PI question

[Guest guest]

This is a good time to check and make sure that you have a clear, written financial policy ... and is pt. given a copy of this before any care begins? and should be verbalized too pt. before care (or even exam) begins...atached is my pt policy in a word format

J. , DCSpringbrookclinic.com Springbrook Chiropractic & Natural Health CenterCSPINE.org Home of the Oregon Chiropractic Forums & Calendar

Sanitas Innata Est

[Guest guest]

Good morning docs, I have a PI related question that I hope I can get some advice on. I have been seeing a patient for about 2 weeks that was involved in a PI in November, 2005. He previously was going to PT but was only seeing minimal results (and was only going 1x/2 weeks for a 30min session---Kaiser). He did not file a claim with his insurance company until the day before he came for his initial visit with me and says that Kaiser (PT) hasn't billed for the past 3+ months yet (which doesn't make sense to me??). I called his insurance company and they say they are still determining if he has PIP coverage, as they just received the claim the day before. I still do not have confirmation of the PIP yet, and his account is reaching near $500. He is coming in today and I plan on telling him that until the PIP coverage is verified, his account needs to become up-to-date as soon as possible. My question is, if his PIP is denied, is representation needed? Should he seek representation immediately? Wait until the PIP decision is made? Any help on this topic is appreciated! Thanks. J. Tomaino, DC

[Guest guest]

Hmmm, why would they deny it and did you call the claim rep? They should be able to provide a quick answer.

If its a nebulous case at the outset, i as the treating doc would absolutely recommend representation. This will help protect his and your interests.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

PI question

Good morning docs, I have a PI related question that I hope I can get some advice on. I have been seeing a patient for about 2 weeks that was involved in a PI in November, 2005. He previously was going to PT but was only seeing minimal results (and was only going 1x/2 weeks for a 30min session---Kaiser). He did not file a claim with his insurance company until the day before he came for his initial visit with me and says that Kaiser (PT) hasn't billed for the past 3+ months yet (which doesn't make sense to me??). I called his insurance company and they say they are still determining if he has PIP coverage, as they just received the claim the day before. I still do not have confirmation of the PIP yet, and his account is reaching near $500. He is coming in today and I plan on telling him that until the PIP coverage is verified, his account needs to become up-to-date as soon as possible. My question is, if his PIP is denied, is representation needed? Should he seek representation immediately? Wait until the PIP decision is made? Any help on this topic is appreciated! Thanks. J. Tomaino, DC

[Guest guest]

At the outset of any claim, the adjuster/ insurer will do a coverage investigation. That's to make sure it is the kind of loss they pay for. E.g., that he was in a car they have a PIP policy on, that he was injured in an auto accident, etc. They probably will not do a medical exam or records review in an ordinary case, although with several months of built up bills which they have not had the opportunity to review plus the commencement of a new mode of treatment which might get expensive, they may request a medical exam in the near future.

If PIP is denied because of a medical exam, it's going to be tougher to find an attorney. Leaning on them before a medical exam will probably help the PIP carrier pay the bills. Leaning on them after a PIP denial is not always successful. If it's a coverage denial, PIP arbitration is a reasonable choice because there is the possibility of attorney's fees after 6 months from the proof of loss. If it's an "amount of benefits" denial and they use the correct language in their no-fees letter, then the client's best possible outcome at PIP arb is ~60% of the medical bills, which is not a very good outcome. And if you lose at the PIP arb, you've litigated and lost causation, which will be used against the claimant in the third party claim.

Making the call to a PI attorney is usually free, and if the case is a good third party case, I often deal with minor PIP issues (i.e. several letters and phone calls but not arbitration) gratis as a courtesy to the client and as a way to protect the third party claim.

Chris

T. Hill, PC520 S.W. Sixth Avenue, Suite 1250Portland, OR 97204Tel: (503) 227-4330Fax: (503) 227-3230chill@...www.cthlaw.com

PI questionGood morning docs, I have a PI related question that I hope I can get some advice on. I have been seeing a patient for about 2 weeks that was involved in a PI in November, 2005. He previously was going to PT but was only seeing minimal results (and was only going 1x/2 weeks for a 30min session---Kaiser). He did not file a claim with his insurance company until the day before he came for his initial visit with me and says that Kaiser (PT) hasn't billed for the past 3+ months yet (which doesn't make sense to me??). I called his insurance company and they say they are still determining if he has PIP coverage, as they just received the claim the day before. I still do not have confirmation of the PIP yet, and his account is reaching near $500. He is coming in today and I plan on telling him that until the PIP coverage is verified, his account needs to become up-to-date as soon as possible. My question is, if his PIP is denied, is representation needed? Should he seek representation immediately? Wait until the PIP decision is made? Any help on this topic is appreciated! Thanks. J. Tomaino, DC

[Guest guest]

Dr. Roselyn,Dr. Goldeen is correct that PIP will follow car in this instance.  Your patient's PIP is first to pay his medical bills.  I am not sure what exclusion Allstate is referring to.  I am happy to talk with you or patient more if you think it would help. 

Thank you Skelton  On Thu, Jun 3, 2010 at 11:00 AM, Ann Goldeen <anngoldeen@...> wrote:

 

The insurance goes with the car.  Usually the driver's PIP pays first.  There is always PIP when passengers are hurt and driver has insurance in Oregon.  Ann Goldeen

 

PI Question

 

Greetings -

Estab pt was passenger in his vehicle which was totalled in recent MVC.  Allstate is suggesting no medical benefits since he was not driving.

Legal advice appreciated!

 

Thanks.

Lily Roselyn, DC

-- SkeltonHeiling Dwyer & Associates1220 SW on, Ste 820Portland, Oregon 97205tel: 503.274.0404 | fax: 503.274.0004jason@... | www.heiling.com

[Guest guest]

That seems crazy. I'm covered in my car whether I'm driving, a passenger or if I'm parked and another person hits my car. Maybe there's some clause for high risk drivers that eliminates this? I've treated patients with high risk policies that have all sorts of diff clauses.

Minga

In a message dated 6/2/2010 9:41:32 P.M. Pacific Daylight Time, lilyroselyn22@... writes:

Greetings -

Estab pt was passenger in his vehicle which was totalled in recent MVC. Allstate is suggesting no medical benefits since he was not driving.

Legal advice appreciated!

Thanks.

Lily Roselyn, DC