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Florida PIP Law Claims (and Denials) Process

Florida’s PIP law was designed to help those injured in an accident seek quick medical attention and not be burdened by the legal process in order to get their medical bills paid. As a doctor who treats patients injured in car accidents, you rely on their PIP coverage to reimburse you. Unfortunately, it can sometimes feel like the insurance company is going out of its way to delay, deny, or underpay your claim. Well, you aren’t being paranoid; insurance companies really do go out of their way to delay, deny, and underpay claims. The good news is that we know the law and know how to make sure you get fairly treated and fully reimbursed for the amount they owe you. Below is a quick look at the process for getting reimbursement under Florida PIP law. if you need help with your PIP law claim, call Shuster & Saben at any of our locations conveniently across the state of Florida.

How Florida PIP Law Claims Work

The primary insurance coverage for anyone injured in a car accident is their “no-fault” or personal injury protection (PIP) insurance. When you treat a patient with a PIP claim, you will generally get an Assignment of Benefits (AOB) from them. This allows you to treat the patient without charging them directly. Instead, you bill the insurer for the amount of service, and the insurer reimburses you for your costs up to the policy limit, which can be $2,500.00 or $10,000.00, depending on whether the insurance company requested proof of an “emergency medical condition” finding.

You have 35 days from the date of service to send in your claim to the insurance company, who then has 30 days to pay your claim (the 30-day timeline is subject to numerous exceptions). If they don’t pay your claim in a timely manner, it is considered overdue. That’s when we come in.

The Demand Letter

Once your claim is overdue, we can step in and issue a demand letter to the insurance company reminding them of their obligations under the law and demanding that they promptly pay the amount requested within 30 days. We will demand they pay the entire amount due plus interest and applicable costs, along with a 10% penalty of the overdue amount up to the maximum allowable penalty for overdue payments. The demand letter will also put the insurer on notice that we intend to sue if the claim is not paid as demanded.

Florida PIP law includes a “demand statute” that sets out what must be included in a demand letter, what level of specificity is required, and how the letter must be sent. This letter should be prepared and sent by a legal professional. As Florida’s leading PIP law firm, we can often resolve the matter at this stage and get your claim paid without the need for further action.

If the demand letter does not settle the matter, we can take further steps up to and including filing a lawsuit. A demand letter is a “condition precedent” for filing a lawsuit, meaning that a lawsuit cannot be filed unless a correct demand letter has been properly sent. The demand letter is therefore a necessary stage in the claim process, as well as the earliest opportunity to resolve the matter.

Lawsuits

Generally speaking, you have five years from the date when the claim becomes overdue to file a lawsuit. This lawsuit will typically go to the small claims division of the county court where your practice is. Filing a lawsuit is sometimes a necessary step to getting paid, but it doesn’t always mean your case will go to trial. There will be many opportunities along the way to settle the case for an appropriate amount. If a trial is necessary, our attorneys have the skills, experience, determination and grit to argue your case before a judge or jury and hold the insurance company responsible for the full amount of what they owe.

Call Shuster & Saben to Get Your Florida PIP Claim Resolved Efficiently and Effectively

Going after the insurance company to get your claim paid is no fun; it can be frustrating and time-consuming and cause a great deal of anxiety regarding the financial health of your medical practice. You deserve to be paid for the services you perform, and our Florida PIP law attorneys will work to get your claim paid successfully, fully, and at the earliest opportunity. If you are faced with an overdue PIP claim, call Shuster & Saben at our offices across Florida or toll-free at 877-511-7829. We are here for you when you need us and ready to go the distance to get your PIP claim paid.

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