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PIP Claim Denied – What Now?


When you are in an auto accident in the state of Florida, your medical bills are supposed to be paid by your Personal Injury Protection (PIP) insurance. Sometimes, however, your insurance company or the Centers for Medicare & Medicaid Services (CMS) may find ways to deny your claim, out of either a good-faith or bad-faith reason. If this has happened to you, it may be a good idea to speak to a personal injury attorney – sometimes, insurance companies want patients to grow frustrated and pay bills themselves, when they still have a job to do. An attorney may be able to help get you the coverage you are entitled to.

Florida PIP Insurance Requirements

Florida is a no-fault state for purposes of auto insurance, though there is a provision in the law that allows drivers to sue each other if the injury caused a serious injury, or loss of a limb or an “important bodily function.” Each Florida driver is required to carry at least $10,000 in personal injury protection insurance, as well as $10,000 of property damage liability insurance (PDL), though many also carry bodily injury liability (BIL) insurance as well. The policy travels with the driver, so to speak; while it will cover injuries sustained in your own vehicle, it will also cover your medical bills if you are a passenger in another person’s car and are injured in a wreck.

It is also a fact that many drivers either do not understand the requirements (especially if they are new to the Sunshine State) or cannot afford that much insurance, but drive anyway. If you are in an accident with an underinsured or uninsured motorist, you may be forced to make a claim on your own PIP insurance to cover your bills. Uninsured or underinsured motorist coverage is recommended in Florida, but it is not required, so many drivers go without. Either way, there are multiple reasons why you might make a claim on your own PIP coverage, only some of which involve you being at the wheel.

How To Force The Issue?

If you believe you have a valid claim, but your insurance company or CMS is disputing that, it is generally a good idea to get an attorney involved, simply because PIP-related claims are notoriously complex. For a private insurance company, sometimes a simple demand letter will solve the problem – even insurance companies misplace documents and make errors. Other times, there may be a pretextual reason for denying the claim, or there may be an actual problem (for example, if your coverage has lapsed or a document is missing from the file).

Be advised that dealing with CMS in particular can be extremely confusing and time-consuming. CMS is the center where Medicare and Medicaid claims are processed, and if you receive either of these, you must submit any claim for medical bills to CMS for payment. Once received, Medicare will assess which bills they will pay without reimbursement being required, and which will be temporarily paid until a judgment is received or another insurance company can pay the amount back to Medicare (a provision called Medicare Secondary Payer). However, there are very specific rules about how a claim will be paid and what must be repaid – it is definitely not recommended to try and navigate this process on one’s own.

Call A Personal Injury Attorney To Help

When you have been in an automobile accident, most of the time, the only thing you want to do is heal and be with your loved ones. Being forced to navigate paperwork and debate can actively slow down your recovery time. The Tampa auto accident lawyers at the Rinaldo Law Group handle PIP claims and issues every day, and we are happy to try and put our experience to work in dealing with yours. Contact our office today at 813-831-9999 for a free consultation.



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