Personal Injury Protection (PIP)

Lots of insureds in Weatherford, Aledo, Willow Park, Mineral Wells, Millsap, Brock, Azle, Peaster, Cool, Hudson Oaks, and other places in Parker County will have Personal Injury Protection benefits included in their auto insurance policies.
Here is an article that discusses an antic one company was using to save money on these PIP claims.
The article was published by the Houston Chronicle on May 13, 2011, and is authored by staff writer, Patrick Danner. The title of the article is, USAA Sued Anew Over Medical Payouts In Crashes Plaintiffs Say Insurer’s Reviews Are “Shams”; Firm Defends Practices.
The article tells us that USAA is again defending itself against charges it utilizes a “cost containment program” to improperly reduce or deny medical payouts to insurance customers injured in auto accidents.
In Texas, payments are governed by the Texas Insurance Code, Sections 1952.151 thru 1952.161.
The article goes on saying that the latest claims against the San Antonio financial and insurance company were made in a federal lawsuit filed this week in Oregon.
The lawsuit, which seeks national class-action certification, charges that USAA uses an outside auditor to assess claims and to “uniformly conclude that medical treatment was not needed.” In other words, USAA is accusing its insureds of fraud.
USAA denies the allegations.
USAA has previously settled two class-action lawsuits that have accused it of using flawed data to arbitrarily deny a portion of the medical benefits for injured customers who have PIP or other medical payments coverage on their USAA auto insurance policies.
One of those cases, filed in Arizona, was settled last summer. Claims are still being processed, so the amount to be paid out under the settlement hasn’t been determined.
The other case, filed in Illinois was settled in 2005. Lawyers for the plaintiffs valued the settlement on their website at $35 million, a figure USAA spokesman Paul Berry called “probably wildly” inflated.
USAA settled the two cases because it was the “right thing to do for our membership,” Berry said. He noted both courts endorsed USAA’s bill review practices.
“We pay all reasonable, necessary, and accident related bills,” Berry said. “That doesn’t mean we pay all bills. If you had injuries or you received some treatment that had nothing to do with an auto accident, we’re not going to pay those bills.”
USAA relies on Alabama based Auto Injury Solutions to help review medical bills to determine whether they are reasonable and necessary and to weed out duplicative and fraudulent claims. Bills deemed suspicious are reviewed by a doctor or other health care professional, Berry said. Even when one of its doctors concludes the medical care wasn’t necessary, the bill still goes through several other reviews, he said.
USAA also can choose to override any instance where a bill is rejected, Berry said.
In the latest Oregon lawsuit, four unrelated USAA customers in separate accidents allege the medical reviews were a “sham.”
It is the agent selling the policy that can often times be a problem when there is a need to make a PIP claim. Talking to an experienced Insurance Law Attorney is one way of insuring that you get what you have paid for when the need for a PIP claim arises.