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Insurance Disputes – Law Office of Arthur Liebling

Insurance Disputes:

Florida Personal Injury Protection (PIP) law provides that your own automobile insurance company is generally required to pay:

  • 80% of your medical bills up to $10,000.00, regardless of who was at fault in the crash;
  • 60% of your lost wages;
  • $5,000.00 in death benefits;
  • Household assistance when you must pay people to do certain chores you would normally do yourself but cannot perform due to the injuries sustained in the crash;
  • Reimbursement for mileage you incur in obtaining medical care, diagnostic tests, or picking up prescriptions related to the crash.

CAUTION: Florida law requires that an injured person receive medical treatment within 14 days of a motor vehicle accident to be eligible for PIP benefits.

Pedestrian/bicycle rider:

  • If you were injured by a motor vehicle while on foot or riding a bicycle, you would generally be covered by the PIP insurance:
    • on your car, or if you do not own a car,
    • on the car of a relative that you reside with, or if you do not reside with a relative,
    • on the motor vehicle that caused your injuries.

Compulsory medical examination:

If you claim an injury from a motor vehicle accident, your insurance company is permitted to require you to attend an examination with a physician they pay for.   The insurance company refers to this examination as an Independent Medical Examination (IME).   More accurately, this is a Compulsory Medical Examination (CME), since, pursuant to Florida law and your policy, attendance is not optional.   If you unreasonably fail to attend, your insurance  company can and will deny PIP benefits and refuse to pay your medical bills and lost wages.

Automobile insurance companies use third parties to arrange examinations of injured claimants.  These third parties notify the claimant by mail to attend the examination at a date and time set by the third party with the insurance company doctor.   The examination is usually conducted in the county where the insured lives or works.

The insured has the right to have a friend, relative, attorney or other person attend the examination with them. The insured also has the right to make an audio or video recording of the examination.   It is strongly recommended that the insured avail themselves of these rights.   Remember, the examiner is not your doctor.   He or she is paid by the insurance company through a third party and the insurance company will rely on the examiner’s report when making the decision to continue or discontinue your PIP benefits.

You should not fill out forms, sign papers or let the examiner or the examiner’s staff scan or photocopy your ID without speaking to an attorney first.

  • During the examination, tell the examiner all of your symptoms since the crash. Some symptoms do not occur every day. Be sure to tell the examiner about these also.
  • Do not perform any tests for the examiner that cause you pain. Be sure to tell the examiner why you are not performing the test.
  • An attorney from our office will always accompany our client and video-record an examination with the insurance company’s doctor.
  • We also make demand for reimbursement of our client’s mileage incurred in attending the exam as well as compensation for wage loss or giving up a personal or sick day to attend.

The Dispute arises when the insurance company decides to deny payment of your medical bills, wage loss, household expense, or death benefit. Automobile insurance companies have devised many clever ways to avoid paying claims. For example,

  • You lied: a favorite tactic with many insurance companies is to deny claims, refuse to pay PIP benefits, or cancel the policy based on a “material misrepresentation” in the policy application.   This means the insurance company is accusing the insured or the person filling out the application for insurance of lying on the application.
  • Your doctor is wrong: Another popular ploy for denial of benefits employed by automobile insurers is to accuse your doctor of providing treatment or services that are not reasonable, medically necessary, or related to the crash.

What can you do when your claim for pip benefits is denied?

Most attorneys in Florida do not handle PIP claims. For over 30 years, our firm has successfully pursued thousands of PIP claims against virtually every automobile insurance company in the state for failure to pay medical bills, wage loss, and mileage expense. We do not charge our clients a fee for this service.