Can A PIP Investigator Demand To Inspect My Office?

Can a PIP investigator demand to inspect my office? Can a PIP adjuster ask to inspect my office?
Does a doctor need to allow a PIP adjuster to inspect the facility?

My office received about five phone calls so far this week from doctors wanting to know if PIP adjusters/investigators have a right to inspect their office and take pictures. PIP insurance companies are probably doing this to other doctors in Florida so I wanted to let everyone know your rights. Don’t get bullied by insurance companies. Know your rights!

1. Is a doctor required to let a PIP adjuster/investigator inspect your office?
No. There is no law that allows a PIP insurance company to enter your office. If you don’t want someone in your office you have the right to throw them out. If the President, Governor, or mother-in-law enter your office you have every right to tell them to leave. If they don’t leave then you can call the police. You can even throw out law enforcement if they don’t have a warrant.

2. Can a PIP adjuster/investigator refuse to pay my bills if I don’t let them inspect my office?
No. They cannot deny your bills (legally). But the law has never stopped an insurance company from incorrectly denying bills. You will have to file a PIP suit but you will win if that’s the only reason they denied your bills. They will also have to pay my attorney’s fee as a punishment for ignoring the law.

3. Can a doctor ask the PIP adjuster/investigator to schedule an appointment?
Yes. You are actually doing them a favor by letting them inspect your office. Feel free to coordinate a time when your patients won’t be there. If an adjuster/investigator decides to give you a surprise visit then you are within your rights to tell them to come back after they schedule an appointment.

4. Does a PIP adjuster/investigator have the right to take pictures of the inside of your office?
No. If you don’t want them to take pictures then tell them that they cannot take pictures.

5. Do I need to show the patient’s medical records to the PIP adjuster/investigator?
No. But they probably have it already because you mail out your bills. For HIPPA laws, you should ask to see a government issued ID and a badge/card showing they work at the insurance company. If they refuse, then you should refuse to let them see the medical records. Remember, that you are doing them a favor by letting them in your office.

6. If a doctor is not required to let the PIP adjuster/investigator enter his/her office then why bother letting them inspect?
At the end of the day, most doctors do not have anything to hide. These adjusters/investigators are either (1) trying to intimidate doctors or (2) are getting paid a good per diem from their company to drive to your office. Feel free to let them inspect your office and know that you’re one of the good guys and have nothing to hide. If they ask you questions, just know that you don’t have to answer them and you can end the inspection at anytime.

Now that you know the law you can be better prepared. Please call me with any questions (888) 948-2144 (ext 21)