PIP Insurance Billing Guide - Davis Law Group, P.S.
2
Davis Law Group, P.S. 2101 Fourth Ave., Suite 630 Seattle, WA 98121 206.727.4000 DavisLawGroupSeattle.com Motorcycle Accidents Primary PIP not automatically required for motorcycle policies. If PIP exists, bill the PIP or Med Pay for the patient’s motorcycle policy. Secondary If patient was passenger on mo- torcycle and/or patient or pa- tient’s household did not own motorcycle, bill patient’s personal car PIP policy Additional If patient is a minor & parents are divorced: patient can possi- bly make claim under both par- ents’ auto PIP policies. Bill the Auto PIP carrier i.e. the car that hit the patient. Secondary Bill patient’s auto PIP carrier or the PIP insurance of some- one in patient’s household. Additional If patient is a minor & parents are divorced: patient can possibly make claim under both parents’ auto/PIP policy. Pedestrian or Bicycle Accidents PIP Insurance Billing Guide Scenario: Patient injured an auto NOT owned by him/her or another member of the same household Primary Bill patient’s PIP carrier or PIP carrier covering the auto patient was in. Secondary Bill patient’s PIP carrier or PIP carrier for some- one in patient’s house- hold. Additional If patient is a minor & par- ents are divorced: patient can possibly make claim under both parents’ auto PIP policies. Scenario: Patient a passenger in an uninsured vehicle Primary Bill patient’s own PIP. If patient doesn’t own a car, or has no PIP, then bill a PIP policy in patients household. Secondary If patient a minor & par- ents are divorced: patient can possibly make claim under both parents’ auto PIP policies. Scenario: If patient was injured in his/her own auto or in an auto owned by someone in patient’s household Primary Bill PIP for that auto. Secondary If patient is a minor & par- ents are divorced: patient can possibly make claim under both parents’ auto PIP policies. Auto Accidents The Ten Biggest Mistakes That Can Wreck Your Washington Accident Case by Christopher M. Davis, Attorney at Law It’s FREE as a public service to injured WA citizens! Get your copy today by visiting: www.WashingtonAccidentBook.com *Some policies allow you to stack the PIP coverage ($10,000 + $10,000) while others will only extend secondary coverage in an amount greater than the primary amount. Example: If the primary coverage is $10,000 and the secon- dary is $25,000, the most the secondary policy will allow is $15,000. You should always request copy of PIP policy to make sure. *Wash. law requires mandatory PIP coverage unless the policyholder rejects PIP in writing. If the carrier says no coverage, always ask for copy of the insured’s written PIP rejection. If no written rejection is produced, the carrier must offer PIP coverage — no exceptions.
Transcript of PIP Insurance Billing Guide - Davis Law Group, P.S.
Da
vis
La
w G
rou
p,
P.S
.
21
01
Fo
urt
h A
ve.,
Su
ite
63
0
Sea
ttle
, W
A 9
81
21
20
6.7
27
.40
00
Da
visL
aw
Gro
up
Sea
ttle
.co
m
Mo
torc
ycl
e A
ccid
en
ts
Pri
ma
ry
PIP
no
t a
uto
ma
tica
lly r
eq
uir
ed
fo
r
mo
torc
ycle
po
licie
s. I
f P
IP e
xist
s,
bill
th
e P
IP o
r M
ed
Pa
y fo
r th
e
pa
tie
nt’
s m
oto
rcyc
le p
olic
y.
Se
con
da
ry
If p
ati
en
t w
as
pa
sse
ng
er
on
mo
-
torc
ycle
an
d/o
r p
ati
en
t o
r p
a-
tie
nt’
s h
ou
seh
old
did
no
t o
wn
mo
torc
ycle
, b
ill p
ati
en
t’s
pe
rso
na
l
car
PIP
po
licy
Ad
dit
ion
al
If p
ati
en
t is
a m
ino
r &
pa
ren
ts
are
div
orc
ed
: p
ati
en
t ca
n p
oss
i-
bly
ma
ke c
laim
un
de
r b
oth
pa
r-
en
ts’
au
to P
IP p
olic
ies.
Bill
th
e A
uto
PIP
carr
ier
i.e
. th
e c
ar
tha
t h
it t
he
pa
tie
nt.
Se
con
da
ry
Bill
pa
tie
nt’
s a
uto
PIP
ca
rrie
r o
r th
e P
IP
insu
ran
ce o
f so
me
-
on
e in
pa
tie
nt’
s
ho
use
ho
ld.
Ad
dit
ion
al
If p
ati
en
t is
a m
ino
r &
pa
ren
ts a
re d
ivo
rce
d:
pa
tie
nt
can
po
ssib
ly
ma
ke c
laim
un
de
r b
oth
pa
ren
ts’
au
to/P
IP p
olic
y.
