PIP Application Not Filed–Chiropractors Now Paid

Massachusetts’ Boston Municipal Court’s Appellate Division recently decided a case that is a win for Massachusetts chiropractors. In the case of Advanced Spine Centers, Inc. v. Pilgrim Insurance Company, the Court decided that when an insurance company suffers no prejudice and receives all the information sought in a “PIP package” sent to an insured/patient, the insurance company cannot deny chiropractic payment based on the fact that it did not receive the returned “PIP package.” The Boston personal injury attorneys at the Law Office of Neil Burns can review your individual case of non-payment for the insured’s failure to return a PIP application.

We previously blogged about this case whereas the ruling also concerned, and changed, the acceptable parameters of having bills reviewed for reasonable and customary charges within a provider’s geographical area. This case is notable because it also addressed the manner in which PIP insurers are able to dismiss claims for unpaid and/or disputed bills following a claim for the same.
PIP insurers, attorneys representing providers, and trial courts have long held that once the insurer pays the full amount of a disputed claim, the claim is extinguished. So, for example, if a provider files suit to recover an unpaid balance, if the insurer paid the disputed amount at any time before trial, then the claim was dismissed; the amount in controversy having been paid. Now, however, that no longer holds true.
In Howard Physical Therapy, Inc. v. Premier Insurance Co. (Appellate Division, Northern District) (App. Div. No. 10-ADMS-10029) (Sept. 23, 2010) the Court held that Massachusetts General Laws, Chapter 90, Section 34M stops any litigation once payment is made by the insurance company. Notwithstanding a dispute over the amount, payment stops the case. The process, and outcome, of collecting unpaid PIP balances just got a lot more interesting, and potentially lucrative, for providers.