What You Should Do If Your Auto Insurance Carrier Refuses to Pay for Your Medical Treatment With PIP Benefits
Posted on Monday, July 6th, 2015 at 11:11 am
This post discusses the PIP benefits that are available on all Kentucky automobile insurance policies for people who live in Kentucky at the time they take out insurance. If you have an Ohio motor vehicle policy or lived in Ohio when you got car insurance, you can check this page of our blog to find out more about Ohio’s no-fault benefit, Med Pay.
Kentucky passed the Motor Vehicle Reparations Act (MVRA) in 1974. Among other things, the MVRA requires all Kentucky drivers to have liability auto insurance, and requires all such auto insurance to have no-fault benefits, which is often called Personal Injury Protection (PIP). PIP benefits must be at least $10,000.00 per person covered by the policy, and can go to pay any medical treatment related to an automobile accident or lost wages related to the automobile accident up to $200 per week. If you look at the itemization of your auto insurance premium, you will see that part of your premium goes to support your PIP benefits.
Kentucky’s main purpose for passing the MVRA law was to make sure Kentuckians injured in car wrecks got prompt medical treatment and rehabilitation by ensuring that money was set aside to pay for whatever treatment was necessary. Although $10,000 does not stretch nearly as far today as it did in 1974 – especially where skyrocketing medical bills are concerned – PIP payments are still a crucial first link in a long chain of medical payments for most car accident victims in Kentucky.
How Does Your Medical Treatment Get Denied By The PIP Carrier?
Northern Kentucky residents have started seeing more and more denials of PIP benefits in recent years. Where car accidents are concerned, Lawrence & Associates mostly represents victims in Boone, Kenton, Campbell, Grant, and Gallatin counties, and in those counties we have mostly observed Allstate and Geico challenging treating doctors by refusing to pay PIP.
Typically, Allstate or Geico will challenge the treating doctor by sending medical records off to a “peer review” or a “utilization review.” These are both bogus terms for “hiring a doctor who has never treated you to second guess your doctor.” The insurance company will send you a formal letter that typically does not address you by name, advising you that your treatment cannot be approved until the “peer reviewer” has given a decision. To make matters worse, your health insurance company will often refuse to cover the bills because, by law, the PIP insurance company is “primary” which means the PIP carrier has the duty to pay before the health carrier does. For this reason, your medical treatment stops entirely, even if you are in pain or getting worse.
Your PIP carrier then sends a “review,” which is the peer reviewers report. It will either accept the treatment as being necessary and related to the car accident, deny the treatment, or recommend an “independent medical exam” (IME). An IME means you have to allow the insurance company to pick a doctor for you and go see that doctor. The trick of an IME is that IME doctors are not truly independent; they are paid by the insurance company and nearly always claim that future treatment is unnecessary. (If they cost the insurance company money, why would the insurance company continue hiring them?) Regardless of whether the treatment is accepted, denied, or referred to an IME, it is rare for the PIP carrier to put the review letter in language that a layperson will understand.
The end result? You pay premiums for PIP coverage and never see the PIP money that you paid for. In the meantime, your untreated injury keeps hurting and keeps getting worse.
How Can An Attorney Help Make Your Auto Insurance PIP Benefits Pay For Your Medical Treatment?
The worst thing about the process above is that the MVRA doesn’t allow it. The MVRA states that a PIP carrier like Geico or Allstate must file a claim in court if it wants to deny PIP payments for your medical treatment. These insurance companies can’t ship all your medical records off to some hidden doctor in a backroom, with no transparency as to why medical treatment is being denied! Rather, the law requires the insurance companies to challenge a treating doctor (and you!) in open court, with full transparency. Auto insurance PIP carriers only get away with this because the average person in Northern Kentucky doesn’t know the rights that come with their auto insurance premiums.
