My PIP Insurance Carrier Denied My Claim or Won't Pay My Medical Bills
Baltimore personal injury lawyers see this happen every day. The PIP law requires that insurance companies pay all "reasonable" and "necessary" medical expenses up to the policy limits for those that buy PIP insurance from them.
The reality is insurance companies almost never pay the full amount of the medical bills they are sent.
Insurers sometimes contest if a service was "necessary", which the courts define as something that in light of the patients condition, and in light of other possible treatments, had some "efficacious value" Sabatier v. State Farm, 609 A.2d 307.
More often, insurers contest if the charge for the service was "reasonable", and refuse to pay it, or refuse to pay it in full.
Not surprisingly, no Baltimore personal injury lawyer has ever seen a case where the PIP carrier refused to pay because the charge was too low, and therefore unreasonable. PIP carriers routinely refuse to honor charges that it views as too high, or "reduce" charges to a level that the carrier, arbitrarily, decides is "reasonable - even though there is no direct authority in the PIP statute authorizing this process.
I've been involved with thousands of PIP applications, disputes, and cases. If the dispute is over medical billing with an insurance company and a doctor, the client may have little interest in the outcome.
What about a situation where the Insurance Company refuses to pay a PIP lost wages claim.
Here, the level of client interest is more palpable, and direct. Disputes over lost wage benefits are much less frequent than those involving reduced medical bills, but they do occur.
*The Assembly has recently enacted a change in this process. Marylanders now have the option of carrying less insurance. An insured may now reject personal injury protection altogether, under specific circumstances. See Insurance Article, Md. INSURANCE Code Ann. § 19-506.1.
-This Article was updated by Eric Kirk on 8/26/19