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Florida PIP Law - Filing a Legitimate Claim and Avoiding Scams

September 25, 2013 Posted By Vanguard Attorneys

In Florida, PIP coverage pays out claims of up to $10,000 in medical expenses and lost wages for each person in a vehicle injured in an accident. Regardless of fault, motorists are required to access the first $10,000 in accident-related costs from their own insurance benefits. Recent reform to PIP law has heightened claim requirements in an effort to curb rampant fraud throughout the state. However, injured motorists will still have access to benefits and care if they follow the appropriate protocol.

Here, we’ll discuss a few tips motorist should follow to ensure their access to benefits when they need them while avoiding the potential pitfalls of scams and other questionable organizations who aim to exploit PIP payout benefits.

Tips for Filing a PIP Claim and Avoiding Problems

Get the Long-Form Accident Report: If you’re involved in an accident, call the police immediately. If you suspect you may need medical treatment or evaluation, inform the police and request a copy of the “long-form” accident report. It is ok to let the police know that you plan to explore your PIP benefits and also plan to comply with the new law. The police should be able to tell you how you can obtain a copy of the long-form accident report to provide to your insurance company.

Follow Protocol: Florida statute 627.736 states that anyone injured in an auto accident is subject to the following:

  • Medically necessary emergency treatment: Accident victims must receive medical care within 14 days of the accident. Hospital admissions and surgeries needed to treat injuries will be covered by the $10,000 limit, provided the treating physician provides documentation. Most true emergencies should require treatment on the same day of the accident
  • $2,500 benefit limit for non-emergency medical diagnoses: If medical treatment is needed, but isn’t necessary to prevent serious injury or death, benefits are capped at $2,500.
  • 60-90 day Payout Period: Insurers are now allotted 60 to 90 days to better investigate suspicious claims. Submitting paperwork and proof of medical treatment should satisfy this requirement for injured motorists.
  • Insurer Requested Second-Opinion: In most cases, legitimate injuries and documented treatment plans should suffice.
  • Exclusion of massage therapy and acupuncture: The new law also excludes PIP payment for supplemental treatments, but a recent injunction has temporarily blocked this provision. For the time being, injured motorists are better off seeking treatment with a licensed physician or licensed chiropractor to ensure adequate access to benefits. If the injunction is lifted, massage and acupuncture therapies may again be excluded.

Be Wary of Referral Services: As a consumer, your best route may be to conduct your own research regarding lawyers and injury treatment. Local lawyer-referral services have come under harsh criticism following large-scale allegations of fraud and unethical practices. 1-800-ASK-GARY and 411-Pain have been publicly criticized for allegedly forcing accident-injury victims to meet with lawyers at pain clinics, placing priority on reaping PIP coverage benefits over actual medical diagnosis and appropriate patient care. Instead, ask a friend or loved one to recommend or lawyer or reputable chiropractor. If your injury is severe, go right to the emergency room and follow the hospital’s instructions for treatment.

If you decide to consult a lawyer-referral service, do not tolerate any high-pressure tactics. Ask for three options for lawyers and medical clinics and tell them you plan to also compare the choices. Any legitimate service should not object to your decision or attempt to dissuade you from making comparisons.

Ignore Unsolicited Offers – If you are solicited by a medical practitioner or other similar service after an accident, and you did not request information from them, they may be fraudsters attempting to take advantage of your injury and access to PIP benefits. It is important to only pursue treatment options with which you have initiated contact. Doing so will help to ensure you aren’t taken advantage of by PIP fraudsters.

References:

Online Sunshine (Legislature)

Florida PIP Fraud News

The Insurance Journal

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