Please accept this week’s blog entry from the accident lawyer in Boca Raton (injury attorney Miami, accident lawyer North Bay Village, injury lawyer Aventura, accident attorney Hallanndale, accident lawyer Fort Lauderdale, injury attorney Delray Beach, injury lawyer West Palm Beach).
It is important to understand that when you are in a car accident and are treating with physicians (chiropractors, orthopedic physicians and any other providers), you are incurring medical bills. Generally, your own PIP carrier (your insurance company) will be responsible for the bills BUT generally people have 80 percent coverage. Thus, there is a 20 percent balance (generally, if another car is at fault, that 20 percent can be claimed against that other driver or their insurance company; further, if your medical provider is on your health insurance plan, you may be able to seek to have the 20 percent balance paid through your health insurance as secondary coverage). Further, your PIP carrier can also claim that the treatment is not reasonable or necessary or they can have you see their doctor for an Independent Medical Examination (IME), which is more fairly described as a Compulsory Medical Examination (see recent blog post discussing same)(CME), and that doctor can find that no further treatment is necessary. The legal basis for the IME or CME is generally the insurance policy as well as 627.736(7), a copy of which is pasted below.
If the doctor finds that no further chiropractic care is needed then the insurance company can refuse to pay for further care. There are a few options here. First, you can pay the chiropractor. Second, you can sign a letter of protection and, assuming that you have a case, you can pay it from your settlement. Third, if you have health insurance which covers chiropractic, you can seek to have health insurance pay it. Fourth (probably the most commmon), your doctor can sue your insurance company to have your benefits “reinstated” so that the treatment that you have after the IME or CME cutoff gets paid (this could take years to get done and just because the doctor sues of course does not necessarily mean that the doctor wins the case). Fifth, you may be able to see a doctor from another specialty to have treatment, as generally an IME or a CME cutoff only applies to the chapter of the physician that cuts the benefits. In other words, generally, a chiropractor can only cut off benefits from chiropractic treatment and not treatment from a medical doctor.
If you have been in a slip and fall accident or car accident, please call Drucker Law Offices today for a free consultation at (561) 483-9199 for Palm Beach County; (954) 755-2120 in Broward County; or (305) 981-1561 in Miami-Dade County.
In sum, when your insurance company sends you to their doctor, that doctor may discontinue your treatment. This can be challenged by what is called a “PIP suit” where your treating doctor sues your insurance company to have the benefits reinstated. However, generally under Florida law, an insurance company’s doctor can only discontinue benefits from the Chapter of physicians to which he has a specialty; thus, a chiropractor cutoff by the insurance company only affects future chiropractic treatment and NOT future medical treatment.
At Drucker Law Offices, we help our clients prove their injury case, including all car accident, slip and fall cases and essentially any injury case where you are injured as a result of the fault of another person or business establishment. If you have been in an accident and would like a free consultation, please call us at 561-483-9199; or 954-755-2120; or 305-981-1561. We only charge fees if we recover money for you. We have our principal office in Boca Raton and satellite offices in Miami, Coral Springs, Boynton Beach and West Palm Beach.
Every case is unique and should be judged based on the specific facts of the case. The advice in this blog is intended to be general and should not to be construed as specific advice for a case or your case. A minor difference in the facts of the case in a fact pattern such as above could change the result. Also, this blog is, as the web site suggests, based on Florida law and the laws of any other states could vary from Florida.
Florida Statute 627.736(7) states:
(7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON; REPORTS.—
(a) Whenever the mental or physical condition of an injured person covered by personal injury protection is material to any claim that has been or may be made for past or future personal injury protection insurance benefits, such person shall, upon the request of an insurer, submit to mental or physical examination by a physician or physicians. The costs of any examinations requested by an insurer shall be borne entirely by the insurer. Such examination shall be conducted within the municipality where the insured is receiving treatment, or in a location reasonably accessible to the insured, which, for purposes of this paragraph, means any location within the municipality in which the insured resides, or any location within 10 miles by road of the insured’s residence, provided such location is within the county in which the insured resides. If the examination is to be conducted in a location reasonably accessible to the insured, and if there is no qualified physician to conduct the examination in a location reasonably accessible to the insured, then such examination shall be conducted in an area of the closest proximity to the insured’s residence. Personal protection insurers are authorized to include reasonable provisions in personal injury protection insurance policies for mental and physical examination of those claiming personal injury protection insurance benefits. An insurer may not withdraw payment of a treating physician without the consent of the injured person covered by the personal injury protection, unless the insurer first obtains a valid report by a Florida physician licensed under the same chapter as the treating physician whose treatment authorization is sought to be withdrawn, stating that treatment was not reasonable, related, or necessary. A valid report is one that is prepared and signed by the physician examining the injured person or reviewing the treatment records of the injured person and is factually supported by the examination and treatment records if reviewed and that has not been modified by anyone other than the physician. The physician preparing the report must be in active practice, unless the physician is physically disabled. Active practice means that during the 3 years immediately preceding the date of the physical examination or review of the treatment records the physician must have devoted professional time to the active clinical practice of evaluation, diagnosis, or treatment of medical conditions or to the instruction of students in an accredited health professional school or accredited residency program or a clinical research program that is affiliated with an accredited health professional school or teaching hospital or accredited residency program. The physician preparing a report at the request of an insurer and physicians rendering expert opinions on behalf of persons claiming medical benefits for personal injury protection, or on behalf of an insured through an attorney or another entity, shall maintain, for at least 3 years, copies of all examination reports as medical records and shall maintain, for at least 3 years, records of all payments for the examinations and reports. Neither an insurer nor any person acting at the direction of or on behalf of an insurer may materially change an opinion in a report prepared under this paragraph or direct the physician preparing the report to change such opinion. The denial of a payment as the result of such a changed opinion constitutes a material misrepresentation under s. 626.9541(1)(i)2.; however, this provision does not preclude the insurer from calling to the attention of the physician errors of fact in the report based upon information in the claim file.
(b) If requested by the person examined, a party causing an examination to be made shall deliver to him or her a copy of every written report concerning the examination rendered by an examining physician, at least one of which reports must set out the examining physician’s findings and conclusions in detail. After such request and delivery, the party causing the examination to be made is entitled, upon request, to receive from the person examined every written report available to him or her or his or her representative concerning any examination, previously or thereafter made, of the same mental or physical condition. By requesting and obtaining a report of the examination so ordered, or by taking the deposition of the examiner, the person examined waives any privilege he or she may have, in relation to the claim for benefits, regarding the testimony of every other person who has examined, or may thereafter examine, him or her in respect to the same mental or physical condition. If a person unreasonably refuses to submit to an examination, the personal injury protection carrier is no longer liable for subsequent personal injury protection benefits.
