Written by a Personal Injury Lawyer for Texas Doctors.
Before getting into how doctors are missing out on thousands — if not tens of thousands — of dollars with Personal Injury Protection, let’s start with a brief introduction…
I’m a PI lawyer in Austin, Texas and I’ve spent thousands of hours litigating cases involving Personal Injury Protection against insurance companies. In doing so, I’ve represented insureds, beneficiaries, and doctors.
So, it’s safe to say that I know a thing or two about how Personal Injury Protection works in Texas. More importantly, I’ve seen behind the curtain of insurance companies and how they actually operate.
With this post, I’m wanting to share those insights with doctors like you so you can have a thriving practice that takes advantage of the benefits provided by the Texas Insurance Code.
Fact #2 – Stacking Personal Injury Protection
Fact #3 – Reasonable Investigation Required
Fact #4 – First Come, First Served
Fact #5 – Insurer’s Deadline to Respond
Quick Summary on PIP
Now that that’s out of the way, let’s start with some foundational information.
In Texas, car-insurance companies are required by law to offer Personal Injury Protection (aka “PIP”). These insurers must offer at least $2,500.00 in PIP coverage.
The only reason why someone in Texas would not have PIP coverage is if that person signed a waiver of their right (typically to save a couple of extra bucks on premium).
As a personal injury lawyer, I always recommend that people carry PIP because it allows the person to get reimbursed for lost wages and to pay for medical treatment after a car wreck — even if they were at fault.
This is because PIP is no-fault insurance. In other words, even if the person caused the wreck, they are still covered by PIP. More importantly, a person can start receiving PIP benefits soon after the wreck because, unlike liability insurance, there isn’t a need to sort out liability.
Keep in mind that a person may be covered by one or more insurance policies because of a car accident. For example, if Sally was rear ended by Bob, then Sally can pay for her medical expenses with both PIP and Bob’s liability insurance (since he is at fault). On the other hand, Bob will only be able to use his PIP to pay for his medical expenses (again, because he’s at fault).
Given all of this, if you’re a doctor that accepts PIP, then you can potentially accept twice the amount of patients (both people that are at-fault and not at-fault) and get paid sooner than pure liability cases.
Therefore, PIP cases can really benefit your practice. Unfortunately, a lot of doctors do not fully maximize the benefits of PIP because they are unfamiliar with the laws in Texas (and so are a lot of lawyers).
To fix this, here are 5 things that Texas doctors must know about Personal Injury Protection.
1) Lawyers Refer More Cases to Doctors that Accept PIP
In the last post, the ULTIMATE GUIDE: How Doctors Get Referrals from Personal Injury Lawyers, there is a section that discusses why doctors that accept PIP are more likely to receive a referral from a Personal Injury Lawyer.
To summarize, it’s because a doctor that accepts PIP can handle the payment of their own medical bills, which lightens the load for the personal injury lawyer. And by using PIP on those medical bills, the client will be able to “double dip” by submitting those same bills to the liability insurance, which typically results in more compensation for the client.
Therefore, if you accept PIP, then make that fact super clear for lawyers to see because that’s one of the criteria we are looking for.
You can do that with GOOGLE marketing and word-of-mouth.
You can also do that by signing up on this very site that you’re on, ReferOver.com, and listing your business.
In doing so, you’ll be able to select an option that shows you accept PIP. Not only will this give you more exposure with Personal Injury Lawyers, it will also allow for them to filter for doctors that accept PIP — which will include you!
You can sign up for free by scrolling to the header of this page and joining today!
2) Stacking Personal Injury Protection
What’s better than a person having their own PIP coverage? A person being covered by another person’s PIP plus their own PIP coverage.
Double the PIP, twice the reach.
In today’s world, using ride-sharing apps like Uber and Lyft is becoming more common. Unfortunately, so are car wrecks for the passengers in those vehicles.
When a person is a passenger in a vehicle involved in a wreck (ride-sharing or not) and comes to you for treatment, then you need to find out whether the driver and the passenger have separate PIP coverages.
Keep in mind, a person’s PIP coverage follows them even if they are not in their own car when a wreck occurs.
Therefore, if the driver has PIP under the driver’s policy (or Uber’s policy) and the passenger/patient has PIP under their own policy, then you can try to bill both PIP policies.
But, here’s the caveat — you should first exhaust the driver’s PIP and then use the passenger’s PIP.
Let’s incorporate the earlier example with Sally being rear ended by Bob. And let’s say that Sally had a passenger named Pam. Bob, Sally, and Pam each have $2,500.00 in PIP from their own policies.
