Posted On: October 3, 2007, 10:59 am CDT

Posted By: JG

Wow Liz: Spoken like a true Adjuster or Insurance Defense Attorney. I would like, for once, if both sides of the issue were addressed instead of these one sided self centered versions.

1)Many of you with opinions on the subject need to actually read your policy so that you understand what it provides.
PIP was created with the hope of reducing litigation which clogged the court system with minor motor vehicle injury claims. The theory was that if the owner of every motor vehicle purchased PIP (which pays 80% of medical expenses and 60% of wage loss to a max of $10,000) this would satisfy the needs of the injured party and he/she would not file suit. An injured party must have a permanent significant injury in order to recover anything other than his medical/wage expenses. THIS IS ABSOLUTELY CORRECT.

2) Unfortunately what happens all too often, is that PIP pays the 10k on most claims (go figure-amazing how some injured parties need $10,000 worth of treatment and are still left with a permanent impairement) and there is still a lawsuit. LIZ: TELL THE PEOPLE HOW FAR THAT $10,000 GOES. IF YOU GO TO THE HOSPITAL E.R., THERE IS USUALLY NO PIP BENEFITS LEFT. AS A PROVIDER, I MAY HAVE TO ACCEPT THE CARE OF THIS PATIENT ON A LETTER OF PROTECTION. THAT MEANS I PAY FOR THEIR HEALTHCARE AND PROVIDE TREATMENT FOR THEM UNTIL A SETTLEMENT IS ATTAINED, WHICH CAN TAKE YEARS, WITHOUT CHARGING INTERESET AND ALMOST ALWAYS TAKING A FEE CUT ON THE PATIENT'S BALANCE. IF THE PATIENT DOES NOT GO TO THE HOSPITAL AND COMES TO MY CLINIC FIRST, THEN THEY ARE EVALUATED AND TREATMENT IS GIVEN FOR THEIR INJURIES. DIAGNOSTIC TESTING (OUTSOURCED) IS ORDERED AND BASED UPON THE RESULTS OF THE DIAGNOSTIC TESTING, THE PATIENT IS REFERRED TO THE PROPER SPECIALIST (OUT SOURCED). BREAKDOWN: $1,200 EACH MRI TEST(AVERAGE 2 AREAS). SPECIALIST CONSULTS $1600 (MINIMUM-1 CONSULT AND 1 FOLLOW UP. LOST WAGES, TRANSPORTATION AND PRESCRIPTION REIMBURSEMENT, ETC. USUALLY, THIS RESULTS IN ABOUT $4,000 TO $5,000 LEFT FOR TREATMENT. WHAT IS THE AVERAGE FAMILY DEDUCTIBLE ON HEALTH INSURANCE? WHAT IF THE PATIENT NEEDS SURGERY. WHAT DOCTOR, ANESTHESIOLOGIST, HOSPITAL OR SURGICAL CENTER DO YOU KNOW THAT CAN GET ALL THIS DONE FOR 4 TO 5 THOUSAND?

3) There are lawsuits over payment of PIP and lawsuits over payment for pain and suffering, so the PIP law no longer does as it was intended. LIZ: YES THERE ARE. SOME NOT SO NECESSARY AND SOME ABSOLUTELY NECESSARY. FOR EXAMPLE: THE PERSON WHO ONLY HAS $10,000 IN PIP COVERAGE WITH NO MED-PAY AND NO UNINSURED MOTORIST WHO NEEDS SURGERY.

