Insurance providers are master advertisers. From friendly European lizards to business-casual ostriches, these massive companies know how to gain your trust through humor and charm.

While their mascots and jingles might make you feel warm and fuzzy, actually dealing with insurance companies after a serious injury is a completely different story.

That difference often becomes painfully clear the moment your insurer suddenly stops paying your PIP benefits.

In this blog, we’ll discuss why your benefits may have been cut, what to do when your medical bills stop getting paid, and how to get your coverage back on track.

Why Were My Benefits Denied?

A bad accident has a way of disrupting all of the constants in your life. Serious injuries can limit your ability to walk, communicate, and live like you did before. Showing up to doctors appointments and resting in bed unfortunately becomes the daily norm for many accident victims.

The sad thing is – auto insurance companies don’t care. Even though your world has imploded and you might feel like a shell of your former self, this is absolutely meaningless to them.

To insurance companies, you’re nothing more than a name and number on a spreadsheet. The less money that gets spent on you, the better.

With this background information in mind, consider this: after months of being treated for accident related injuries, you receive a letter saying you owe one of your medical providers thousands. How is this so? Weren’t they given clear instructions to bill your auto insurance?

The reason for this unsettling discovery could be:

• Missing paperwork or incomplete documentation: Sometimes when bills aren’t properly submitted to your insurance by medical providers, coverage can be denied.

• Adjuster delays or administrative issues: Adjusters are often assigned to multiple claims and have dozens of different providers to pay. This takes time and can cause delays.

• Insurer questions the treatment plan: If your insurance adjuster questions the necessity of a particular treatment, coverage for said treatment may be denied.

• Independent medical examination (IME) cutoff: If an IME doctor (hired by the insurer) deems you “recovered”, you may be denied coverage for future benefits.

While there is clearly a possibility that administrative errors are to blame for your denied benefits, the much more likely cause is your insurance company’s strong incentive to pay as little as possible toward your claim.

What You Should Do Right Away

If your benefits were denied and you’re now on the receiving end of angry phone calls and collection notices – don’t panic. This happens all the time.

First and most importantly, don’t stop receiving medical treatment. Gaps in treatment can hurt your health and also undermine the perceived severity of your claim. If PIP payments stop being made by your insurer, you should:

• Continue treatment
• Contact your attorney as soon as possible to explain the situation
• Instruct your medical providers to continue billing your auto insurance
• Gather unpaid bills, denial letters, and collection notices related to your care

Most providers will understand the situation you’re in and will happily continue billing your auto insurance. If a provider refuses to do so (or insists on billing your health insurance instead), let them know you’re working with an attorney and ask them to contact your attorney’s office for a more detailed explanation of what’s going on.

How an Attorney Gets Your Benefits Restarted

Scenarios like these are the exact reason personal injury attorneys exist. If you’re not yet working with a personal injury attorney at this stage in your claim, now would be a great time to consider contacting one.

Assuming you’re already working with an attorney, the next steps to get your coverage back on track are:

• Clearing up paperwork issues: Having dealt with similar scenarios before, your attorney will likely know exactly what incomplete documents and/or missing forms are holding things up. A quick phone call to one of your providers is sometimes all that’s needed to resume your PIP coverage.
• Speaking directly with the adjuster: In many instances, coverage is denied due to delays on part of your adjuster. Often, your attorney will be able to get things back on track by simply calling your adjuster and speaking with them.
• Challenging improper IME findings: If your coverage was denied due to the result of an IME, your attorney can provide additional medical records and challenge the findings of this exam.

Paper work and administrative issues are normally fixed within a couple of days. Challenging the findings of an IME often takes longer, but an experienced attorney will know how to navigate this process.

Most issues resolve before legal action is needed. However, if your insurer is being particularly difficult and refuses to pay even after your attorney disputes your IME, a first-party lawsuit (against your own insurance company) may be necessary to obtain the full extent of your PIP benefits.

Get David Get Paid

If you were recently denied PIP benefits after an accident, there’s only one personal injury firm you need to know. That’s Femminineo Law.

We have the experience and legal-expertise to get your benefits back on track. Whether you’re dealing with adjusters, need help starting a claim, or are just generally overwhelmed after an accident, we can help.

Give us a call at 855-65-CRASH or visit our website today! We’ll make sure you’re taken care of.

Get David. Get Paid.