PIP Insurance Can’t Require Your Provider to Testify

When someone is injured in a motor vehicle accident, PIP, or Personal Injury Protection insurance covers up to $8,000 of medical bills, regardless of who was at fault.  This excellent no-fault medical coverage covers the full bill, unlike most medical insurance companies that negotiate the bill, and therefore has some say as to where you go for treatment, or what treatment is permissible.  Because motor vehicles are inherently dangerous, this required insurance helps everyone who is injured get basic medical care following a collision. 

On the other hand, PIP insurance companies have their own bag of tricks for reducing coverage.  Generally they will send you for an “IME” or insurance doctor examination.  Those insurance doctors usually send a report instantly saying you are all better and need no more treatment.  Thus, the PIP insurance company has grounds for stopping payment on future treatment.

PIP Refusing to Pay Providers

Another trick is that PIP simply refuses to pay your medical provider, using the IME or some other excuse.  In a recent case that was heard in the Salem District Court, the judge held that a medical provider is not required to testify as to his or her treatment of the injured motor vehicle victim.

The insurance company, Government Employee Insurance Company, attempted to avoid making a payment to VIP Physical Therapy.  We can guess why:  the bill for three injured parties in the same vehicle was close to $20,000.  The insurance company sent the victims to their insurance physical therapist and doctor, who, believe it or not, reported not only that the victims of the motor vehicle accident were better, but that the medical treatment was excessive and unreasonable.  This was notwithstanding the fact that the insurance doctor saw the victims after their treatment and could not have known how badly injured they were at the time of treatment.  The insurance company, of course, exercised their right to take the EUO (Examination Under Oath) of the car accident victims. They complied.

Next the insurance company attempted to take the EUO of the physical therapists.  They refused to show up to testify.  And the insurance company refused to pay any of the bills.

Physical Therapists Filed Suit Against The Insurance Company

When the physical therapists filed suit to collect their bill, the PIP insurance company defended stating that there was non-cooperation and insisting on statements under oath.  The Salem Court, however, found that the insurance company was not reading the PIP language in the insurance contract correctly:  while the “unpaid” party, the injured patient, must appear for both the physical examination by the insurance doctor and the oral examination by the insurance attorney, the medical provider need not comply with a request for examination.

The Court stated strongly that the intent of the PIP statute was “to provide prompt payment of PIP benefits and reduce litigation.”

Retain An Experienced Personal Injury Attorney

In the above case, an aggressive attorney represented VIP Physical Therapy, winning the case in Salem District Court.  The victims of the motor vehicle accident were treated by physical therapists who where not paid, wherefore, the case needed to proceed.

If you are injured, be sure to get an experienced personal injury attorney.  Neil Burns has represented victims of personal injury, worked with medical providers, submitted PIP applications, and secured payment through PIP for his clients since 1985.  We work on a contingent fee, so clients do not pay unless we are successful.  Call for a free consultation:  617-227-7423.

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