Whose Insurance Will Pay for My Medical Treatment?

Crossword puzzle with Insurance circledAs a Florida resident, you’ve probably heard the term “no-fault State” when discussing insurance or car accidents. So what does “no-fault” mean exactly? No-fault insurance means that your automobile insurer will pay some or all of your medical bills and lost earnings if you get into a car accident, regardless of who was at fault for the crash. This type of insurance coverage is typically referred to as “PIP” or personal injury protection.

Florida law requires that all drivers carry PIP coverage on their auto insurance policy. If you are injured in an accident, Florida PIP will pay 80% of your medical costs and 60% of your lost wages up to the coverage limit and subject to the deductible you choose on your policy. If your injury is considered an emergency, the coverage limit is $10,000. If your physician does not note your injury as an emergency condition in your medical records, then the coverage limit is $2,500.

If you have health insurance, it should pay the remaining medical costs not covered by your PIP policy but only after PIP has been exhausted.

Am I Guaranteed PIP Coverage After an Accident?

To be eligible for PIP, you must get medical treatment within two weeks of the car accident. Failure to get medical care within those two weeks will result in a denial of your PIP claim. Also, PIP will only cover conditions complained of during the initial visit. Reimbursement for lost wages may require that your employer complete a wage and salary verification form as well as a note from your health care provider explaining your limitations due to the traffic crash. These forms can be obtained by request from your insurer.

Is PIP the Same as Medical Payments Coverage?

No. “Med-Pay” is an optional coverage that can be purchased in addition to PIP. Med-Pay coverage can be purchased in various increments with the most common being $5,000 in additional coverage. Med-Pay covers medical expenses, including 20% of the medical costs not covered by PIP.

Do I Have to Pay My Insurance Company Back If I Obtain a Settlement from the Other Party’s Insurance Company?

If you obtain a monetary settlement for the injuries sustained in an accident, your auto insurer typically has a right to subrogation (reimbursement) for any Med-Pay benefits paid, but not for the required PIP benefits. That is the standard protocol for Florida auto policies, but those rules vary from state to state.

Additionally, your health insurance carrier may claim a right to subrogation as well, but every health insurance policy is different so your attorney should obtain a copy of the policy before agreeing to pay any insurance liens. Even in cases with legitimate health insurance liens, your attorney can negotiate a reduction of the lien before payment.

If you have questions about how various coverages affect your rights, call Dismuke Law at (863) 292-6922 for a free consultation.