Pe
de
stri
an
or
Bic
ycl
e
Acc
ide
nts
PIP
In
sura
nce
Bil
lin
g G
uid
e
Sce
na
rio
: P
ati
en
t in
jure
d
an
au
to N
OT
ow
ne
d b
y
him
/he
r o
r a
no
the
r
me
mb
er
of
the
sa
me
ho
use
ho
ld
Pri
ma
ry
Bill
pa
tie
nt’
s P
IP c
arr
ier
or
PIP
ca
rrie
r co
veri
ng
the
au
to p
ati
en
t w
as
in.
Se
con
da
ry
Bill
pa
tie
nt’
s P
IP c
arr
ier
or
PIP
ca
rrie
r fo
r so
me
-
on
e in
pa
tie
nt’
s h
ou
se-
ho
ld.
Ad
dit
ion
al
If p
ati
en
t is
a m
ino
r &
pa
r-
en
ts a
re d
ivo
rce
d:
pa
tie
nt
can
po
ssib
ly m
ake
cla
im
un
de
r b
oth
pa
ren
ts’
au
to
PIP
po
licie
s.
Sce
na
rio
: P
ati
en
t a
pa
sse
ng
er
in a
n
un
insu
red
ve
hic
le
Pri
ma
ry
Bill
pa
tie
nt’
s o
wn
PIP
. I
f
pa
tie
nt
do
esn
’t o
wn
a c
ar,
or
ha
s n
o P
IP,
the
n b
ill a
PIP
po
licy
in p
ati
en
ts
ho
use
ho
ld.
Se
con
da
ry
If p
ati
en
t a
min
or
& p
ar-
en
ts a
re d
ivo
rce
d:
pa
tie
nt
can
po
ssib
ly m
ake
cla
im
un
de
r b
oth
pa
ren
ts’
au
to
PIP
po
licie
s.
Sce
na
rio
: If
pa
tie
nt
wa
s
inju
red
in h
is/h
er
ow
n
au
to o
r in
an
au
to
ow
ne
d b
y so
me
on
e in
pa
tie
nt’
s h
ou
seh
old
Pri
ma
ry
Bill
PIP
fo
r th
at
au
to.
Se
con
da
ry
If p
ati
en
t is
a m
ino
r &
pa
r-
en
ts a
re d
ivo
rce
d:
pa
tie
nt
can
po
ssib
ly m
ake
cla
im
un
de
r b
oth
pa
ren
ts’
au
to
PIP
po
licie
s.
Au
to A
ccid
en
ts
Th
e T
en
Big
ge
st M
ista
ke
s T
ha
t C
an
Wre
ck Y
ou
r W
ash
ing
ton
A
ccid
en
t C
ase
b
y C
hri
sto
ph
er
M. D
av
is,
Att
orn
ey
at
La
w
It
’s FREE
as
a p
ub
lic s
erv
ice
to
inju
red
WA
ci
tize
ns!
Ge
t yo
ur
cop
y to
da
y b
y v
isit
ing
:
ww
w.W
ash
ingto
nAccidentB
ook
.co
m
*S
om
e p
olic
ies
all
ow
yo
u t
o s
tack
th
e P
IP c
ove
rag
e (
$1
0,0
00
+ $
10
,00
0)
wh
ile o
the
rs w
ill o
nly
ext
en
d s
eco
nd
ary
co
vera
ge
in a
n a
mo
un
t g
rea
ter
tha
n t
he
pri
ma
ry a
mo
un
t. E
xam
ple
: If
th
e p
rim
ary
co
vera
ge
is $
10
,00
0 a
nd
th
e s
eco
n-
da
ry is
$2
5,0
00
, th
e m
ost
th
e s
eco
nd
ary
po
licy
will
allo
w is
$1
5,0
00
. Y
ou
sh
ou
ld a
lwa
ys r
eq
ue
st c
op
y o
f P
IP p
oli
cy t
o m
ake
su
re.
*W
ash
. la
w r
eq
uir
es
ma
nd
ato
ry P
IP c
ove
rag
e u
nle
ss t
he
po
licy
ho
lde
r re
ject
s P
IP in
wri
tin
g.
If
the
ca
rrie
r sa
ys n
o c
ove
rag
e,
alw
ays
ask
fo
r co
py
of
the
in
sure
d’s
wri
tte
n P
IP r
eje
ctio
n.
If
no
wri
tte
n r
eje
ctio
n is
pro
du
ced
, th
e c
arr
ier
mu
st o
ffe
r P
IP c
ove
rag
e —
no
exc
ep
tio
ns.