If a PIP carrier wrongfully denies you the payment of your PIP benefits, you are allowed to sue that company in court and get 18% interest on all overdue payments. Further, if the PIP carrier didn’t have a “reasonable foundation” for denying your PIP benefits, you can force the insurance company to pay for your attorney’s fees. However, forcing the PIP carrier to relinquish your insurance benefits to you will necessarily involve filing the case in court and proving the insurance carrier is wrong. The insurance carrier will hire attorneys to represent it. That means you’ll need an attorney to represent you too.
Don’t Give Up On Your Right to Kentucky PIP Benefits
At Lawrence & Associates, we are Working Hard for the Working Class. We take great pride in representing Northern Kentucky residents who have been injured in car accidents. We can’t fix broken bones or heal cuts, but we can make sure no one takes advantage of you while you are hurt. PIP carriers that ignore the law to line their pockets with your money should be brought to justice. We can help. Call us today.
However, there is always fine print to read and this fine print is very important. The Kentucky Supreme Court said that HIPAA is a factor here. 
Many people understand the importance of seeking an attorney after they have been involved in a car accident. One of the reasons for this is due to the fact that a licensed attorney will be able to tell a person exactly how much time they have to file or settle their accident related claim. This is known as the Statute of Limitations, and if a claim is not filed within the allowed time frame, then in most situations, it will not be heard by the Kentucky Courts.
At the firm of Lawrence & Associates in Fort Mitchell, Kentucky, we fight for the rights of people who have suffered serious injuries and the families of fatal accident victims. We work tirelessly to help our clients get compensation and deal with the medical, financial and emotional effects of serious accidents. We want to share with you the results of a case we oversaw in September of 2011. We will supply as many details as possible while still respecting our clients need for privacy.
At the firm of Lawrence & Associates in Fort Mitchell, Kentucky, we fight for the rights of people who have suffered serious injuries and the families of fatal accident victims. We work tirelessly to help our clients get compensation and deal with the medical, financial and emotional effects of serious accidents. We want to share with you the results of a case we oversaw in September of 2011. We will supply as many details as possible while still respecting our clients need for privacy.
At the firm of Lawrence & Associates in Fort Mitchell, Kentucky, we fight for the rights of people who have suffered serious injuries and the families of fatal accident victims. We work tirelessly to help our clients get compensation and deal with the medical, financial and emotional effects of serious accidents. We want to share with you the results of a case we oversaw in July 2013. We will supply as many details as possible while still respecting our clients need for privacy.
In a recent survey conducted by AT&T, 49% of American adult drivers admitted that they text while driving. [1] That’s a surprising statistic compared to only 43% of teens who admitted they too text, email, and check social networks while driving. While any licensed driver can partake in the act of texting while driving, as the AT&T study shows, adults are the worst offenders. Why can’t adults put the mobile phone down while behind the wheel? When asked why, respondents to the survey answered candidly that “it was a habit,” “it makes me more productive,” and “I like to stay connected.” A few years ago adults said they never did it, but in today’s fast paced world, texting while driving has become the new norm. While texting while driving may help someone stay more connected or be more productive, there can be very serious consequences of driving while texting.
In Northern Kentucky, a car accident occurs several times every hour on average. Often, following a car accident, injured Northern Kentucky drivers will receive a call from the other driver’s insurance company asking for a recorded statement about the injury. Below are tips that will ensure you get full and fair compensation for any injuries you receive in an accident.
Insurance policies are generally quite confusing and often vary between insurance companies. Most of them promise you a better rate, or better coverage in the event of an accident. Knowing what some of the standard policies cover will help in choosing the right coverage for you. For example, one thing that does not vary between insurance companies that do business in Kentucky is the minimum PIP coverage. PIP stands for ‘Personal Injury Protection’ (also known as Basic Reparation Benefits in other states). In Kentucky, every car insurance company licensed to sell insurance in the Commonwealth is required to provide $10,000 of minimum No-Fault benefits in the case of an automobile accident. This minimum benefit amount is per person, and it covers medical expenses and/or wage losses attributed to the accident.
