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Progressive Insurance = File Suit

We sent Progressive Insurance a demand letter in a case where the client had some pretty serious injuries, including 50 staples in her head to close a scalp laceration. Progressive faxed us a letter stating it cannot conclude its investigation until we obtain different bills from the medical providers that are on certain health claim forms, because Progressive wants the individual CPT codes for every visit. CPT codes are numbers assigned to every task or service a doctor may provide to a patient.

Are CPT codes necessary for Progressive Insurance to determine whether medical care rendered was fair, reasonable, necessary, and causally related to the car accident? I think the best way to frame the question is to ask whether a jury can render a verdict without CPT codes. The answer, of course, in that I have never in my life heard testimony that included CPT codes at trial.

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There are a few insurance companies I trust well enough that I’m willing to jump through a few dumb hoops to help them deal with whatever internal challenges the adjuster might have to making a fair settlement offer. Progressive Insurance has taught me time and time again that if you take the time to jump through their hoops, you are just delaying the inevitable lawsuit that I am sure to file.

Progressive continues to cement its reputation as an insurance company that will not make a fair settlement offer until a lawsuit is filed. I think this business model works for Progressive because it writes generally small insurance policies. You rarely see a Progressive Insurance policy in Maryland for over $100,000 and it is often the Maryland minimum coverage of $30,000 per person/$60,000 per accident. So, in many of our Progressive cases, the underinsured motorist carrier is prepared to make an offer but can’t until Progressive tenders its policy.

These small insurance policies embolden Progressive, so they know they can always pony up the policy at the last minute and avoid any real pain. As big of a tough guy as Progressive is in discussing settlement before suit is filed, it is about one-tenth as brave as State Farm in taking a case to verdict.

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  • Jeremy D. Tunis, Esq.

    I have had this exact same issue with Progressive and their beloved CPT codes. For a particular case I am currently handling, I provided full EOBs and medical records with the demand letter and the they refused to tender an offer without CPT codes. My client and I tracked them down, sent to Progressive and they responded by offering 33K for a case that has 21K in meds and where liability has never been questioned and the policy limits are 100K. Needless to say we filed a week later. They just responded to the suit but no word yet on an offer.

  • http://www.innova-pain.com Dr. Andrew White

    I am no fan of the insurance companies. As a personal injury chiropractor in St George UT, I have had my share of insurance company foot-dragging. The CPT code should not be hard to obtain. In fact, I am surprised that they would request it again. I always send the HCFA forms to the insurance co and the form has the CPT codes clearly listed. I can see how they should be allowed to know exactly what was done to the victim, but they should not be allowed to line-item veto the claims or charges.