RE: PIP question non-co-operative patient

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The insurer has a high burden to succeed in a non-cooperation defense. You might also offer them the information you have which would ordinarily be on the PIP application, and point out to the insurer that they’re not prejudiced because of the lack of the PIP app when they have the same information they would have had. Be careful about taking the insurer to small claims or circuit court vs private arbitration under the policy. Oregon’s claim splitting rules say essentially that anyone whose rights derive from another’s (i.e. your right to pursue the claim on an assignment of part of the patient’s rights) can bind all the parties to a judgment. They also require all claims to be brought in a single case to prevent repeated litigation of related issues, e.g. one suit for the first month of tx, another for the rest of the tx, another for the pain and suffering, another for the property damage. Once one part of the case is reduced to judgment, it will likely bar all other parts of the case, and if the patient later needs to use the court system, your small claims or circuit court judgment will bar the patient’s claim. Private arbitration under the PIP policy allows you to stand in the shoes of the insured and is not binding on any related court cases. You can also do that yourself, or hire an attorney, although without the ability to recover attorney’s fees in addition to the bills, you’re looking at a max upside of 60% or so if you hire an attorney to recover your bills via PIP arbitration. T. Hill, PC520 SW Sixth Avenue, Suite 1250Portland, OR 97204(503) 227-4330chill@...http://www.portlandinjurylaw.com From: oregondcs [mailto:oregondcs ] On Behalf Of Dr. Elliott MantellSent: Friday, May 11, 2012 4:47 PMTo: Oregon DC'SSubject: PIP question non-co-operative patient Hello all especially PIP attorneys, I had a patient who was under care for several months. He was referred from a regular patient and both were in the same MVA. Apparently the non-co-operative patient who was the passenger (the driver was at fault, and she has filled out the Insurance PIP application) has not filled out his PIP application. To date he has not returned our calls or responded to the bill that was sent to him. He is not currently under care. I know my office manager should have been alerted to this sooner. Nevertheless, she has told me that the adjuster has stated that she or he have tried to contact the patient even at his employment, but has not had calls returned or PIP application requests returned. The patient has signed a Direct Payment Authorization and Notice of Assignment Doctor's Lien form and Office Policy Regarding Insurance Payment form in which he authorized payment of any medical benefits, or settlement to the physician. So are these forms good enough where in the PIP carrier Nationwide, or can they not pay because the patient has failed to file PIP application. We have not seen the patient in over 6 weeks. We do have in our file a report request from Feb 28, 2012 from Nationwide's Chiropractic reviewer, but with a note from the claims adjuster on March 14, 2012 stating that that form was no longer required.Any advice short of taking him to small claims court, of which I dont believe it would be easy to collect from him once a judgment is obtained. thank youElliott Mantell DC