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

Whiplash Syndrome. Is it a Medical Emergency?

Whiplash Syndrome.  Is it a Medical Emergency?

Alan Himmel, DC

This is another post on whiplash syndrome.  Again, I am not writing this stuff for the purpose of spinning something into something more than what it is.

Ask anyone who has ever been rear ended in a car accident, and they will tell you how it felt.  I remember one of my patients a couple years back described to me that it felt like he got his bell rung.  I thought that was a good way of putting it.  He was a huge guy also... almost like an NFL lineman.

Of course, some people, depending on how they are sitting, eg, if their head was against the head rest or turned (6) at the time of the impact, may feel less discomfort than others.  There are also other factors involved like whether your car is moving at the time it was rear ended. (I would actually like to get into that in another post, because what happens here is actually paradoxical to one's thinking.  I will explain in another post.)

So, in a previous post, we have already talked about the fact that more than 50% of  whiplash syndromes fail to resolve. But, what, for example is so terrible about a sprain/strain of the cervical muscles, or even a disc herniation?  What other things occur to a victim of whiplash, or an acceleration/deceleration injury?  I actually did a little research this morning.  www.Pubmed.com is a wonderful source for the latest research abstracts for virtually any scientific subject you may be interested in.  I use it all the time. And you should not take MY word on this topic, when there's tons of literature on this subject.

The following is just the tip of the iceberg when it comes to research on whiplash injury.  Matsui et al, at the Japan Neurological Institute studied whiplash victims and saw that many of these patients experienced various conditions such as chronic fatigue, headache, and vertigo.  Furthermore, his group saw that individuals who underwent treatment for these injuries had reported "good outcome" rates up into the 80% range. (1) Now, what they consider good outcome I don't know.  Good outcome and complete recovery may be two entirely different things.  I actually saw multitudes of studies on vertigo and whiplash.  It seems that vertigo is a common theme after getting rear ended.  Here is a a few articles:  Clinical Symptoms of Equilibrium disorders in patients with whiplash syndrome, Benitez, et al., and Postural  Control Disorders in Initial Phases of Whiplash, Cobo, et al (2,3).  Other authors concluded that 10% of whiplash injuries result in tinnitus, deafness, and vertigo. Trantor, et al.(4).  I can go on for hours finding new articles on this subject. Here is one that caught my attention:  Here is a young lady with minor trauma to the neck, and was diagnosed as having a whiplash.  Patient had normal X-rays, however had paraesthesia of the left arm.  Angiography later revealed the patient had a vertebral artery dissection. (5)

I don't think it is a very long stretch to see that whiplash injuries are very often medical emergencies.  They don't always present as medical emergencies, but the research confirms it.  Doctors should assess these patients objectively, however relating the patient's complaints back to the cause.  And, clinicians should not assume that all whiplash injuries are the same and require the same treatment.  These injuries very often cause permanent deficits of body function and use.  Tinnitus, vertigo, postural changes, and deafness are just a very small handful of the seriousness of whiplash injuries.   If you have been hurt in a whiplash type injury, you can email Dr. Himmel, or you can call Dr. Himmel at 954-659-8600.  I generally answer the phone myself.

Stay tuned.  My next post will be on the physics of the rear end car accident.

1. Neurol Med Chir (Tokyo). 2012;52(2):75-80.Cervical neuro-muscular syndrome: discovery of a new disease group caused by abnormalities in the cervical muscles.Matsui T, Ii K, Hojo S, Sano K.

Source

Japan Neurological Institute and Matsui Hospital, Kannonji, Kagawa, Japan. t.matsui@matsui-hp.com

2.  Acta Otorrinolaringol Esp. 2009 May-Jun;60(3):155-9.[Clinical symptoms of equilibrium disorders in patients with whiplash syndrome]. Uehara Benites MA, Pérez-Garrigues H, Morera Pérez C. Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital La Fe, Valencia, España. michel_u@hotmail.com

3. Med Clin (Barc). 2009 May 2;132(16):616-20. Epub 2009 Apr 22.[Postural control disorders in initial phases of whiplash].Pleguezuelos Cobo E, García-Alsina J, García Almazán C, Ortiz Fandiño J, Pérez Mesquida ME, Guirao Cano L, Samitier Pastor B, Perucho Pont C, Coll Serra E, Matarrubias C, Reveron G.

Source

INVALCOR (Laboratorio de Biomecánica), Barcelona, España; Servicio de Medicina Física y Rehabilitación, Hospital de Mataró, Mataró (Barcelona), España; Universidad Pompeu Fabra, Barcelona, España. 34260ep@comb.es

4. J Forensic Leg Med. 2009 Feb;16(2):53-5. Epub 2008 Nov 1.A review of the otological aspects of whiplash injury.Tranter RM, Graham JR. ENT Department, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Lewes Road, Haywards Heath, West Sussex RH16 4EX, United Kingdom. rtranter@uk-consultants.co.uk

5. Emerg Med J. 2008 Sep;25(9):609-10. Neck pain and minor trauma: normal radiographs do not always exclude serious pathology. Ribbons T, Bell S. Accident and Emergency Department, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, UK. tamsinribbons@doctors.org.uk

6. Spine (Phila Pa 1976). 2008 Jul 1;33(15):1643-9.  Head-turned postures increase the risk of cervical facet capsule injury during whiplash. Siegmund GP, Davis MB, Quinn KP, Hines E, Myers BS, Ejima S, Ono K, Kamiji K, Yasuki T, Winkelstein BA.

Source

MEA Forensic Engineers & Scientists, Richmond, BC, Canada. gunter.siegmund@meaforensic.com