If Pam is your patient, then you will need to exhaust Sally’s $2,500.00 in PIP before using Pam’s own PIP. If Sally is your patient, then Sally can only use her PIP. And obviously neither Sally nor Pam will be able to use Bob’s PIP because Bob was in a separate car.
Now, let’s fully exhaust this scenario by changing the facts. If Pam was in Bob’s car instead and you treated Pam, then you would need to exhaust Bob’s PIP (because PIP is no-fault insurance) before using Pam’s PIP.
In either situation, Pam will have up to $5,000.00 in PIP benefits to work with because of stacking.
In short, if you hear that someone was a passenger in the car wreck, then your ears need to perk up because you may be able to get double the PIP coverage.
3) Reasonable Investigation Required
Insurance companies are required to pay all reasonable and necessary medical expenses under PIP.
Even more importantly (this can’t be stressed enough), insurance companies are required by Texas law to conduct a reasonable investigation into whether the bills you send them are reasonable and necessary.
Therefore, if the insurance company partially reduces or denies your entire bill under PIP by claiming the bill is unreasonable/unnecessary, then you need to figure out how the insurance company reached that determination by looking at the reason code on the Explanation of Reimbursement (EOR) or Explanation of Benefits (EOB).
Most likely, the reason code will show that the insurance company only ran your bill in a computer database and that the database recommended that your PIP claim be denied or reduced (unfortunately, it happens all of the time).
Despite what insurance companies will say, this is not a reasonable investigation because it does not consider subjective factors that go into each bill. For instance, the database doesn’t consider your experience and qualifications as a doctor, which can help justify your medical bills.
And by solely relying on a computer, insurance adjusters are not actually adjusting PIP claims — they are rubber stamping the computer’s denials.
Most Texas doctors give up on collecting the unpaid portion of their bills because they don’t know this next part…
If your medical bills are reduced or denied by a computer system, then the Texas Insurance Code may allow for you to receive up to three times the unpaid amount of the medical bills you submitted plus attorney’s fees.
But, the only way this can apply to you is if the client signed an Assignment of Benefits. As a result, every Texas doctor that accepts PIP should protect themselves by always having the client sign an Assignment of Benefits.
If you have an Assignment of Benefits and the insurance company used a computer system to reduce your bill, then reach out to me at firstname.lastname@example.org because you very well may have a legal right to be paid under the Texas Insurance Code.
I’d be happy to look into the matter.
4) First Come, First Served
This one is short and simple.
Yet, doctors make this mistake all of the time!!!
Always remember that PIP is first come, first served.
This means that if the client sees other doctors, then the client’s PIP may be exhausted by those other doctors. So, if you wait to submit the bills to PIP until after treating the client, then there may not be any PIP money left if the other doctors beat you to the punch.
And if you’re too late to collect PIP, then you’re stuck waiting for the entire case to resolve and you’re having to keep your fingers crossed that the liability settlement will pay your bills.
Avoid this issue by not procrastinating. Be smart by submitting PIP claims periodically during the course of treatment.
5) Insurer’s Deadline to Respond
This is another harm that Texas doctors are unaware is occurring every day.
Under Texas Law, insurance companies are required to respond to your insurance claims within 15 days.
More specifically (and I’m summarizing the law here for simplicity purposes), insurance companies must ask for more documentation within 15 days of receiving your PIP claim.
If the insurance company doesn’t ask for more documentation or after receiving additional documentation, then the insurance company must accept or reject payment of your PIP claim within 15 business days from receiving the PIP claim or the new documentation.
This means that you should always fax in your PIP claims so you have proof when the insurance company received the claim. And then begin counting down the days.
If the insurance company doesn’t respond timely, then you’re owed the entire claim amount, interest, and attorney’s fees (assuming you have an Assignment of Benefits).
If the insurance company refuses to pay you for the delay, then shoot me an email at email@example.com because I’ll be happy to see if I can help.
In my experience, most Texas doctors are unaware of most, if not all, of these facts surrounding PIP.
Actually, most lawyers are unaware of some of these facts as well because PIP violations by insurance companies are not “big-ticket items” and therefore never hit those lawyers’ radars.
But for doctors that accept PIP, these insurance violations and tactics can really add up over time for the doctor. As a result, the unaware doctors are losing out on potentially thousands or tens of thousands of dollars.
Avoid having a similar fate by using these 5 important facts to your benefit today!
Now the boring stuff:
This is not legal advice. This content and all of the content on this site is for informational purposes only. You should contact your attorney to obtain legal advice with respect to any particular issue or problem. Nothing here should be construed to form an attorney client relationship of any kind.