Dirty Little Insurance Secrets that You Won’t Learn from a Talking Lizard.

If you are ever the victim of someone else’s negligence, there are a few hidden surprises waiting for you from your friendly neighborhood insurance company. Let’s use an automobile collision as an example.

Personal Injury Protection (PIP) Benefits

Regardless of who was at fault, your own auto insurance Personal Injury Protection (PIP) benefits are the primary source to pay on your medical bills – and this is the first unpleasant surprise. Most people have $10,000 in PIP benefits, but you can only benefit from all of your own benefits if (a) you begin treatments or medical evaluations within 14 days and (b) if an authorized medical professional (chiropractors & massage therapists do not count) says that you have an emergency medical condition.

Say you started treatment and the doctors bill your policy – they won’t just pay the bills as they come in. Instead, PIP insurers are permitted to only pay 80% of twice the amount that Medicare would pay for each particular treatment you receive, regardless of what the services rendered actually cost – so there will always be an amount left over. Additionally, they won’t even start paying until enough bills have come through that your deductible (usually $1,000) has been met.

Since you are under contract with your own insurer, you will have to submit to their “Independent” Medical Exam (IME), if they request it. By “request”, it means that they will unilaterally set the appointment and demand that you go. This is an examination by a doctor who regularly does IME’s for money and who, logically, wants to keep the insurers happy and sending more IME’s their way. It is a small surprise, then, how their diagnosis tend to come out. Your PIP carrier will use the examiner’s opinion to cut off your benefits.

Your PIP carrier might also summon you to an Examination Under Oath (EUO). This is like a deposition, where you are grilled about your case and your medical treatments, however, the Civil Procedure & Evidence rules do not apply, so they can be very invasive. Again, the point of an EUO is to justify cutting off your benefits and saving themselves money (to buy more time for TV ads?).

Stay tuned for information about Bodily Injury and Uninsured Motorist insurance.

Dennis Phillips, Esq. is an attorney with Coffey McPharlin, with offices in Ft. Lauderdale and Plantation. ​

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