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It is my understanding that no fault pays 80 percent and I would be responsible for 20 percent on a personal injury claim.

Orlando, FL |

I got treated one week after a rear end collision which I am not the at fault party. First, can the doctor's office charge me the 20 percent that I am responsible for along with any extra monies that the no fault policy would not pay for? For example and to keep it simple: If a particular service cost $100.00, then no fault would pay $80.00 and I would pay $20.00. If No Fault decides to only pay $40.00 of that $80.00, would I be responsible for the remaining $40.00 plus the $20.00? Can I collect the difference from the at fault driver's insurance. Also, the doctors office told me that the services that they have provided are completely covered under my insurance plan, however, massage therapy is not as I just learned from my carrier. Why do they do this?

Attorney Answers 7

  1. 80% of the allowed PIP fee, and you pay 20% of that allowed PIP fee.

    The 20% you pay would be collectible from the at-fault driver's insurance (depending on the liability facts of your case, of course).

    Candidly, I would be concerned if you are racking up big bills for massage therapy and similar/related treatment. Big bills for massages do not mean you'll get a big offer from the other side. Soft tissue injuries treated with massage don't have much compensatory value, regardless of how big the bills might become.

    If you are not careful, your massage bills might eat up anything you get offered to resolve your claim.

    Consult a local injury attorney (if you don't already have one).

    DISCLAIMER: We do not have an attorney-client relationship. Only those persons who have a signed written fee agreement and authority to represent with me is an actual client. This response does not form an attorney-client relationship, nor is it intended to be anything other than my educated opinion or viewpoint. It should not be relied upon as legal advice. I recommend you consult a lawyer if you want professional assurance that this information, and your interpretation of it, is appropriate to your particular situation. Do not act on any information in this response without seeking legal advice from an attorney in your area.

  2. Generally, yes your PIP will pay 80% of allowed treatment. Under the new rules, massage therapists are not authorized providers. If your doctor bills the therapy he is giving you, even though it may partially involve massage modalities, I have seen this covered by PIP. It depends on what type of doctor you are seeing and his experience in dealing with PIP. As you were injured and the accident wasn't your fault, your injury attorney should be overseeing this and would also be able to explain this. I assume you have representation? You will have a difficult time collecting from the other driver's insurance on your own.

  3. My colleagues are correct . . .

    In no way am I offering you legal advice, and in no way has my comment created an attorney-client relationship. You are not to rely upon my note above in any way, but insted need to sit down with counsel and share all relevant facts before receiving fully-informed legal advice. If you want to be completely sure of your rights, you must sit down with an experienced criminal defense attorney to be fully aware of your rights.

  4. You only owe the remaining 20%.

    Unless you have entered into a letter of protection with the doctor, then you owe him for that remaining 20% when the bill comes due unless you two have made other arrangements.

    A bill is a bill, and your doctor has no way of knowing of the at-fault party has liability coverage or if the at-fault party's insurance company will pay. Sometimes, doctors will reduce the remaining 20% if your attorney negotiates well.

    I have handled personal injury claims as an adjuster, and now, as an attorney, and I find that PIP confuses more people than any other issue.

    I am a Florida attorney who practices in the areas of personal injury, criminal defense, and civil rights. My answers on Avvo are not legal advice, and they do not create an attorney-client relationship. If you contact me--please understand that I cannot contact you--then I will carefully evaluate your case and determine if I will accept you as a client. Unless you and I sign a contract for legal representation, then I am not your attorney. Furthermore, Avvo is a limited forum and not well-suited for complex legal analysis. You should always obtain competent legal advice from attorneys who will carefully evaluate all your case's facts. Avvo isn't the place for that.

  5. Pip is fairly complex: if you have not already done so, hire counsel.

  6. Your question has multiple parts. The long and short of is that your Personal Injury Protection will pay bills up to $10,000.00 in medical expenses that your insurance carrier considers reasonable and necessary. You may have a deductible which reduces the $10,000.00. You may have Medical Payment coverage as well although most Florida policies do not include Med Pay. Additionally you may also have Underinsured Motorist coverage which may be applicable. Assuming the other person has insurance the party that injured you will be entitled to what is called a set off in the amount that your Personal Injury Protection paid. Meaning if they evaluate the claim at $20,000.00 they would reduce that amount by whatever your company paid. You should probably hire an attorney. Good Luck.

    The response herein is not legal advice and does not create an attorney/client relationship. The response is in the form of legal education and is intended to provide general information about the matter within the question. This is not meant to be legal advice in any way shape or form. By answering this question I am not intending to form a client lawyer relationship with you. You should contact a lawyer licensed in your state in order to receive an authorative answer to your question.

  7. The answer to a big part of your question depends on the specific language of your insurance policy. The explanation of benefits should tell you why the insurance company is paying the way it is paying. Why did the insurance company not pay 80% of the charge? Did they reduce the bill based on a fee schedule? Did a deductible apply? Your best bet would be to consult with an attorney that handles personal injury protection lawsuits.

    This answer is based on the limited information that is being provided in the question and should not be construed as legal advice. The answer provided is general in nature and since the law changes frequently and may be interpreted or applied differently depending on your location and the specific facts and circumstances of your situation, this answer is not intended as a substitute for case-specific advice, which should be obtained from a competent lawyer after that lawyer has obtained all of the necessary facts and circumstances surrounding your specific situation. Lastly, this answer in no way creates an attorney/client relationship.

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