Personal Injury Protection (PIP) Litigation
Overview
Personal Injury Protection (PIP) litigation requires careful and constant attention by any insurance company that provides such coverage. Small changes in the statute or regulatory framework can have a significant impact on the function and practice of PIP coverage and claims processing for an insurance company. Additionally, each day brings about new issues that plaintiffs' bars in PIP states are developing and pursuing in an attempt to gain additional leverage.
Marshall Dennehey recognizes that PIP litigation is as much dependent upon an innovative, efficient and intelligent approach to handling such claims and litigation as it is upon implementing solid and dependable claims practices company wide. We strive to protect our clients' interests and act as a primary resource our clients turn to when questions regarding PIP arise in their regular day-to-day claims processing practice.
Our PIP practice group is comprised of attorneys who are familiar with PIP laws and who have experience handling all facets of PIP litigation. These attorneys also devote a portion of their individual practices to insurance fraud and special investigation practice. Together, these groups provide practical solutions for all types of claims arising out of the use and operation of automobiles.
Marshall Dennehey currently defends clients in PIP matters throughout three major states with mandatory PIP coverage including New Jersey, New York, and Florida and act as national and regional coordinating counsel for major insurance carriers.
The areas of primary concern in PIP litigation include:
• General PIP Practice
• Permissive fee schedule litigation
• Medicare Part B statutory compliance (upcoding, physician's fee determinations, NCCI edits, modifiers)
• Application of the reserve provision for emergency services or hospital inpatient care
• Deductible application issues
• Requests for additional documentation
• HCFA form compliance
• Demand letter compliance
• Commercial motor vehicle right of reimbursement
• Licensure issues/lawfully rendered medical services issues
• Exhaustion of benefits issues
• Usual and Customary Reduction
• In permissive fee schedule cases, application of UCR to emergency services and care
• Peer review litigation
• Provider discovery of billing practices and existing billing agreements with insurance carriers
• Medical Necessity
• IME cut-offs and opinions on absence of injury
• Peer review and medical film review
• Pre-suit discovery
• EUO investigation of prior medical history
• Litigation discovery of claimant's medical history and accident facts through subpoena power
We would welcome the opportunity to work with you in the handling and litigation of PIP claims. Members of our practice group are also available to give presentations at your location or in one of our offices.
