Handling PIP claims for healthcare providers is a passion here at the LaBovick Law Group. We force insurance companies to disclose every single iteration of their insurance policies and we read them! Knowing the language of the policy is the reason why we caught State Farm’s 2012 policy gaff and held their feet to the fire!
The Gaff
From 2012-to the present, State Farm reimbursed providers at 80% of 200% of the Medicare Fee Schedule for most medical services rendered even though their policy was vague as to what fee schedule they would pay. In other words, State Farm gave themselves leeway on how to pay claims. This is simply not permitted. But trying to figure out if language is “vague” is like trying to figure out which television at Best Buy looks better. They all look great on the wall until you really start checking them for fine differences on different stations.
The Action
We attacked State Farm’s Personal Injury Protection insurance policy as to vagueness. Simple but not an easy thing to prove.
The Battle
The judge heard the case on June 30, 2016.
Our argument explained that State Farm, for the past four years, was IMPERMISSIBLY SHORTING all Medical Providers across the State of Florida! This was an inclusive argument, in that we argued that ALL medical professionals in Florida, not just our provider, deserved a larger reimbursement due to State Farm’s failure to choose how they will pay for medical services. We argued State Farm’s policy is confusing and fails to elect any method to the exclusion of the other
State Farm expertly explained that they properly elected to pay all Florida providers pursuant to the Medicare Fee Schedule. They made some interesting analyses on what they intended to say. They actually believe they are permitted to vaguely state their intent because the Office of Insurance Regulation provided them a “Stamp” which says their policy meets the “readability requirements”; aka, Floridians can read the policy!
The Judge was complimentary to both sides but took it under advisement. We walked away on pins and needles to wait for his verdict.
The Verdict
GREAT NEWS! One month later, on July 30th we received a favorable Verdict! The Judge agreed with our argument and executed an Order in our client’s favor.
The FACTS today
FACT 1 – From 2012-to the present, State Farm reimbursed providers at 80% of 200% of the Medicare Fee Schedule for most of the medical services rendered.
FACT 2 – STATE FARM did so even though their policy was vague as to what they would pay you.
FACT 3 – STATE FARM had 2 Choices:
- Pay 80% of your charges
- Pay 80% of the schedule of maximum charges (Medicare Fee Schedule Methodology)
State Farm had to choose one to the exclusion of the other.
State Farm could not pick BOTH and pay at each way on their whim.
FACT 4 – STATE FARM’s new policy fails to give ANY Notice to Medical Providers as to what it will pay.
The Order’s Effects
This important decision strikes down the fee schedule language and should help providers receive better reimbursement rates.
State Farm will be forced to pay 80% of your reasonable charge.
You will not be bound to the Medicare fee schedule for State Farm PIP claims between 2012 and today.
State Farm can no longer reimburse at whatever schedule they feel like. They have been paying at their leisure since 2012.
This history of the improper payment goes back 4 YEARS! It is important to get us your State Farm PIP files now! Don’t wait. The Statute of Limitations will start to run in the next 12 months on many of these claims. We cannot force an insurer to change its ways without your active participation.
The Battle Continues
State Farm will appeal the decision. We will fight it at the appellate level. This is an important decision and will likely go to the 4th District Court of Appeals.
Don’t wait for that appeal to happen. You can move now. The law is on your side! It is important to have your PIP claims filed now, not later.
CONCLUSION
It is essential for practitioners to have a PIP litigation attorney look over every single PIP claim submitted for reimbursement. Every single one must behave a legally proper Demand letter submitted. Yes, every single claim! You have no idea how much money we pick up for providers in the Demand process which the doctor did not believe existed! Our system is designed to do that seamlessly and effortlessly once we set it up with your office.
Our firm, the LaBovick Law Group has proven, time and time again, to spearhead the attack on insurance companies who mislead medical providers and act against their obligations on the PIP policy and the law. We will not back down from a fight, even against a giant insurer like State Farm.
This message is for Medical Providers and for Personal Injury Attorneys: Give us a call. Let us prove our value! Let us maximize PIP reimbursements for medical services rendered to patients injured in Motor Vehicle Accidents. We work with doctors, PI lawyers, hospitals, urgent care centers, physical therapy clinics, durable medical goods companies, ER services, and many other specialties. We are available 24/7/365 for a call. (561) 623-3681. Once we make contact I will provide you with my personal cell number so you always have access to a PIP attorney for questions on the fly!
