What Does it Mean when they say PIP is Primary?

What Does it Mean when they say PIP is Primary?

Dr. Alan Himmel

PIP No-Fault Insurance is primary in Florida.  What this means is, if you are involved in a car accident in the State of Florida, and you either have your own car with insurance or are living with a resident relative (living in a house with family member who has a car with insurance) you are required by law to have all claims for injuries filed through PIP.  PIP is primary, meaning that even if you have your own health insurance, Medicare, Medicaid, or group plan, you have no choice but to use PIP first.

Most doctors who treat trauma/accident patients know this, unless they are new and have not been trained or have no experience with these types of patients.

So, what happens if you go see a doctor after a car accident, and hand them your health insurance card?  Well, if the doctor bills health insurance instead of PIP, there is actually a chance that the bill will get paid.  Why?  Because at this point, the insurance company is unaware of the fact that the patient is being treated for a car accident.  They process they claim as they do any other claim.

But, this is what I have seen over and over again over the years.  After a few weeks or months, the health insurance company will send a letter out to the policyholder and ask him a few questions, the most important one being describe the circumstances that led to your injury, and were you in a vehicle at the time of your injury?

If, through these questions, the insurance company learns that the patient was indeed in a car accident, the insurance company will usually proceed in one of two ways:  First, they can ask for the money back from the doctor.  Or second, they can wait to see if there is a legal settlement which will be paid out to the patient, and if so, they can put a lien on the settlement in order to be paid back.

If you have health insurance, you can use it for claims that are over and above the PIP payable amount (Secondary, not Primary). In other words, since PIP mainly pays 80% of the claim, health insurance can pick up the 20%.  You can also submit deductibles to them, and you can submit all claims to health insurance that exceed the $2500 or $10,000 in coverage.  If PIP denies the claim completely for reasons of failure to pay policy premium, or failure to carry, or anything, then health insurance can be billed in these circumstances.  But, remember, if you have a settlement pending that is due to this accident, you will pay the insurance company back from your settlement.

If you are one of those patients who just does not want to use your PIP car insurance for one reason or another, you will find yourself in one of the two scenarios up above.  Chances are, your health insurance will request the money back from the doctor or you will have to pay it out of any settlement you receive.

I have been treating car accident patients since 1996.

Consult with me for injuries relating to car accidents. I can be reached directly at 954-659-8600. Always consult with an attorney with issues regarding the law.  I am not an attorney.

My office address is:

Alan Himmel, DC, PA.
3161 Dykes Road
Miramar, FL.  33027

Can Whiplash Cause Concussion?

Can Whiplash Cause Concussion?

Dr. Alan Himmel

Talked about it before.  Let's talk about it again.  Can a mild whiplash cause a concussion?  The literature says, yes.  And, I have had several patients over the years, and one currently, who has the affects of post concussion syndrome.

Attorneys who represent injury clients need to be aware of this issue as well.  The most recent patient that I am treating who I am sure has suffered a concussion, has all of the symptoms of this injury, including headache, vertigo, disorientation, and confusion.  This will be a patient who will tell you that their head just doesn't feel the same since the accident.  It can be very frustrating to the patient, and the patient may find themselves searching doctors who could figure it out.  Oddly enough, attorneys will very often dismiss concussion, wanting to focus the claim on disc injuries and the usual soft tissue findings. Why?

I think that the major sticking point for attorneys is simply not understanding the physics involved in a car accident, and not knowing what a concussion actually is.

You don't have to strike your head against the inside of the car and you don't have to get hit in the head by something to cause concussion.  Think of it like this:  The brain is encased within the skull and around the brain is a thin layer of fluid which separates the brain from the inside of the skull so it does not touch (among other purposes of the fluid). The fluid is called cerebral spinal fluid or CSF.  So, the brain, in a way, is swimming in this fluid and the small fluid space between the brain and the inside surface of the skull is like a barrier because you don't want the brain to touch anything.

Okay, now think about what will happen to a person's head when at rest, when the car he is in is hit from behind.  The person's head will move in the direction of where the force came from.  This is one of Newton's laws of motion.  Every action has an equal and opposite reaction.  But, what about the brain which is "floating" within the skull?  It too, must obey the laws of physics, and at this point, the brain will then crash into the inside of the skull on the opposite side.  Right there is your concussion.



Now, keep in mind that concussion is not always possible to see on MRI or CAT scan.  Concussion is regularly diagnosed based on neurological symptoms, signs, and complaints.  Lawyers and insurance companies want objective proof, but they cannot always have it with concussion.  The lawyer who is representing the client with concussion, must be aware of these things.  A lawyer who is representing injury clients must be an expert in the law, and although its not required to be trained like a physician, he should also have a working knowledge of different types of injuries involved.

So, keep an eye out for a concussion when whiplash is involved.  They are generally not life threatening, but concussions can be quite serious, and recurrent concussions can be even worse.

I can be reached at 954-659-8600

My office address is:

Alan Himmel, DC, PA.
3161 Dykes Road
Miramar, FL. 33027

The Changes to the Florida PIP law have worked to stop fraud: True or False?

The Changes to the Florida PIP law have worked to stop fraud:  True or False?

Dr. Alan Himmel

The articles are beginning to come out stating that the changes in the PIP laws that occurred in 2012 have decreased the rate of fraud, and costs to insurance companies, and ultimately to consumers.  This is a good thing if its true.  It may be that the decreases in payouts are due to the $2500 insurance cut off, or the 14 day rule, which states that you better get to a doctor within 14 days or you get $0.00 in coverage.  It may also be due to the fact that now, there is no coverage for acupuncture or massage, two effective, safe, alternatives to medications and surgery.

As a practitioner who sees accident patients in FL, doctors now have two less options to offer patients when they are suffering from painful injuries from automobile trauma.  Plus, patients have to get better with 75% less insurance coverage than they had in the past, since not all patients will have an "emergency medical condition"  (EMC) which is supposed to allow the patient to have their full benefit.

So, I ask you:  What do you think is the true reason that insurance companies are reporting savings?   Could the answer be that there is now more opportunity for the insurance carriers to deny coverage, since the payouts are capped now in many cases?  Or, could it be true that the savings is due to less fraud?   I would be one of the first to start celebrating if I was sure that the savings to insurance companies was about the reduction in crime, but I am not 100% sure about that one.