The PIP Suit Process for Healthcare Providers


Florida PIP law is a fluid and rapidly evolving area that has seen several amendments in recent years.

Over the past year, we've posted several articles about current trends and topics in Florida's ever-changing no-fault laws.

Our goal is to educate medical providers on the issues so that they are better able to formulate intra-office policies to deal with new changes in legislation and for us to be a resource of information.

Since we handle PIP claims and lawsuits on behalf of Florida medical providers, I've tried to take a step back and explain how the process works, what a provider can expect, fees, expectations, and what to determine.

What should the providers see whether or not PIP requisition can be sent. Florida PIP law states that bills are overdue if not paid within thirty (30) days, lacking proper proof they are not responsible for the claim.

If your bills have been rejected or reduced, as shown on the Explanation of Benefits, or simply not paid without explanation, you have a possible PIP claim.

Pre-suit demand letter

per fl. state. 627.736(10), which explains the pre-claim process, we send a demand letter to the insurance company notifying them of the dispute and advising them that they have the claim payment including interest, penalties, and postage.

30 days to do so, or a lawsuit will be filed. If the claim is not paid, a lawsuit is filed and the insurer bears the risk of attorney's fees. Attorney's fees are not recoverable if the claim is paid as per the demand letter.

PIP Litigation: Procedure

There are innumerable issues to explain on this topic, but for the purposes of brevity I will keep it short and simple.

Once a lawsuit is filed, usually in the small claims division of the county court, the clerk automatically sets a pre-trial conference date at which the insurance company's attorney must appear.

Most newly filed cases will be settled on or before the pre-trial conference date, giving the provider the advantage that they will receive payment immediately.

For cases that proceed beyond the date of the pre-trial conference, discovery begins; In the form of inquiries, requests for production, and statements.

We understand that medical providers and billing managers are busy individuals and are often reluctant to submit and engage in lengthy searches.

Hence, we try to resolve their cases as quickly as possible to minimize the active involvement of the client so that they can concentrate on treating the patients and running the office.

Fees and Settlements

First, medical providers should know that our fees never come from your outstanding PIP benefits.

For cases that settle pursuant to a pre-suit demand letter, our fees are only the statutory 10% penalty (limited to $250.00) and postage. As follows:

$800.00 in PIP benefits + interest to the medical provider (at 4.75%)

$80.00 (10% statutory penalty) + postage reimbursement for us to

lawsuit, paying our fees per Fla. Directly to us by the State Insurance Company. 627.428. In the same example above, the medical provider would still receive $800.00 in benefits and interest, and we would receive our attorney's fees separate and apart from the benefits; (We do not take a part of the customer's recovery).

Insurance companies have an incentive to settle cases on demand, to avoid risking attorney fees; This is the reason why more than half of our cases are disposed of within 30 days from the date of sending the demand letter.

For a free legal consultation, 866-458-3265


Medical Providers and Billing Managers Not Be Paid for Fees Mark this for review as a potential issue.

If you see Office Visits being coded down (for example, 99204 to 99202), this is an appropriate decrease in demand.

If your patient is referred for an IME and benefits are subsequently suspended, this is a claim ripe for requisitioning. Essentially, any time EOB/EOR indicate non-payment, you have a potential problem for PIP demand.

Take the time to read the explanation code on the EOB/EOR that explains the reason for the denial. While a small percentage have a valid denial (i.e., no coverage), the majority do not, when in doubt, ask us.

Medical providers and the billing manager must keep track of when claims are due.

EOBs/EORs are sometimes not sent and a claim can go unpaid for months and years without explanation.

Once 30-35 days have passed, if no payment is received and there is no EOB/EOR explaining the non-payment, then the claim is ready for demand.

In short - see reflected denials on EOB/EOR, see down codes, see less deductions than would normally be expected, see IME suspensions, and see paast due payments.

Frequently Asked Florida PIP Questions

Can we solicit our own PIP? - Short answer, yes you can. Will it be as effective as if a law firm did it, most likely not.

We have skilled lawyers and experienced staff members who know how to proofread demand letters to minimize errors, maintain accuracy and comply with strict statutory norms.

Experience tells us that insurance companies are more likely to respond to attorneys' demands than non-attorney demands because of the potential for immediate litigation. Lastly, why should employees take time off and fight with the insurance company? Let's do this.

Why don't we just bill health insurance for unpaid claims? Assuming health insurance is present on a particular claim, payments are often dramatically less than the allowable PIP fee schedule and may not even be paid until the deductible is met.

The health insurance claim process is long and the appeals process is a nightmare; PIP is intended to shorten the process.

What about out-of-state insurance policies? If a policy is written under the laws of another state and the particular insurance company is not authorized to write policies in Florida, the insurance laws of the other state shall prevail.

For example, Erie Insurance writes policies in the Midwest, but not Florida. Therefore, if your patient's bills are being sent to Erie for PIP payment (provided the state has PIP), any denials or issues will be handled by the underwriting state; not Florida.

We cannot make a demand under Florida's PIP law as it does not apply. Any litigation would also have to be brought in the underwriting state.

Can a demand be made for medical payment benefits? No. Medical Payments or Medpay is purely contractual coverage and Fla. Not part of the state. 627.736, which controls PIP.

Issues involving MedPay are breach of contract only and the same pre-suit requirements as for PIP do not apply. Hence, there is no entitlement to interest, penalty or postage.

What are the documents you need for PIP demand? An assignment of benefit (AOB) and an itemized ledger that specifies specific codes and charges are required before any work can be completed.

Additional documentation may be required on specific case issues, we will advise accordingly. Without the AOB, we cannot make a demand on behalf of a medical provider. If your patient hasn't signed an AOB, get it done!

How long should the process take? Once the PIP requisition is sent, the insurer's response is expected within 30 days of receipt.

If there is no response, we file a lawsuit immediately and there is no time limit within which a case must be disposed of; it varies.

How can we get the documents you have? We understand that different offices of different sizes have different priorities. Our goal is to make the collection process as convenient as possible.

We are adequately equipped and skilled enough to visit your office, audit your files and collect work on your own without any assistance; This way your staff resources are conserved.

We may also accept new PIP work via email or fax; Whatever is easier for the office workers.

How do I know what's going on with our affairs? Customer satisfaction and communication is important in this business. Upon provider request, we will generate monthly or weekly status updates for all active cases. Reports can be customized to suit your needs.

How long can we go back to file a claim? The standard statute of limitations for contract claims is 5 years. For PIP purposes, it is 5 years from the date the claim is past-due; Not more than 5 years from the date of loss. As a cautionary tip, if profits are exhausted that is often the end of the line for pip claims.

Contact Dolman Law Group Accident Injury Lawyers, PA

While there are many other topics to explore and discuss, I hope this article will serve as a general overview of how PIP works in Florida and how we can apply them.

Let's handle If you are a medical provider, current or prospective, and have any questions about whether you have a potential claim, please give us a call. We are here to serve you.

In addition, our attorneys and staff will be available at your office to audit your billing records to determine the presence and potential success of potential PIP claims.

Dolman Law Group Accident Injury Lawyers, PA

800 North Belcher Road

Clearwater, FL 33765


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