Denia
l of PIP Insura
nce M
edical C
laim
Denia
l of PIP Insura
nce M
edical C
laim
Denia
l of PIP Insura
nce M
edical C
laim
Denia
l of PIP Insura
nce M
edical C
laim
Ther
e ar
e se
vera
l rul
es t
hat
gove
rn u
nder
wha
t ci
rcum
stan
ces
an a
uto
insu
ranc
e co
mpa
ny c
an d
eny
or li
mit
a P
IP m
edic
al c
laim
.Th
ere
are
seve
ral r
ules
tha
t go
vern
und
er w
hat
circ
umst
ance
s an
aut
o in
sura
nce
com
pany
can
den
y or
lim
it a
PIP
med
ical
cla
im.
Ther
e ar
e se
vera
l rul
es t
hat
gove
rn u
nder
wha
t ci
rcum
stan
ces
an a
uto
insu
ranc
e co
mpa
ny c
an d
eny
or li
mit
a P
IP m
edic
al c
laim
.Th
ere
are
seve
ral r
ules
tha
t go
vern
und
er w
hat
circ
umst
ance
s an
aut
o in
sura
nce
com
pany
can
den
y or
lim
it a
PIP
med
ical
cla
im.
Firs
t, in
eve
ry c
ase
prio
r to
den
ying
a c
laim
for
PIP
ben
efit
s, t
he in
sura
nce
carr
ier
mus
t pr
ovid
e th
e cl
aim
ant
wit
h a
writ
ten
expl
ana-
tion
of c
over
age
unde
r th
e po
licy,
and
incl
ude
a no
tice
tha
t th
e ca
rrie
r m
ay d
eny,
lim
it o
r te
rmin
ate
bene
fits
in c
erta
in s
itua
tion
s.
Seco
nd, t
he P
IP c
arrie
r m
ay o
nly
deny
, lim
it o
r te
rmin
ate
PIP
bene
fits
if t
he t
reat
men
t is
con
side
red
eith
er (1
) not
rea
sona
ble,
(2) n
ot
nece
ssar
y, (3
) not
rel
ated
to
the
acci
dent
, or
(4) n
ot in
curr
ed w
ithi
n 3
year
s af
ter
the
acci
dent
. Th
ese
are
the
only
rea
sons
whi
ch w
ill Th
ese
are
the
only
rea
sons
whi
ch w
ill Th
ese
are
the
only
rea
sons
whi
ch w
ill Th
ese
are
the
only
rea
sons
whi
ch w
ill ju
stif
y a
deni
al o
f th
e cl
aim
.ju
stif
y a
deni
al o
f th
e cl
aim
.ju
stif
y a
deni
al o
f th
e cl
aim
.ju
stif
y a
deni
al o
f th
e cl
aim
. O
nly
one
of t
hese
fou
r re
ason
s ne
ed b
e pr
esen
t to
just
ify
a de
nial
. Th
ird, t
he P
IP c
arrie
r’s
deci
sion
to
deny
, lim
it, o
r te
rmin
ate
the
clai
man
t’s
PIP
bene
fits
mus
t be
bas
ed o
n th
e re
view
and
opi
nion
of
a m
edic
al o
r he
alth
care
pro
fess
iona
l, i.e
., a
phys
icia
n. S
peci
fica
lly, a
"med
ical
or
heal
th c
are
prof
essi
onal
" can
not
incl
ude
an in
sura
nce
com
-Sp
ecif
ical
ly, a
"med
ical
or
heal
th c
are
prof
essi
onal
" can
not
incl
ude
an in
sura
nce
com
-Sp
ecif
ical
ly, a
"med
ical
or
heal
th c
are
prof
essi
onal
" can
not
incl
ude
an in
sura
nce
com
-Sp
ecif
ical
ly, a
"med
ical
or
heal
th c
are
prof
essi
onal
" can
not
incl
ude
an in
sura
nce
com
-pa
ny's
clai
m r
epre
sent
ativ
es, a
djus
ters
, or
man
ager
s or
any
hea
lth
care
pro
fess
iona
l in
the
dire
ct e
mpl
oy o
f th
e in
sure
r. pa
ny's
clai
m r
epre
sent
ativ
es, a
djus
ters
, or
man
ager
s or
any
hea
lth
care
pro
fess
iona
l in
the
dire
ct e
mpl
oy o
f th
e in
sure
r. pa
ny's
clai
m r
epre
sent
ativ
es, a
djus
ters
, or
man
ager
s or
any
hea
lth
care
pro
fess
iona
l in
the
dire
ct e
mpl
oy o
f th
e in
sure
r. pa
ny's
clai
m r
epre
sent
ativ
es, a
djus
ters
, or
man
ager
s or
any
hea
lth
care
pro
fess
iona
l in
