• Lawlor | Zigler has an impressive record of trial verdicts and negotiated settlements on behalf of clients in a broad range of serious personal injury cases. We have dedicated our law practice to representing people that are in a fight for the future, and we can help you.

Personal Injury Protection (PIP)

When an individual is involved in a motor vehicle accident (regardless if he/she is at fault) and needs medical treatment due to injury, he/she is entitled to up to $10,000 in benefits through the Florida Motor Vehicle No-Fault Law. At Lawlor ǀ Zigler we can help you recover money you did not even know you had owed. The statute allows us to go back as far as 5 years to recover benefits.

If an insurance carrier has denied coverage due to any of the reasons listed below give us a call. We have an experienced staff that can identify which claims were wrongfully paid.

  • Payment denied based upon:
    • Independent Medical Examination (IME) Cut Off
    • Failure to appear at an Examination Under Oath (EUO)
    • Paid at reduced amount of 200% Medicare Fee Schedule
    • Alleged Material Misrepresentation

On January 1st, 2013 the PIP statute/Florida Motor Vehicle No-Fault Law was amended by the Florida Legislature. Many changes took place, some include:

  • Subsection (1)(a) requires that the claimant receive initial services and care within 14 days after the motor vehicle accident in order to be eligible for benefits under the Florida Motor Vehicle No-Fault Law
  • The initial services and care must be provided by:
    • a medical doctor, osteopath, dentist or chiropractor; or
    • a hospital; or
    • a facility owned by a hospital; or
    • emergency medical service (EMS) personnel
  • If a medical doctor, an osteopath, a dentist, a physician’s assistant, or advanced registered nurse practitioner determines that the claimant suffered from an emergency medical condition, reimbursement for all services and care is up to $10,000.00.
  • If, however, a medical doctor, an osteopath, a dentist, a physician’s assistant, or advanced registered nurse practitioner determines that the claimant did not suffer from an emergency medical condition, reimbursement for all services and care is limited to $2,500.00.
    • Emergency medical condition is defined as “A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
      1. Serious jeopardy to the patient’s health;
      2. Serious impairment to bodily functions;
      3. Serious dysfunction of any bodily organ or part.
  • The insurance company’s right to take an Examinations Under Oath (EUO) is now included in the PIP statute and attendance is a condition precedent to receiving benefits (overruling Custer Medical and related cases on the EUO issue)  The claimant’s failure to attend two defense medical examinations creates a ‘rebuttable presumption’ that the failure to attend was an ‘unreasonable’ failure.
  • Durable medical equipment prosthetics/orthotics and supplies are not explicitly subject to the Medicare Part B fee schedule.

The Medicare fee schedule is fixed as the one in effect on March 1 of each year and is the one to be used until March 1 of the following year notwithstanding any subsequent change made to the fee schedule or payment limitation.

Although these changes have occurred that significantly benefit insurance carriers, insurance companies are still wrongfully denying payment and there is still a way for us to recover money on some claims. Our staff is up to date with all the new changes and continuously follows any updates that occur regarding PIP.

If you have piles of unpaid claims with unpaid PIP coverage or if you just have questions about the process, please call us at 1-855-465-2889 or contact us online.