Personal Injury Protection (PIP) coverage is mandatory on your automobile policy and is the primary source of payment in the event of an accident. PIP coverage reimburses medical providers for the services that they provide as well as the insured for lost wages, mileage, and prescriptions. One would think that if a doctor prescribes you a treatment plan that is related to your auto accident that your Personal Injury Protection Coverage (PIP) on your policy will reimburse the providers for those treatments, right? Unfortunately, that's not the case. According to Florida No-Fault Statute 627.736, Acupuncture and Massage Therapy are NOT covered services under the No-Fault Law.
Recently, Rue & Ziffra presented a Personal Injury Protection suit against an insurance carrier that denied reimbursement for several dates of services where the client received manual therapy. Now, keep in mind that manual therapy is a reimbursable treatment under the Florida No-Fault Statute if performed by a chiropractor or a physician.
The Defense's argument was clear. They argued that the Florida No-Fault Statute states any treatments performed by a Licensed Massage Therapist (LMT) are not reimbursable, not just massage therapy but manual therapy as well.
Our argument was the opposite, we believed that the plain language of the Statute states that a Licensed Massage Therapist can perform services and be reimbursed as long as it is not massaged therapy.
Initially, the Seventh Circuit County Court agreed with our position. The Court Ordered that a Licensed Massage Therapy can provide services, other than massage therapy, and the insurance carrier should reimburse the provider for these services.
Defense Counsel appealed the Seventh Circuit County Court's decision to the Fifth District Court of Appeal. Through competing Briefs to the Appeals Court, our initial decision from the Seventh Circuit County Court was overturned. This would mean that ANY service provided by a Licensed Massage Therapist would not be reimbursable under the Florida No-Fault Law, whether it is massage or manual therapy.
What does this mean for you?
As the treater, you always want to follow the recommendations of your doctor and their projected treatment plans. However, you will want to be cautious of the fact that you could be financially responsible for all services performed by a Licensed Massage Therapist. Such services would include massage therapy and/or manual therapy. However, these services can be performed by other medical professionals such as chiropractors and physicians and be reimbursed. As for acupuncture, this service will always be denied and the charges for those services will be your financial responsibility.
Should you find that your insurance carrier has denied medical charges for manual therapy, please reach out to Rue & Ziffra and we can review those denials for you. We will do a complimentary evaluation of the denial and see if there are grounds for a PIP suit against your insurance carrier for these denied dates of service.