What is a PIP suit?

“PIP” suits are governed under Florida statute 627.736 with a statute of limitations of 5 years. “PIP” stands for personal injury protection and in “no-fault states” like Florida; it is required insurance coverage through your personal auto insurance company.

The basic principle behind no-fault law is that in exchange for limiting the right to sue the at-fault party for pain and suffering in cases of “relatively minor” accidents (generally, those not permanent and in excess of the $10,000 P.I.P. threshold), the injured claimant is assured a speedy and virtually automatic payment of his medical bills and lost income by his own insurer.

When you are involved in a car accident, PIP pays 80% of your medical expenses, lost wages and other incidentals up to the required $10,000.00. With respect to a determination of whether a charge for a particular service, treatment, or otherwise is reasonable, consideration may be given to evidence of usual and customary charges and payments accepted by the provider involved in the dispute, and reimbursement levels in the community and various federal and state medical fee schedules applicable to automobile and other insurance coverage, and other information relevant to the reasonableness of the reimbursement for the service, treatment or supply.

Why do you need to sue in PIP cases?

Claims range from a few hundred dollars to as much as several thousand dollars. The legislature allows medical providers a cause of action in this case under FL. STAT 627.736. In a situation as described, a medical provider may retain the services of competent legal counsel to handle the matter and collect what is due and owing. In many cases, medical providers are not aware that they may seek action against these insurance companies. It is common for these medical providers to have hundreds of bills that were either partially paid by the insurance companies or not paid at all. Essentially, this adds up to thousands of dollars sitting unpaid within their files.

What you need to do to get payment?

F.S. § 627.736(5)(c) generally requires medical services providers to submit their bills directly to the P.I.P. insurer within 35 days of the service date. The constitutionality of this provision has been upheld by the Supreme Court of Florida.  If the provider fails to comply with billing time limits, neither the insurer nor the patient is responsible for payment of the late-billed charge.

The statute provides:
(c) With respect to any treatment or service, other than medical services billed by a hospital or other provider for emergency services and care as defined in s. 395.002or inpatient services rendered at a hospital-owned facility, the statement of charges must be furnished to the insurer by the provider and may not include, and the insurer is not required to pay, charges for treatment or services rendered more than 35 days before the postmark date or electronic transmission date of the statement, except for past due amounts previously billed on a timely basis under this paragraph, and except that, if the provider submits to the insurer a notice of initiation of treatment within 21 days after its first examination or treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 75 days before the postmark date of the statement. The injured party is not liable for, and the provider may not bill the injured party for, charges that are unpaid because of the provider’s failure to comply with this paragraph. Any agreement requiring the injured person or insured to pay for such charges is unenforceable.
1. If the insured fails to furnish the provider with the correct name and address of the insured’s personal injury protection insurer, the provider has 35 days from the date the provider obtains the correct information to furnish the insurer with a statement of the charges. The insurer is not required to pay for such charges unless the provider includes with the statement documentary evidence that was provided by the insured during the 35-day period demonstrating that the provider reasonably relied on erroneous information from the insured and either:
a. A denial letter from the incorrect insurer; or
b. Proof of mailing, which may include an affidavit under penalty of perjury, reflecting timely mailing to the incorrect address or insurer.
2. For emergency services and care rendered in a hospital emergency department or for transport and treatment rendered by an ambulance provider licensed pursuant to part III of chapter 401, the provider is not required to furnish the statement of charges within the time periods established by this paragraph, and the insurer is not considered to have been furnished with notice of the amount of covered loss for purposes of paragraph (4)(b) until it receives a statement complying with paragraph (d), or copy thereof, which specifically identifies the place of service to be a hospital emergency department or an ambulance in accordance with billing standards recognized by the federal Centers for Medicare, and Medicaid services.
3. Each notice of the insured’s rights under s. 627.7401 must include the following statement in at least 12-point type.
BILLING REQUIREMENTS.—Florida law provides that with respect to any treatment or services, other than certain hospital and emergency services, the statement of charges furnished to the insurer by the provider may not include, and the insurer and the injured party are not required to pay, charges for treatment or services rendered more than 35 days before the postmark date of the statement, except for past due amounts previously billed on a timely basis, and except that, if the provider submits to the insurer a notice of initiation of treatment within 21 days after its first examination or treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 75 days before the postmark date of the statement.

How we can help?

While the process is not as simple as one might think, with a law firm behind the claims like The Miami Law Firm, the process may be much more expedited. Since statute of limitations on these cases are 5 years, we can go back and demand that the insurance companies pay the bills that they were contracted to pay through PIP.   We do all the work and the insurance company pays your legal fees.  Our law firm makes sure that the insurance providers actually pay you.

While the process is not as simple as one might think, with a law firm behind the claims like The Miami Law Firm, the process may be much more expedited. Since statute of limitations on these cases are 5 years, we can go back and demand that the insurance companies pay the bills that they were contracted to pay through PIP.   We do all the work and the insurance company pays your legal fees.  Our law firm makes sure that the insurance providers actually pay you.

We will come to your office to discuss your records and how we can add you to an online private dashboard where you can see how your case is progressing and outcomes of our efforts. Better yet, we DON’T CHARGE YOU A PERCENTAGE FROM OUR LEGAL SERVICES.  At The Miami Law Firm, we only charge the insurance company bases on the legal fees provided under the Florida Statute.

The types of PIP cases The Miami Law Firm handles.
We represent medical providers such as Chiropractors, , Psychiatrists, specialists, and MRIs, Orthopedic Surgeons facilities throughout the State of Florida.

Contact us today at 786.454-2411.

Car accident attorney