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We represent individuals and medical providers to pursue claims that have been wrongfully denied and/or underpaid by an insurer. We have experience in Florida No-Fault (PIP), Homeowners Insurance Claims, Health Insurance Claims, and various other claims where insurance has denied or underpaid a claim. The circumstances for which each case widely vary depending on the facts surrounding the claim. We work solely on a contingency basis and do not get paid unless we recover underpaid or denied medical benefits on your behalf. We have a wide variety of solutions to assist your practice. We recognize that each office has a unique work-flow. Our firm will work with your office to provide a customized solution that is efficient and has the least impact on your resources. Our firm does all the work, so your office can focus on current claims and patients. Contact us today for a free consultation.
The Florida PIP law is coverage that every person that owns a motor vehicle is required to carry. It provides $10,000.00 of benefit to cover an injured person’s medical bills and/or lost wages. In the unfortunate event a person passes away as the result of an accident, there is also a $5,000.00 funeral benefit to help cover expenses for your loss.
Florida PIP benefits can apply to a number of people that have been involved in an accident. Whether you are a driver of a vehicle, owner of a vehicle, pedestrian, riding a bike, or a passenger in a vehicle you may have a source of PIP benefits available to you to cover your medical care and/or lost wages. Each scenario is fact specific and many people have multiple sources of PIP benefits available to them. Contact our office today with your situation and we can advise you of whether PIP benefits apply and from what source.
PIP covers all reasonable and necessary medical care including but not limited to: emergency room treatment, hospital care, ambulance and/or paramedics, chiropractic, physical therapy, orthopedic, osteopathic, diagnostic imaging, and spiritual healing. Medical benefits are reimbursed at 80%. In addition, to medical benefits, PIP also covers lost wages and reimburses an insured person at 60% of their lost wages. Contact our office today to find out if your services are covered under your PIP policy.
Yes, there are several requirements an insurer may require an insured person and medical provider to do when a Florida PIP claim is presented, here are a few:
- 14 Day Rule – An insured person must receive qualified treatment within 14 days of the accident, or PIP benefits are forfeited.
- Emergency Medical Condition (EMC) – An insured must be diagnosed with an EMC by a qualified physician, if not benefits are limited to $2,500.00 rather than the $10,000.00.
- Independent Medical Examination (IME) – An insurer has the option to have an insured person examined by a doctor of their choice to determine if care is still necessary and reasonable. Unreasonable refusal to attend the examination can suspend PIP benefits.
- Examination Under Oath (EUO) – An insurer has a right to question an insured person under oath regarding the facts and circumstances surrounding the accident and care being received by the insured. Failure to appear may result in the suspension of PIP benefits.
- (6)(b) Request – Under the PIP law, an insurer is allowed to request certain information from a medical provider regarding the necessity of treatment and the reasonableness of the amount billed for services. Not all requests are valid, and in many instances the requests are overbroad. Failure to properly respond to a request may result in medical bills not being paid.
- Timely Billing – A medical bill must be submitted within 35 days from the date of treatment. There is an exception when a provider submits a notice of initiation of treatment (NOIT) within 21 days, a provider is then allowed to submit bills up to 75 days from the date of treatment. In addition, in certain circumstances a provider is provided incorrect insurance information or submits bills to the wrong insurer. A provider’s bills may still be timely if certain requirements are followed by the medical provider. Contact our office for further details, as each circumstance is unique.
Riding a motorcycle is a great way explore the outdoors and enjoy the Florida weather. Unfortunately, motorcyclists face the danger and risks of an accident due to the negligence of others. Despite how cautious or careful you try to be on the open road, you cannot control another driver’s negligent operation of an automobile.
It is a reality that the stakes tend to be higher when riding a motorcycle. When injured, you may have a claim for your injuries caused by the negligence of another driver. Motorcycle accidents can leave a rider with catastrophic injuries due to not having the security of a seatbelt or the frame of a vehicle around them.
If you have been injured by another driver while riding a motorcycle, you may be able to recover for your damages. Each case and situation are unique. Contact our office for a free evaluation of your motorcycle accident today. We service clients throughout the entire State of Florida.
Slip-and-fall accidents, unfortunately, are quite common and can amount to high medical bills, lost wages and a variety of personal problems. At Simon & Zacharewski, we are here to help.
When a slip-and-fall accident occurs, the injured person must prove that the business either knew or ought to have known about the dangerous hazard and failed to correct it. As a result, this failure to correct the danger that the business knew or ought to have known caused the slip-and-fall.
Large companies have their legal teams ready for unfortunate events such as slip-and-falls. You should have your legal team too. No matter how large the company is, at Simon & Zacharewski, we are dedicated to helping you recover damages as a result of a slip-and-fall. Our clients can focus on getting better, while we focus on seeking justice. For a free consultation, call our office today to speak with an attorney.
Florida’s dog bite statute is Fl. Stat. § 767.04. An owner of a dog may be liable for injuries their dog causes if: their dog bites another person, and the person is in a public place or lawfully in a private place.
Even if the owner of a dog had no prior knowledge or warning that the dog may bite someone, the owner may be liable. This is known as “strict liability”. That is, the person who has been injured does not have to prove that a lack of reasonable care caused the dog bite to occur. A person may be strictly liable because the event happened, not because of the owner’s intent or negligence.
There are a couple defenses to a Florida dog bite claim for injuries. The owner may claim the injured person was trespassing or that the injured person was comparatively negligent. If the person was trespassing onto the private property of the dog owner, then it may be argued that they are not entitled to damages for the injuries caused because the injured person was unlawfully on the dog owners land and therefore trespassing. Under comparative negligence, if the injured person’s own negligence was the cause or partially the cause of the dog bite, the amount of damages the owner of the dog would have to pay in damages would be reduced by a percentage equal to the amount of fault the injured person would have accountable for.
Florida has a deadline to file a lawsuit for a dog bite claim known as the “statute of limitations”. In Florida, an injured victim of a dog bite has four years to file a lawsuit from the day the victim was injured from a dog bite. If a law suit is not filed within the four-year period, you will not be able to pursue a claim in the Florida Courts.
Any injury that is the result of a dog bite is unique to the facts and circumstances surrounding a potential claim. It is important to consult with an experienced attorney to inquire what remedies may be available to your specific and unique situation. For a free and confidential consultation, contact our office to speak with an attorney today.
At Simon & Zacharewski, we help families who have lost a family member due to the negligence of another.
We understand that the sudden death of a family member can leave one’s family with more questions than answers. Our firm will take the time to review the facts and preserve what evidence is needed, so we can build the strongest case on behalf of your loved one.
In a wrongful death case, unlike a cause of action for negligence, you only have a two-year statute of limitations. That is, you only have two years to bring a cause of action against the party who may have been at fault for the accident. At Simon & Zacharewski, we have the compassion, patience, and empathy to guide you. Our firm has the resources and fortitude to bring justice to you and your family.