1. Should I accept an Assignment of Benefits (A.O.B.) from my patients?

Yes, you should accept an A.O.B. This A.O.B. should include an assignment of rights. It is critical to your ability to pursue unpaid or improperly paid claims. Moreover, you should have someone review your current or future A.O.B. to determine whether it properly protects your right to collect on improperly paid claims.

2. Why do some Personal Injury Attorney's tell me not to accept an Assignment of Benefits?

There are several possible reasons why a P.I. Attorney would advise you to not accept an A.O.B.

1. They are not aware that a provision on the P.I.P. Statute was found unconstitutional and therefore, doctors who accept an A.O.B. are no longer compelled to arbitration.
2. They want to control the case on behalf of the patient, settle the P.I.P. suit and then use the medical benefits to negotiate your bill.
3. They want to generate a fee for the P.I.P. suit as another source of attorney revenue.
4. They care about both the patient/client and the doctors bill and want to do the right thing for everyone by getting the doctor paid properly for services provided.

Although there are many attorneys that fit in the category four, I still suggest that doctors accept an A.O.B. because of the inherent conflict of interest if the P.I. attorney is representing both the patient and the doctor.

3. Must I accept as full payment the "Usual & Customary" schedule statistically generated by the insurance company or the database of a third party?

No, you are not required to accept as full payment the U & C schedule communicated to you by the insurance company. Florida Statute requires PIP insurance carriers to pay "80% cost of the reasonable and necessary treatment." Therefore, the test is reasonableness not statistically calculated U & C. Since insurance companies and third party databases will not provide you or I with the data, we assume it is unreliable at best. Moreover, most companies that own the data are either owned or controlled by insurance companies.

4. Must I accept PPO contract rates for PIP claims?

For most claims the answer is no. Although you may have contracted with third parties such as Beechstreet, CCN or Medview, these contracts do not allow PIP Insurance Companies like Allstate, Nationwide and Progressive to avoid the requirements of the Florida PIP Statute. Florida Statute Section 627.736 (10) allows for PIP Insurers to create a voluntary PPO if they amount other things (1) issue a PPO PIP policy to their insured; (2) provide a list of contracted providers to their insured at the time they issue the PPO PIP policy and (3) if the PIP insurer direct contracts with the providers in the network.

To our knowledge, no PIP carriers are currently complying with these requirements. Therefore, the overwhelming majorities of Florida courts who have ruled on this issue say you do not have to accept PPO contract rates for PIP claims.