What Are Judges Doing About State Farm’s Unlawful PIP Policy?

 In PIP Claims & Collections

New PIP Statute, New State Farm Shenanigans

Back to 2012-2013. The PIP law is now amended. State Farm changed their policy to include fee schedule language. The language they thought would allow them to reduce medical provider’s charges to Medicare fee schedule and workers compensation fee schedule reimbursements. It was not until recently our Honorable Judges caught on that State Farm was once again perpetrating a fraud.  Once again, State Farm’s policy is in limbo as it should be!

What happened when the PIP law changed? 

The PIP law WAS amended in parts of 2012 and 2013. The fee schedules were included into the new PIP amendments. Amendments allow the  insurer to pay via the fee schedules as  long as the language is included in their policy.

There are two methods an insurer may choose; However, The insurer is only entitled to choose one of the following:

  1. Reasonableness Method-An insurer must decide the reasonable charge to pay to the medical provider  by considering a slew of factors such as:
    1. Provider’s usual and customary charge
    2. Reimbursement levels in the community
    3. Federal/state medical fee schedules
  2. Fee Schedule Method- Insurer must include language stating they will pay pursuant to the fee schedules. Example: We will limit reimbursement to 80% of: Medicare fee schedules.

Unlawful and confusing State Farm policy!

State Farm unlawfully amended their policy. Why was it unlawful? The policy includes both methods. Yes, State Farm included BOTH methods. An insurer must choose one method.  State Farm says they will pay pursuant to a reasonable amount. They likewise mention paying pursuant to the fee schedules.

STATE FARM CANNOT DO THIS.

State Farm is obligated by the Florida PIP Law to choose one of the above methods. State Farm cannot unilaterally include both in their policy.  Is that not confusing? How can you expect to know if you’ve been paid correctly? It’s next to impossible. How can a provider expect to know if they’re being paid correctly? The insured likewise has no idea if the doctor is getting paid correctly. This creates ambiguity and confusion. It’s another attempt by State Farm to pull a fast one on THE INSURED, MEDICAL PROVIDER AND THE COURT.

Plantiff attorneys are fighting back! Fortunately, at least 2 courts: Miami Dade County and Duval County have ruled against State Farm regarding their confusing and unlawful policies. These two Honorable Courts agreed the policy is vague, ambiguous, and provides no clarity as to which method is being chosen. We are currently awaiting guidance from Broward Courts and from a District Court if these cases are eventually appealed.

However, these cases are monumental in a few respects:

  1. Showing State Farm they cannot get away with their unlawful policies.
  2. Showing insurers we will fight the good fight.
  3. Setting precedent for fellow providers/insureds.
  4. Preventing other insurers from utilizing the same ambiguous and confusing language in their policies.
  5. Detracting State Farm from challenging medical providers billing.

State Farms’s old policues are just as egregious!

State Farm’s pre 2012 policies were just as unlawful. State Farm “alleged” they chose the reasonableness method. Their policy likewise contained the reasonableness method language. State Farm was mandated to look at various factors to decide what to pay you, the medical provider. But, they lied to the insureds. State Farm considered only one source per suit.

Whether it was Medicare fee schedule, workers compensation fee schedule, etc., State Farm solely chose one reimbursement without any other factors.  I have taken numerous depositions of claims adjusters from State Farm.  I can tell you first hand, the adjusters admit to solely considering 1 fee schedule in paying your bills.

THE IMPORTANCE OF FIGHTING THESE STATE FARM POLICIES

****AN INSURER MUST CHOOSE ONE OF THE 2 METHODS. THE POLICY MUST BE CLEAR AS TO WHICH REIMBURSEMENT IS CHOSEN. FAILURE TO BE CLEAR WILL RESULT IN YOU, THE PROVIDER, BEING REIMBURSED 80% OF YOUR TOTAL CHARGES******

You are most likely owed thousands of dollars in improper reimbursements! We can help you recoup.

 

Send your PIP to LaBovick, LaBovick & Diaz

LaBovick LaBovick & Diaz is always out in front of the newest issues.  We have been challenging State Farm’s policies for years.   I have crafted specific discovery tailored around State Farm’s new and old policies. How can an insurer say one thing and do another?

An insurance contract is an essential document. An insurance contact contains all of the aspects of your agreement with that insurer. Imagine agreeing on a price to buy a house, signing a contract, and then being charged double. Essentially, State Farm is alleging it is paying you one way, and behind closed doors, the insurer is solely considering one factor and paying you another way.

We are ready to fight the battle with State Farm and the other insurers improperly reimbursing your bills . We ensure you spend the least amount of time dealing with the actual litigation issues.  Our goal is to get you reimbursement as soon as possible. We are not the firm to stretch out a case to garner more fees.

Fight State Farm and other insurers!

If you refuse to file PIP suits and file PIP claims, the insurers will win.  Insurance Companies strive to create headaches for everyone involved in the process; insureds, providers, etc. These large corporations hope you submit your bills and accept whatever you receive. However, these two cases prove that the judicial system and our PIP litigation services truly make a difference regarding your bottom line. Call us immediately to schedule a Free PIP AUDIT!

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