2 Reasons PIP Insurance May Deny Your Claim
Personal injury protection (PIP) insurance is supposed to cover medical and funeral expenses incurred as a result of being involved in an auto accident, regardless of who's at fault for the collision. Unfortunately, providers will find no reason to deny claims just to save a few dollars. Here are two common reasons why your insurer may deny your PIP claim and what you can do about it.
You Missed the Deadline
It's common for insurance providers to set time limits for taking certain actions, such as submitting claims, to ensure the process concludes in a timely manner. Sometimes, though, these deadlines are unreasonably short. For instance, Florida requires claimants to seek medical treatment for injuries sustained in auto accidents within 14 days of the incident to qualify for payment through PIP.
Unfortunately, if you miss the deadline, your claim won't be accepted and, even worse, PIP doesn't offer any exceptions or exemptions. However, you can get the responsible party to pay for your expenses by suing them directly. Depending on the laws in your state, this can get a little tricky, so it's best to work with a personal injury attorney to maximize your chances of successfully getting paid.
Your Condition or Care Doesn't Meet the Requirements
Another reason for a claim denial is either your medical condition or the care you received (or both) do not meet the minimum requirements for approval. For instance, some policies are written so that they only cover emergency medical conditions, which are defined as acute conditions that cause serious problems to the patient's health and require immediate treatment.
If your condition doesn't meet the standards set by the insurance company, they'll deny your claim. Likewise, if the medical care you receive doesn't match what's described in the policy, then the company won't pay for the treatment.
The problem is that these definitions sometimes leave too much room for interpretation, which leads to a situation where the insurance adjuster and the healthcare provider can't agree on whether a condition or treatment is covered. Since the insurance company is the one footing the bill, then the opinion of the adjuster will take precedence.
You can mitigate this issue by getting second and maybe even third opinions and submitting them to the insurance provider. If all the medical professionals you meet with say the same thing, then the company may be forced to reevaluate and approve your claim.
Regardless of how you choose to proceed, it's essential you hire an attorney to represent you. The lawyer can make sure the insurance company treats you fairly and provide suggestions on how to overcome any challenges the provider puts in the way of you getting paid.
For more information about this issue or help with your auto accident lawsuit, contact a local personal injury lawyer.