If you have been in an accident and file a PIP claim (personal injury protection) in the state of Florida, your insurer is obliged to pay certain amounts based on your contract, or declarations sheet — regardless of who is responsible for the event.
Unfortunately, many Florida policyholders have had their PIP claims denied, or may be hesitating to file because they fear their company will raise their rates. In either case, if you have suffered an injury in an accident and you have paid your premiums conscientiously, you are entitled to receive money to cover your medical bills.
How Much Can I Receive From a PIP Claim?
If your injuries are the result of a motor vehicle accident, Florida state’s “no-fault” insurance law specifies the following minimum payouts:
- Emergency medical treatment (i.e., life-threatening injuries) — $10,000
- Non-emergency medical treatment (illnesses or injuries related to a motor vehicle not requiring immediate attention)– $2,500
- Other “reasonable” medical bills (for x-rays, therapy, rehabilitation, ambulance transport, etc.) — 80 percent
It is important to have all documentation from the hospital, treating physician and others involved in your care. Often, insurers will deny a claim even if the insured has these documents, so they’re always handy to have in the event you have to fight for your claim. It also bears mentioning that PIP covers claims for “reasonable” medical bills only if you were treated within 14 days of your injury.
How Do Insurers Get Away with Denying a PIP Claim?
There are several methods that insurance companies use in order to deny legitimate claims — and in many cases, it is totally beyond the control of the policy holder. This often happens when the medical care provider bills the insurer directly. An insurer may claim they never received a bill, alter billing codes associated with the treatment in question, pay the wrong provider, misapply the deductible, or tell the one filing the claim that a “reasonably amount” had already been paid. They may also claim that the “Assignment of Benefits” (AOB, the arrangement by which a third party bills an insurer for services) was invalid.
Another excuse that insurance companies may use in order to deny a valid PIP claim is to state that the insured failed to attend what is known as an “Examination Under Oath,” or EUO. This is a procedure during which an insurance company representative questions the claimant under oath, in the presence of a court reporter. However, simply failing to show up for an EUO is not a legitimate reason for denying a claim.
What to do if Your PIP Claim is Denied
If your claim is denied, the first action you can take is to file a demand for an internal review. This will give you an opportunity to find out if you made any errors in filling out forms and make any necessary corrections. You can also file an appeal, in which case your claim will be reviewed by different person.
Experienced lawyers can determine if your claim for PIP benefits should have been approved. Having an experienced attorney may make navigating the insurance claims process easier, and increase the likelihood of receiving the maximum compensation you deserve.
