WHAT IS PIP?
A Personal Injury Protection (PIP) Suit is a lawsuit brought by a medical provider against an insurance company to recover benefits properly owed to the medical provider for treatment rendered to an injured person from an automobile accident, for which the insurance company failed to pay the benefits. The attorney’s at Thompson Legal, P.A. can handle both a PIP lawsuit on behalf of a medical provider, as well as sending a PIP Demand, which is a prerequisite to filing a PIP suit.
Florida PIP Law is constantly evolving. Our firm stays up to date on any changes the Florida Legislature makes, or Florida Courts decide in the area.
- As Health care providers, you will inevitably have patients who have been in car accidents and are covered under the Florida mandated minimum of Personal Injury Protection (“PIP”) insurance. As a result, you will be billing the PIP insurances for the dates of service and must ensure you are going through the correct billing process under Florida law. You will need to bill the PIP insurer within a certain timeframe, and then evaluate how they decide to reimburse you. After you have sent the bill to the insurer, it is likely that the payment you receive will be less than what you billed, and may even be less than what is required under the policy or by statute. At this point, to recover the total amount of money rightfully owed to you, you will need to hire a PIP attorney to send a pre-suit Demand Letter.
THE DEMAND LETTER
What is a Demand Letter in the context of PIP law? It is a formal letter which provides notice of intent to initiate litigation against the insurance for paying you less than what was due in benefits. The Demand Letter may not be sent to the insurer until the claim is overdue, meaning the insurance has had the opportunity to review the bills, and decided to pay less than what was owed, or deny the claim all together. Attorney Steve Thompson and Attorney Stephanie Taylor can advise you on the correct timing of a PIP Demand Letter, and handle the entire process altogether from A to Z.
WHAT IS REQUIRED IN THE DEMAND LETTER?
Under Florida Statute 627.736 (10), the demand must state that it is a “demand letter under Florida Statute 627.736,” and specifically include the following:
- The Name of the person who the patient is insured under
- If they are uninsured because they do not own an operable motor vehicle, then the Name of a relative who is insured and lives in the same residence, or the owner of the vehicle which they were operating, or the owner of the vehicle in which they were a passenger, or the person who they were struck by (if they were not operating a “self-propelled” vehicle).
- A copy of the assignment of benefits which gives rights to claim the insurance benefits
- The claim number or policy number which the bills were originally submitted under
- The name of the medical provider who rendered treatment, services, accommodations, or supplies that are the basis for the claim of reimbursement
- An itemized statement of the charges, including the dates of treatment and the amount of each treatment, service, accommodation, and the type of benefit claimed to be due
- Typically, this is simply the provider’s billing ledger which includes the dates of service, Current Procedural Terminology (“CPT”) codes billed for each date, and the amount the provider is claiming for each CPT code
- Other forms which satisfy the itemized statement of charges requirement are properly completed Centers for Medicare and Medicaid Services (CMS) 1500 form, UB 92 forms, or any other approved standard form
The above must be included for the Demand Letter to be proper and satisfy the requirements of Florida State 627.736 (10). Otherwise, the insurances may try to deny the claim for underpayment of bills. It is best do hire a Florida PIP Attorney to prepare the Pre-Suit PIP Demands for you. Thompson Legal, P.A. will prepare PIP Demands for you at no out of pocket cost, and only gets paid if we are successful in obtaining benefits for you!
- The Name of the person who the patient is insured under
MAILING THE DEMAND LETTER
The Demand Letter itself, along with all of the attachments listed above, must be delivered by United States certified or registered mail. A request for reimbursement of the costs for postal service is also included, which the insurance will reimburse when they pay the claim pursuant to the Demand Letter.
The Demand Letter must be sent to the person and address specified by the insurer for the purposes of receiving PIP claims, which is registered with the Florida Office of Insurance Regulation, whether the insurer domestic or foreign to the State of Florida.
WHAT HAPPENS NEXT?
The Insurance has 30 days after receipt of the Demand Letter to pay the overdue claim, including interest and a penalty of 10 percent of the overdue amount (subject to a maximum of $250.00). If the insurer fails to pay, then a lawsuit may be filed seeking the claims due. That’s it. When you have sent bills to an insurer seeking reimbursement for treatment of an individual covered under their policy, the insurer has to pay. If the insurance fails to reimburse, you can send the Demand Letter seeking proper reimbursement.
If you need any help along the way contact the attorneys at Thompson Legal, P.A. to handle the matter for you and to ensure you are getting the full reimbursement owed to you under Florida law.
HOW MUCH DOES IT COST TO HIRE A PIP ATTORNEY?
The great news is that the under Florida Statute 627.736, the prevailing party collects attorney’s fees from the losing party. What that means is that it does not cost you any money out of pocket to hire a PIP attorney to collect benefits owed to you. Whether Thompson Legal is successful through a verdict, or through settlement, the insurance company pays your attorney fees!