The number one question I get asked in my practice is: “Why, if I am not at fault for this accident, does my own insurance company have to pay my medical bills?” That is a very fair and honest question. Unfortunately, the answer is because that is the way the Florida Legislature wants it to be.
Florida is PIP/No-Fault Auto Insurance State. PIP stands for personal injury protection. PIP/No-Fault coverage was designed and developed so that victims of motor vehicle accidents could get medical care and treatment regardless of fault. It was also designed to eliminate the need for lawsuits in cases of relatively minor car accidents and injuries. Under these premises, the Legislature required drivers and owners of motor vehicles to carry $10,000 in PIP coverage. That coverage was to pay 80% of a given medical bill, up and until a $10,000.00 coverage cap. The same coverage cap provides for reimbursement of loss wages at 60% of one’s average weekly wage.
This system was, in the words of the Florida Supreme Court, designed to provide swift and virtually automatic payment of auto accident related medical expenses and loss wages. Thus, the quickness and ease of payment of these claims was the trade off in requiring a non-at-fault party to have to use their own insurance.
Well, if you have been in or know of anyone who has been in an auto accident recently, you know that PIP is anything but swift and automatic. Under current law, which was amended in 2012, and took full effect this year, PIP only covers $2,500.00 in medical care unless there is an Emergent Medical Condition. This limitation applies despite the fact that you still have to purchase $10,000.00 in PIP coverage, and despite the fact that you still must go through and use your insurance first for your injury claims.
Recently, a Tallahassee trial court issued an injunction against the $2,500 limitation in benefits. That matter is currently on appeal. Despite the presence of the injunction, there are a number of insurers simply ignoring the same and telling their insureds that they will only receive $2,500 in benefits. I have even seen some claims where the insurers are denying any and all payment of bills, claiming that the injuries were not caused by the accident. Does this sound swift and painless to you?
So, again, why must your insurance company get stuck with the initial bills? Because, simply, that is the law as it stands today. I don’t agree with it, but until the Legislature changes us to a Mandatory Bodily Injury state that is how it is.
Now, let me tell you two common false-truths the insurers like to spread. Number one, due to the injunction, there is absolutely no reason, currently, for a PIP auto insurer to impose a $2,500 limitation in PIP benefits. If they do, they are wrong, and you should fight back. After all, you paid for $10,000 in coverage, right?
Number two, don’t let any insurance company tell you that you have to come up with $500-$1,000 out of your pocket to get medical treatment. They are describing to you a deductible that likely exists in your policy. The truth is that if you have a lawyer, and you are not at fault for the accident, that money will be reimbursed from the at-fault party at conclusion of settlement of the case.
Again, if you are in an accident, the insurance company, even your own, likely isn’t on your side or there to help. Arming yourself with information is your best weapon against bad advice.
By the way, given all the bad information out there about accident claims and given that most people are just getting frustrated and giving up, I launched a new website this week called accidentquestions.com. We built it to literally work like Google®. So if you have a question or you are confused, but you don’t want to have to talk to anyone yet, like an adjuster or a lawyer, just go there and ask the question first. You will likely find your answer, and I hope, some help.
Michael T. Gibson is an Auto Accident Lawyer in Orlando. The law firm of Michael T. Gibson can help you obtain compensation for medical treatment, loss of wages, pain and suffering, etc. that you have incurred as a result of a car accident. Call 407-422-4529 or visit the website at www.autojusticeattorney.com.
