So, you've managed to navigate the Personal Injury Benefits (PIP) portion of your automobile insurance policy enough to obtain coverage for your medical treatment arising out of your motor vehicle accident. You have even gone on an Independent Medical Examination (IME) by one of your insurance company's doctors to evaluate whether you have reached Maximum Medical Improvement (MMI). And now, you've received a letter from your insurance company advising you that, as of a very near date in the future, you will no longer be covered by PIP for medical treatment for a certain specialty.
So, why has your insurance company cut you off from treatment when you feel that you still need to go? The most common reason is that the PIP doctor that you saw for your IME made the determination that you have reached MMI and no additional medical treatment will help you get any better. Another reason could be that your doctor's office is not following PIP protocol and has not properly documented why you need continuing treatment.
If the determination was made by your PIP carrier that you have reached MMI, that decision can be overturned. It is up to your doctor's office to send a written appeal, documenting why you need continuing treatment and explaining that you have not reached MMI. If your doctor's appeal is denied, it is up to the doctor whether or not he/she will continue treating you and arbitrate the claim in a PIP arbitration. Alternatively, once PIP has denied treatment, you can utilize your private health insurance to pay for continuing treatment.
So, don't lose all hope if you get a cut-off letter from PIP. If you have a lawsuit, your attorney will receive a copy of the letter and can advise you what to do. If you do not have an attorney, talk to your doctor to find out if he/she will be filing an appeal of the decision. Do not hesitate to contact me directly if you have any automobile accident injury questions.
Lara Lovett is a member of Stark & Stark’s Lawrenceville, New Jersey office, specializing in Accident & Personal Injury Law. For more information, please contact Ms. Lovett.