A number of medical providers are being ripped off by their patients’ personal injury protection 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 lawyer 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 personal injury protection 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 attorney to guarantee that the insurance company doesn’t incorrectly pay or omit to pay a medical provider for the medical services rendered.

The Personal Injury Protection Florida statute is very rigid with certain requirements that you must abide to be successful in recovering money. Our office can handle the entire process, from analyzing the file, to sending the demand letter, filing the lawsuit and ultimately litigating the case. Our personal injury protection lawyers are familiar with the process from beginning to end and know the applicable deadlines. Let us help you.