Guest guest Posted January 16, 2012 Report Share Posted January 16, 2012 Unless they close their Case . I always have a conversation with the patient about this exact topic. I tell them that keeping their case open for the entire year behooves them for reasons such as exacerbation of original injury. “If you don’t have an urgent need monetarily, it would behoove you to keep the case open. Once you close the case your benefits stop for the most part and we won’t be able to treat you under PIP.†ph Medlin D.C. From: Cluen Sent: Monday, January 16, 2012 11:39 AM ; Vern Saboe Subject: House Bill 2369 Hi All! I had a patient come in for treatment due to an exacerbation of their condition. Their accident was in June 2011. They received treatment for 3 months. They came in again in December for an exacerbation for 2 visits. State Farm (her insurance) sent an explanation of review stating that because they settled with the 3rd party, State Farm will no longer be paying for treatment. We spoke to the adjuster and she is refusing to pay (regardless of explaining House Bill 2369). I thought that this bill clarified that the primary PIP cannot stop payment for treatment for 1 year. I know they can IME, but they are just denying it. Is there a way to make the insurer pay? Thanks, Cluen, DCAuto & Work Injury Center3311 NE MLK Blvd. Suite 202Portland, OR 97212503-282-4878 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 16, 2012 Report Share Posted January 16, 2012 As I said in our phone conversation and for the list serve you are correct one of the provisions of this bill the Oregon Chiropractic Association got through the Oregon Legislature in 2009 was that even if your PIP patient settles with the at fault liability carrier that settlement cannot disrupt the patient's first party PIP benefits. Yes, you patient's PIP adjuster can ask for a PIP IME to determine the clinical necessity of your continued curitive treatment but, the PIP claims representative cannot unilaterally stop PIP payments....The OCA's bill also addresses the preditor third party settlement baloney when the liability agent shows up on your patients door step with a check for $300 or $500 in one hand (the carrot) and a release from all future liability for pain and suffering and medical treatment written in 1pt font in their other. Consumers now have 5-business days to give the carrot back. Also these releases must have a clear in large font explaination of the serious nature of them taking the carrot..... Vern Saboe House Bill 2369 Hi All! I had a patient come in for treatment due to an exacerbation of their condition. Their accident was in June 2011. They received treatment for 3 months. They came in again in December for an exacerbation for 2 visits. State Farm (her insurance) sent an explanation of review stating that because they settled with the 3rd party, State Farm will no longer be paying for treatment. We spoke to the adjuster and she is refusing to pay (regardless of explaining House Bill 2369). I thought that this bill clarified that the primary PIP cannot stop payment for treatment for 1 year. I know they can IME, but they are just denying it. Is there a way to make the insurer pay? Thanks, Cluen, DCAuto & Work Injury Center3311 NE MLK Blvd. Suite 202Portland, OR 97212503-282-4878 Quote Link to comment Share on other sites More sharing options...
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