Personal Injury Protection and Medical Claims Coverage Lawyer | David Lee Sellers, Pensacola Florida

Personal Injury Protection Coverage or PIP is insurance coverage which is required for all motorists owning motor vehicles in Florida. The law is also very specific on when the claims for reimbursement are to be paid. The law states that the bill for reimbursement is to be paid within 30 days of submission and that a ten percent interest penalty accrues on delinquent bills. This is very important for you to keep in mind whether you are the accident victim who has submitted the bills or you are the provider of medical services to the person injured in a vehicular accident.

The following is a summary of the benefits payable in PIP coverage:

MEDICAL EXPENSES are covered at 80% of reasonable charges incurred for necessary treatment of accident related injuries. This includes medical, surgical, x-ray, dental, ambulance, hospital, professional nursing, rehabilitative services, prescriptions, eye glasses, hearing aids, prosthetic devices, and remedial religious treatment or services by a recognized method of healing.

TRANSPORTATION COSTS are reimbursed at 80% of the transportation costs incurred to obtain medical treatment and/or prescriptions, therapy, etc. Reimbursement will be on a "per mile" rate. You must submit an itemized list of dates , mileage and destination in order for your claim to be considered. We will provide you with these forms upon request.

INCOME LOSS is reimbursed at 60% of loss of income and/or earning capacity due to injuries sustained in the accident. The inability or limitation to work must be verified in writing by your physician. This provision may apply even if you were "in between" jobs at the time of your accident.

REPLACEMENT SERVICES LOSS is reimbursed for reasonable expenses incurred for ordinary and necessary services you would have performed except for the injury, for the benefit of your household, during the time you are unable to work. These services can include maid services, lawn care, etc.

DEATH BENEFITS are reimbursed at $5, 000.00 per person. The maximum amount payable under PIP coverage is $10,000 unless your policy affords a greater amount.

PIP coverage is also of particular importance if you are the service provider of medical or other covered services, to someone who has been injured in a vehicular accident. Insurance companies often significantly delay the payment of the submitted bills or tie up payment by requesting utilization reviews, independent examinations or other documentation which is oftentimes unnecessary. Whether you are the insured or the service provider to the insured, it can be very frustrating and time consuming to deal with these companies to recoup what is rightfully due you.

That is why our firm devotes a considerable amount of time and education, as well as a division of our firm's staff to focus specifically on recovering timely and complete payment of bills and/or wages. If you need any further information or clarification on PIP coverage and benefits that are payable, or the law which governs this area, please do not hesitate to ask us.

We also frequently give in-service presentations to various medical offices and organizations about how to best handle PIP claims and the law surrounding the coverage.

Medical Payments Coverage (MPC)

MPC is an optional coverage. If you purchased this coverage MPC will pay:

  • MEDICAL EXPENSES which are reasonable and necessary medical treatments of injuries sustained in the accident. (See the PIP summary above for types of covered expenses). Until your PIP coverage is exhausted, (unless instructed differently) MPC will pay 20% of your medical expenses, and transportation costs. Once PIP coverage is exhausted, MPC will pay 100% or reasonable, necessary accident related medical expenses, etc., up to the limit you purchased.
  • FUNERAL EXPENSES are covered by MPC up to $3,000.00 for an accident related death.
  • In the event you were a passenger in a vehicle driven or insured by someone other than a resident family member, this other person's medical payments coverage may pay for some of your bills without regard to who caused the accident.
  • The maximum amount payable under MPC depends on the coverage you have selected, usually the amounts of $2,000.00, $5,000.00 or $10,000.00.

As with the PIP summary, should you need clarification or additional information, please do not hesitate to ask us.

Collection of Personal Injury Protection (PIP) Claims

Anyone injured or incurring any medical bills resulting from any type of accident involving a motor vehicle is entitled to have a significant portion of his/her medical bills and lost wages paid by PIP (personal injury protection) insurance.

If you are a provider of medical services, there are times when you are called upon to treat someone who has been injured in a motor vehicle accident, who is covered by PIP insurance. You in turn submit a bill for your services to the insurance company for payment. As a business owner, you recognize that it is your right to be paid for services rendered in a timely and complete fashion. We pursue these claims daily for a wide variety of medical care providers in Northwest Florida at no cost to the provider or the patient, whether or not we represent the individual on the underlying claim.

Or, you may be a person who carries PIP insurance and is trying to collect for medical expenses, transportation costs, income loss, death benefits or other replacement services loss. It is only natural that when you or your medical care provider submit(s) your documented claims, you expect to be reimbursed. There are times, however, when insurance companies significantly delay or deny payment of these obligations.

Whether you are the insured or the service provider to the insured, it can be very time consuming and frustrating to deal with these companies to recoup what is rightfully due you. Our firm is very experienced in handling these matters; we devote a considerable amount of our time, as well as a division of our firm focusing specifically on recovering timely and complete payment of bills and/or wages.

If you live in Escambia, Santa Rosa, or Okaloosa counties including Gulf Breeze, Ft. Walton, Navarre, and Destin and need representation from a Personal Injury Protection Coverage or Medical Payments Coverage attorney, contact David Lee Sellers. He has the experience in Personal Injury Protection claims to ensure that you receive just representation and compensation.

 

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David Lee Sellers and his staff specialize in personal injury protection and medical payments coverage laws and claims.