Insurance Games With Pip Payout Logs

PIP payout logs can be invaluable tools to determine whether benefits are exhausted or if an insurance company has paid medical providers the correct amount of interest and medical bills. Insurance companies are hard-pressed to produce PIP payout logs before litigation. This is because a not-so-thoughtful District Court of Appeals ruled that an insurance company is not required to produce a PIP payout log pre-suit on the grounds that it would cause increased litigation if PIP payout logs were produced pre-suit. Later, the Florida Legislature amended the PIP statute that required insurance companies to produce PIP payout logs within 3o days of receipt of a request, but this can only be done post-suit.

The PIP law also requires an insurance company to inform a medical provider within 15 days of the date that an insurance company exhausts its PIP policy limits that its benefits are exhausted. But how can a medical provider verify if benefits are truly exhausted pre-suit? A medical provider is out of luck on this one because the only time an insurance company is required to give a medical provider a PIP payout log is after a lawsuit is filed. This means that the only way to truly verify if benefits are exhausted is to file a lawsuit. How the District Court of Appeals’ rationale that preventing a PIP payout log to be produced pre-suit will slow litigation is a complete mystery and is another example of how District Courts of Appeals can sometimes misunderstand PIP law.

PIP payout logs are also notoriously incorrect. Let’s face it, anyone can create a PIP payout log and put anything on it. PIP payout logs are not statements under oath and can be inaccurate with no penalty to an insurance company. I have seen PIP payout logs that list medical providers that have never made a PIP claim, and show payment to those medical providers; PIP payout logs that list interest as a “medical bill”; PIP payout logs that have wrong dates of service and wrong amounts of medical bills. It is to the advantage of the insurance company to include as much as possible listed on a PIP payout log to reach its $10,000.00 policy limits to claim that benefits are exhausted as an excuse to deny medical bills. So, a medical provider must verify the accuracy of a PIP payout log as a PIP payout log is simply a guide to the amount of medical bills that have been paid. A PIP payout log is by no means the end-all to be all to what the insurance company paid. In exhaustion of benefits cases, the best practice to truly verify of benefits are exhausted is to review explanations of review and copies of canceled checks.