Wednesday, 13 October 2021 17:24

Oh, My Aching Back! Look Who Else Deals with Short Pays

Written by Rebecca Barnabi, glassBYTEs.com


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The glass industry isn’t the only one to deal with insurance short pays. Chiropractors do too.

On Sept. 22, a Florida federal judge certified a class of health care providers to pursue claims that GEICO has engaged in a practice of underpaying personal injury claims, which violates the insurance company’s policy language.


Randy Rosenberg, a chiropractor in Florida, filed suit in May 2019 against GEICO for requiring a 100% reimbursement of submitted charges less than the amount permitted in the insurer’s fee schedule. Rosenberg alleges it has been GEICO’s general business practice to pay 80% of claims. Rosenberg’s complaint includes a count for breach of contract. It recently became a class action suit.


The case highlights traffic accidents in which GEICO vehicle policyholders are injured, and their personal injury benefits are assigned to health care providers paid by GEICO. In Florida, all vehicle operators must possess personal injury protection of at least $10,000 for medical expenses and lost wages under the state’s Motor Vehicle No-Fault Law.


U.S. District Judge Aileen M. Cannon ascertained in a 16-page order that Rosenberg could provide other class members, via a database of claims paid, which GEICO provided in discovery.


GEICO argued Rosenberg’s method was unreliable because The Fontana Group Inc. collected the data by searching for claims featuring the notation “BA.” GEICO uses the “BA” or billed amount code in 15 scenarios. Each claim would require an individual review.


Cannon, however, determined the 6,000 providers with which it was found GEICO used the billed amount code were sufficient to give the case a class definition. An expert witnessing on GEICO’s behalf agreed that Rosenberg’s discovery relying on the “BA” code was flawed but did not dispute the finding when it was revised with additional information from GEICO. Rosenberg identified...

...more than 40 class members, which satisfies the requirement for class certification.


At issue in the case is not only GEICO’s alleged underpayment of claims but, according to Cannon, whether the insurance company’s use of the “BA” code was lawful, which prevails over any individual’s case.


According to GEICO’s personal injury protection policy (PIP), the insurance company will pay 80% of medical benefits in accordance with Florida law. Florida’s PIP statute allows insurers to limit reimbursement to 80% of charges for services, supplies and care for up to 200% of the allowed amount. This language is why Rosenberg claims GEICO should be responsible for the full amount of charges billed by providers up to 200%.


We thank glassBYTEs.com for reprint permission.


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