Insurance carriers may be reducing, underpaying, or even outright denying valid PIP insurance claims. If you are a healthcare provider and you treat patients who have Florida PIP benefits, you may have been affected by these kinds of tactics from giant insurance companies, and you may actually be owed money.

What is PIP Insurance?

Personal injury protection insurance, or PIP insurance, is a type of auto insurance that is both mandatory in the state and no-fault—that is, under Florida auto insurance policies, it allows individuals to pay medical bills from a car accident injury up to $10,000 without even needing to prove fault. The Florida PIP statute was enacted nearly 50 years ago, back in 1971, as part of its no-fault auto insurance system.

Florida PIP benefits can be complicated, and it is also constantly changing, so large insurance carriers can sometimes use the complicated nature of this insurance to underpay policyholders and healthcare providers alike. Insurers may be underpaying or incorrectly paying insurance claims, or they might completely refuse payment, but may not have a valid reason to do so.

What are Reasons Florida PIP Benefits Might be Underpaid?

Insurance companies may use a variety of methods to underpay PIP insurance. For instance, an insurer might apply the deductible after reducing the bill, rather than before, which leads to a discrepancy in payment.

In 2013, Florida PIP benefits were updated to change Medicare coding policies, and insurers might be reducing bills incorrectly based on outdated policies.

Some insurers may attempt to take advantage of the Medicare fee schedule or other fee schedules without notifying the insured, resulting in unfairly limited reimbursements.

Insurance companies may claim that the bill was never received, or that they have already paid a “reasonable amount,” or even alter the code that identifies the procedure/service performed.

In some cases, if a claimant failed to show up to an examination under oath (EUO), an insurer may try to argue that this is a reason to deny or reduce a claim. However, the Claims Journal notes that not showing up for an EUO is not enough for a claim to be reduced or denied.

What Companies Are Denying PIP Claims?

A number of large insurance companies operating in Florida may be denying or underpaying claims, including:

• United Services Auto Association
• Southern-Owners Insurance Company
• Infinity
• Florida Farm Bureau
• Metropolitan Casualty Insurance Company
• Geico
• Progressive
• Windhaven

Can I File a Lawsuit Over PIP Insurance Claim Denial?

If you are a healthcare provider or a policyholder of PIP insurance and believe you may have been affected by valid PIP insurance claims that were wrongfully denied or underpaid, you may be able to join this class action lawsuit investigation.

Filing a lawsuit can be a daunting prospect, especially while dealing with complex insurance issues, so Top Class Actions has laid the groundwork for you by connecting you with an experienced attorney. Consulting an attorney experienced with PIP insurance issues can help you determine if you have a claim, navigate the complexities of litigation, and maximize your potential compensation.

This article is not legal advice. It is presented
for informational purposes only.