4) Maybe the state should mandate that doctors who charge their patients (or their carriers) $10,000 for treatment of neck and back strains must completely cure their patients. That would be much better legislation if you ask me. LIZ: THE STATE SHOULD MANDATE SOMETHING, JUST NOT THAT OF WHICH YOU WRITE. THE STATE SHOULD MANDATE THAT CLINICS CAN NOT USE THEIR OWN DIAGNOSTIC TESTING AND THEIR OWN SURGEONS. THAT WAY THERE WOULD BE EITHER TRUE OBJECTIVE FINDINGS OR A TRUE LACK OF OBJECTIVE FINDINGS. MAYBE THE STATE SHOULD REQUIRE THAT ALL MEDICAL PROVIDERS ENGAGED IN BILLING FOR PIP BE LICENSED AND INSPECTED BY AHCA. CURRENTLY, ONLY NON-PHYSICIAN OWNED OR OWNERSHIP OF A CLINIC WHERE THERE ARE PROVIDERS WORKING WITH A HIGHER SCOPE THAN THE OWNERS ARE REQUIRED TO BE LICENSED. MAYBE THE STATE SHOULD REQUIRE A 200% MEDICARE FEE SCHEDULE (ALREADY BEING CONSIDERED) MAYBE THE STATE SHOULD ACTUALLY ENFORCE THE LAWS THAT REQUIRE DRIVERS TO HAVE INSURANCE BECAUSE RIGHT NOW, NO-ONE GETS PROSECUTED FOR NOT HAVING IT. MAYBE THE STATE SHOULD MANDATE THAT INSURANCE COMPANIES ACTUALLY PAY CLAIMS OF THEIR INSURED, WHO PAYS PREMIUMS FOR THEIR INSURANCE, INSTEAD CUTTING OFF PEOPLE'S BENEFITS AFTER GETTING AN INDEPENDANT MEDICAL EVALUATION (HA HA HA) FROM SOME HACK M.D. WHO DOESN'T EVEN HAVE THEIR OWN PRACTICE AND TRAVELS FROM PLACE TO PLACE TO CONDUCT THESE EXAMINATIONS(PAID FOR BY THE INSURANCE CO.) MAYBE, SINCE COMPUTER PROGRAMS DO ALL THE WORK, INSURANCE COMPANIES SHOULD BE MANDATED BY THE STATE AND BE GIVEN THE AUTHORITY TO HAVE INVESTIGATORS INSTEAD OF ADJUSTERS TO INVESTIGATE FRAUD. MAYBE THE STATE SHOULD MANDATE THAT ADJUSTERS GO TO MED SCHOOL BEFORE THEY CAN TELL A DOCTOR WHAT IS MEDICALLY NECESSARY.

I CAN GO ON FOREVER BUT AS YOU SEE, LIKE MOST COINS, THIS ONE IS TWO SIDED.

5) While they are at it - why don't they also mandate that lawyers can't charge their clients 33% to 40% fee if an ex-insurance adjuster actually handled their case? I AM NOT AN ATTORNEY SO I CAN NEITHER SUBSTANTIATE OR UNSUBSTANTIATE THE NEED. I CAN TELL YOU THAT THERE IS MONEY BEING MADE BY INSURANCE DEFENSE ATTORNEYS IN LARGE AMOUNTS ALSO, WHICH I AM SURE TRICKLES DOWN INTO OUR PREMIUMS.

AS YOU CAN SEE, I WILL BE THE FIRST ONE TO ADMIT THINGS CAN BE IMPROVED AND I UNDERSTAND EACH SIDE OF THE ISSUES AS THERE ARE MANY UNSCRUPULOUS MEDICAL PROVIDERS AND ATTORNEYS. JUST AS THERE ARE INSURANCE COMPANIES THAT ASSUME ALL CLAIMS ARE FRAUDULENT.

THE ANSWER IS NOT TO GET RID OF THE CURRENT PROCESS BUT IT IS TO REGULATE AND INVESTIGATE THE PROCESS.

I FEEL LIKE ITS ELECTION TIME AND EACH SIDE IS PERFORMING THEIR "SPIN" ON THE SITUATION. WAKE UP AND TELL THE TRUTH! WITH A CENSUS REPORTED 20% OF FLORIDIANS WITHOUT HEALTH INSURANCE, MORE LIKE AN ACTUAL 40%, PIP'S ELIMINATION WOULD HAVE DIRE CONSEQUENCES FOR FLORIDA CITIZEN'S HEALTHCARE AND ECONOMIC WELL BEING. IF PIP DIES, THE ONLY BENEFICIARIES ARE THE INSURANCE COMPANIES AND SOME POLITICIANS.