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Medicare Fee Schedule and Florida PIP Coverage


In the state of Florida and other states that use no-fault auto insurance systems, specific issues involving insurance payouts are often part of traffic accident personal injury claims. Florida personal injury lawyers need to address these issues from a local and state perspective to help represent their clients’ interests in court. These kinds of issues are often at the heart of how settlements or payouts cover the costs of an injury, especially those related to medical bills.


PIP Coverage

Personal Injury Protection (PIP) coverage was put in place in no-fault systems to help provide payouts to traffic accident injury victims. Various rules were set for evaluating accidents and adjusting payouts. These are often integrated into a traffic accident personal injury case, where the responsibility for compensating injured parties has to be worked out between various companies and individuals. Amendments to FS §627.736(5)(a) permitted insurance companies to significantly limit payment of certain expenses.

Medicare Fee Schedules

Florida insurance companies have used Medicare fee schedules to adjust personal injury protection claims. While this may be applicable in some instances, Florida courts have challenged some uses of Medicare fee schedules, because they may not be in keeping with the broader principles of PIP coverage. Medicare provides a different payment model that has specific applications to a “full practice” care provider’s business. In some cases, there’s the question of whether a Medicare payment model would unfairly restrict amounts of money paid for post-accident and recovery care.

Advocating for Personal Injury Victims

We, Florida personal injury lawyers in the state of Florida will understand the history of Florida’s no-fault system and PIP payment issues that have arisen from this model. We do the fact-finding to make sure that courts understand the responsibility of parties to compensate our clients. We will also look at whether payouts are artificially limited or restricted, according to rules that may be contradictory or overly restrictive of settlement awards or payouts.

Having a qualified and knowledgeable Florida personal injury lawyer involved in an automobile accident case is a critical part of getting compensation for traffic accident injuries and other kinds injuries suffered because of someone else’s mistakes. Getting the best advice can make all of the difference in whether a family can get the money that they need for costs of care, recovery and more.


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