the
dire
ct e
mpl
oy o
f th
e in
sure
r. T
hus,
an
adju
stor
can
-no
t de
ny a
PIP
cla
im o
n hi
s or
her
ow
n, a
nd w
itho
ut t
he s
uppo
rt o
f a
med
ical
opi
nion
. Fo
urth
, the
med
ical
or
heal
thca
re p
rofe
ssio
nal r
elie
d on
by
the
carr
ier
mus
t be
cur
rent
ly
mus
t be
cur
rent
ly
mus
t be
cur
rent
ly
mus
t be
cur
rent
ly
licen
sed,
cer
tifi
ed, o
r re
gist
ered
to
prac
tice
in t
he s
ame
heal
th f
ield
or
spec
ialt
y as
the
hea
lth
licen
sed,
cer
tifi
ed, o
r re
gist
ered
to
prac
tice
in t
he s
ame
heal
th f
ield
or
spec
ialt
y as
the
hea
lth
licen
sed,
cer
tifi
ed, o
r re
gist
ered
to
prac
tice
in t
he s
ame
heal
th f
ield
or
spec
ialt
y as
the
hea
lth
licen
sed,
cer
tifi
ed, o
r re
gist
ered
to
prac
tice
in t
he s
ame
heal
th f
ield
or
spec
ialt
y as
the
hea
lth
care
pro
fess
iona
l tha
t tr
eate
d th
e in
sure
d.ca
re p
rofe
ssio
nal t
hat
trea
ted
the
insu
red.
care
pro
fess
iona
l tha
t tr
eate
d th
e in
sure
d.ca
re p
rofe
ssio
nal t
hat
trea
ted
the
insu
red.
Fi
fth,
if t
he c
laim
ant
is b
eing
tre
ated
by
mor
e th
an o
ne h
ealt
h ca
re p
rofe
ssio
nal,
the
re-
view
sha
llsh
all
shal
lsh
all b
e co
mpl
eted
by
a pr
ofes
sion
al li
cens
ed, c
erti
fied
, or
regi
ster
ed t
o pr
acti
ce in
the
sa
me
heal
th f
ield
or
spec
ialt
y as
the
prin
cipa
l pre
scrib
ing
or d
iagn
osin
g pr
ovid
er, u
nles
s ot
herw
ise
sam
e he
alth
fie
ld o
r sp
ecia
lty
as t
he p
rinci
pal p
resc
ribin
g or
dia
gnos
ing
prov
ider
, unl
ess
othe
rwis
e sa
me
heal
th f
ield
or
spec
ialt
y as
the
prin
cipa
l pre
scrib
ing
or d
iagn
osin
g pr
ovid
er, u
nles
s ot
herw
ise
sam
e he
alth
fie
ld o
r sp
ecia
lty
as t
he p
rinci
pal p
resc
ribin
g or
dia
gnos
ing
prov
ider
, unl
ess
othe
rwis
e ag
reed
to
by t
he in
sure
d an
d th
e in
sure
r. ag
reed
to
by t
he in
sure
d an
d th
e in
sure
r. ag
reed
to
by t
he in
sure
d an
d th
e in
sure
r. ag
reed
to
by t
he in
sure
d an
d th
e in
sure
r. Th
is d
oes
not
proh
ibit
the
insu
rer
from
pro
vidi
ng a
ddi-
tion
al r
evie
ws
of o
ther
cat
egor
ies
of p
rofe
ssio
nals
.
Fina
lly, t
he in
sura
nce
com
pany
’s e
xpla
nati
on f
or t
he d
enia
l of
PIP
bene
fits
mus
t be
cle
ar
enou
gh s
o th
at t
he c
laim
ant
does
not not
not
not
need
to
reso
rt t
o ad
diti
onal
res
earc
h to
und
er-
addi
tion
al r
esea
rch
to u
nder
-ad
diti
onal
res
earc
h to
und
er-
addi
tion
al r
esea
rch
to u
nder
-st
and
the
reas
on f
or t
he a
ctio
n.st
and
the
reas
on f
or t
he a
ctio
n.st
and
the
reas
on f
or t
he a
ctio
n.st
and
the
reas
on f
or t
he a
ctio
n. A
sim
ple
stat
emen
t, f
or e
xam
ple,
tha
t th
e se
rvic
es a
re
"not
rea
sona
ble
or n
eces
sary
" is
not
suff
icie
ntno
t su
ffic
ient
not
suff
icie
ntno
t su
ffic
ient
.
Da
vis
La
w G
rou
p,
P.S
. 2
10
1 F
ou
rth
Ave
., S
uit
e 6
30
Sea
ttle
, W
A 9
81
21
20
6.7
27
.40
00
Da
visL
aw
Gro
up
Se
att
le.c
om
C
hri
s D
av
is
Att
orn
ey
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