The state has always seen a high number of cases involving personal injury protection litigation and it could see a surge in the near future because of recent court rulings.
In April, the Third District Court of Appeal (DCA) in Priority Medical Centers, LLC a/a/o Susan Boggiardino v. Allstate Insurance Co., maintained the 2012 revisions to the Florida No-Fault Act demanding the carrier to compensate a diagnostic imaging provider in accordance to the 2007 non-facility limiting charge.
The court said this relates when the amount is higher than the participating physician fee schedule.
The rendering is likely to negatively impact insurance companies’ liability for a possible underpayment in almost any claim from the past five years in which an X-ray or MRI code was reimbursed according to the participating physician fee schedule.
Alexander J. Mendez, with the law firm Marshall Dennehey Warner Coleman & Goggin, said he couldn’t comment on the increase in liability costs for insurers.
“Based on the ruling, once a pre-suit demand letter is received by an insurer from a plaintiff with the CPT [current procedural terminology] codes in question for limiting charge reimbursement, it is my opinion that they should respond with the proper adjusted benefits owed,” he said. “This may help decrease litigation expenses or seek early dismissals if payment was properly issued and the plaintiff files suit."
Mendez added there appears to be an uptick in cases where the plaintiff is a diagnostic imaging provider or a provider who had billed a diagnostic CPT code falling under the ruling Priority Medical.
“However, it should be noted it is not simply diagnostic CPT codes that are in need for adjustment, but also CPT codes where the 2007 limiting charge is the highest rate,” he stated.
“With an influx of cases from these providers, both the plaintiff and plaintiff’s attorneys are seeking adjusted reimbursement at the Limiting Charge rate and statutory attorney’s fees and costs, respectively. While the providers are receiving a nominal adjustment in benefits, the true drive behind the increase in lawsuits being filed is the ability for plaintiffs to successfully challenge the reimbursement and be awarded attorney’s fees."
Mendez said additionally, there are lawsuits pending prior to the Third DCA’s ruling.
"While for many years these lawsuits may have seemed frivolous and defendable, as the providers were generally properly reimbursed at the participating physician fee schedule, they are now ripe for settlement," he said.
Mendez said this could potentially increase rates but it was difficult to foretell.
“Personal Injury Protection (PIP) has historically been a high volume practice with new reimbursement issues/case law coming out frequently and carriers are aware of this ever-changing landscape,” he said.