Florida is known as a “No-Fault” state. This means Florida follows a “no-fault” system when it comes to the payment of medical bills following a car accident in Florida. In short, if you are the registered owner of a vehicle in Florida, your Personal Injury Protection insurance, otherwise referred to as “PIP” will pay your medical bills up to the limits of your coverage. This is generally $10,000.00. Many PIP policies have a $1,000.00 deductible, meaning you have to pay the first $1,000.00 of medical bills before your PIP benefits begin. In many cases, if you are represented by an attorney the treating physicians may waive the $1,000.00 deductible to start treating you right away.
Does the PIP pay all of medical bills?
No. PIP will only pay 80% of the medical bills. The amount submitted by your physician to your insurance carrier may also be reduced based upon a fee schedule created by the insurance companies and insurance industry to decide how much any given medical treatment should cost. In some cases these fee schedules are reasonable, and in others they are not reasonable on the reimbursement rates. The good news is that if you physician accepts PIP benefits, they cannot balance bill you for the amount the insurance company reduces the bill and states you should not have been charged. This is called an adjustment by your physicians and should be reflected on your bill.
Well then who pays the other 20% of the medical bills?
In short, you do. Let me explain:
If you have sustained a “threshold injury” such as (a) significant and permanent loss of an important bodily function; (b) permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement; (c) significant and permanent scarring or disfigurement; or (d) death, then you may recover from the driver who caused the accident or hit your car in the accident. Most drivers involved in a car accident in Florida suffer what is known as a permanent injury and receive an impairment rating from their treating physician. This impairment rating may be as low as 1% and has the possibility of rising to 99%; however, the 99% impairment rating is most likely reserved for the person who has been injured and now must spend the rest of their lives as a ventilator dependent quadriplegic. Your physician will monitor your progress and eventually issue a rating depending on the injuries you have sustained in the car accident. A 100% impairment rating is a wrongful death action and your survivors bring the claim on behalf of your estate.
Therefore, if you are involved in a car accident, and have been injured, or think you have been injured you need to seek immediate medical attention.
Here is the dirty little secret the insurance industry does not want you to know:
On January 1, 2013, the law changed. If you or your family member or friend has been involved in a car accident after January 1, 2013, the law now says you MUST seek medical treatment within fourteen (14) days or even you own insurance company (your PIP benefits your PIAD for) will NOT pay your medical bills.
If you wait to see if you will heal after the accident and wait more than 14 days, you are out of luck. Nobody but you will pay your medical bills or lost wages. The insurance industry pulled this scam on Floridians and hoodwinked the Florida Legislature into changing the law. In fact they probably wrote the new laws themselves. The insurance industry claimed it would reduce costs, and in turn reduce premiums, but ask yourself and your family and friends, have their automobile insurance rates decreased since January 1, 2013. I thought not!
What is even worse, your insurance agent or company if you buy online, is not even required to tell you about the change in the law. They run all kinds of cute commercials on television, but not one of them tells you about the change in the law and how it will prevent you from having your insurance paying for your medical bills for the medical care you may need following a car accident in Florida!
HOWEVER, just going to a doctor within 14 days of a Florida car accident is not all you need to do to be eligible for your PIP/No Fault benefits which may be as much as $10,000.00. For more information on the requirement or diagnosis of an “Emergency Medical Condition” in order to get your full PIP/No Fault benefits see our blog on this topic.
Do I have to go to the emergency department after a car accident?
Not necessarily. Obviously if you are hurt seriously you need to seek immediate medical attention. No you do NOT! In fact, unless If you or someone you know is involved in a car accident, they must see a doctor right away. Waiting too long will eliminate your rights under your car insurance contract.
auto insurance claims after a car accident. In a no-fault state, drivers are required to carry auto insurance that pays personal injury protection, or PIP, benefits. When the policyholder suffers an accident, the PIP benefits in the policy pay for any medical expenses and certain non-medical-related costs associated with the accident — like lost wages and the costs of hiring someone to do household chores (known as “replacement benefits”).
All Florida drivers are required to carry minimum PIP benefits in their policies. When a crash occurs, each person involved in the crash turns to his or her own policy to pay the costs of medical care and other losses. These benefits kick in regardless of who was at fault in the accident. By contrast, in an “at-fault” insurance state (also known as a “fault” or “tort liability” state), drivers may choose whether to file claims with their own insurers, file claims with another driver’s insurer, or take the other driver to court to prove he or she was the one at fault, and therefore the one responsible for paying the costs of the accident.
Florida’s “Injury Threshold”: Florida drivers can only step outside of the state’s no-fault system — and pursue a claim against the at-fault driver directly — if the injuries resulting from the accident are considered “permanent,” if significant and permanent scarring or disfigurement occurs, or if significant and permanent loss of an important bodily function results from the crash.
Auto Insurance Requirements in Florida
Florida drivers are required to carry the following minimum insurance:
- $10,000 in personal injury protection (PIP) benefits, and
- $10,000 in property damage liability (PDL) benefits.
Unlike most other U.S. states, Florida does not require drivers to have bodily injury liability (BIL) benefits (which pay the costs of others’ injuries if a crash occurs). All auto insurance policies must be purchased from insurers licensed to do business in Florida. Driving without insurance in Florida is illegal, and a driver may have his or her license suspended if caught driving without at least the minimum required insurance. To get a license reinstated, a driver has to show proof of insurance on every vehicle owned in the state of Florida, and must pay a fine of up to $500 per violation.
Uninsured/Underinsured Motorist Coverage in Florida
Florida drivers are not required to buy uninsured/underinsured motorist (UIM) coverage. This kind of coverage must be offered by an insurer at the time a policy is purchased in Florida, but the purchaser can reject UIM coverage as long as they decline in writing. UIM coverage pays additional PIP benefits if a policyholder is hit by a driver who does not have any insurance (uninsured) or who does not have enough insurance to cover the costs of the policyholder’s medical bills and other damages.