What is Personal Injury Protection (PIP)?
Personal Injury Protection (PIP) is commonly referred to as “no-fault” auto insurance. Florida is considered a “no-fault” state, which means each person’s own car insurance will pay for injuries and damages resulting from an accident, no matter who was at fault. Each driver is required to carry a personal injury protection (PIP) policy, covering a minimum of $10,000 per person, per crash. It was intended to provide injured drivers up to $10,000 in immediate medical coverage in lieu of establishing fault through the court system.
However, PIP benefits may only be provided to you if you receive medical treatment for your injuries within two weeks of an accident. Otherwise, you become ineligible to receive PIP benefits. PIP coverage will only pay for 80% of your medical costs, including mileage reimbursement traveling to and from your Doctor. Your PIP benefits may be capped if you do not have an Emergency Medical Condition (EMC) at $2,500. PIP does not cover Acupuncture of Massage therapy.
What is Med-Pay?
Also referred to as Medical Payment Benefits, these are costs incurred for medical care that you, or any covered member of your policy, sustain in a motor vehicle accident including:
EMT and ambulance fees
1. Hospital visits and stays, doctor visits
2. Surgery and X-Rays
3. Professional nursing services and care
5. Dental procedures needed as a result of an accident
6. Injuries sustained as a pedestrian or riding a bicycle if a vehicle hits you
One characteristic that’s noteworthy about Med-Pay is that the coverage follows the policyholder. In other words, if you’re walking, riding in a friend’s vehicle, or using public transportation, your medical payments coverage remains active. This applies both in and out of the state you’re insured in. Med-Pay benefits cannot be applied to trailers or
other equipment attached to them.
What is an Emergency Medical Condition (EMC)?
An EMC is defined in Subsection (1) of the PIP Statute as: a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
a) Serious jeopardy to patient health
b) Serious impairment to bodily functions
c) Serious dysfunction of any bodily organ
PIP will only provide coverage for follow-up services that are related to the diagnosed conditions if the initial treatment is for a medical condition diagnosed as an EMC.
Tactics That Insurance Companies Employ to Avoid Paying Doctors?
Often, insurance companies try to get away with paying medical providers less than they should. Billing for PIP is complicated, and insurance providers will use every trick they can to find a mistake. They alter the coding to pay less, claim they never received the bills, or try some other way to avoid paying the full amount due. Either way, you are required to pay your medical bills. Feel free to ask if any payment arrangements can be made.
What is a Letter of Protection (LOP)?
While waiting for your case to settle, your treating physician may request a letter of protection from your attorney. The letter of protection is a contract that the unpaid expenses will be paid out of the settlement of your claim. Basically, it’s a common method to protect the Doctor’s right to future payment.
What is a Medical Lien?
A Medical Lien is the right of a health care provider, doctor, or hospital to assert an interest in the personal injury recoveries of its patients. In consideration for not collecting payment for services in-full up-front, the Doctor is securing his medical bills for later payment. The amount that can be recovered by way of a medical lien will be limited to the cost of the treatment or service provided. The Doctor’s Lien is sent to all attorneys insurance companies involved to provide notice of their obligation and fiduciary duty to pay the patient’s medical bills.
What if My Injuries are Severe?
Florida law does allow you to file a personal injury lawsuit after a car accident if the injuries are serious. Serious injuries are those resulting in:
1. Significant and permanent loss of an important bodily function
2. Permanent injury within a reasonable degree of medical probability
3. Significant and permanent scarring or disfigurement
When are PIP Insurance Benefits Considered Overdue?
Generally, PIP insurance benefits are overdue if they are not paid within 30 days after the insurer is furnished with written notice of the covered loss, and the amount of the loss. An insurance company may have an additional 60 days to investigate the claim if the insurer has a reasonable belief that a fraudulent insurance act has been committed.
What are Damages?
If you can prove another person was at fault for injuring you, you may be entitled to be compensated for your losses. Those losses include:
1. Past, current, and future estimated medical expenses
2. Physical Therapy, Rehabilitation, and Emotional Therapy
3. Lost wages from work, including travel time for medical appointments and therapy
4. Any property damaged because of the incident
5. Any permanent disfigurement or disability
6. Diminished earning capacity
7. Pain and suffering
8. The cost of hiring someone to do household chores when you were incapacitated
9. Your emotional distress, including any anxiety and/or depression
10. Interference with your family relationships, called “Loss of Consortium”
11. Any other costs that were a direct result of your injury
What is Loss of Consortium?
Loss of Consortium refers to the deprivation of the benefits of a family relationship due to injuries. An example of this could be an injured husband’s inability to perform marital duties possibly leading to his wife’s estrangement following a severe spinal disc injury.
How Much is My Case Worth?
That is a question that should be answered by a qualified trial attorney. There are three main components in most cases, namely the medical expenses, legal expenses, and the patient’s award based on damages. As a general guideline, cases are often estimated to be worth triple the patient’s medical expenses, though this is a gross oversimplification. There are overriding factors that need to be considered like Comparative Negligence.
Florida operates under a pure comparative negligence standard. This means that your recovery will be limited by the amount you were found to be negligent. For example, if you are suing another driver and your actions are deemed to be 50% at fault, then your settlement for damages will be decreased by 50%
What if More Than One Person Is to Blame for Your Injury?
Any person found to be 10 percent or less at fault will not pay out of pocket for any of your economic losses. Any person found to be more than 10 percent but less than 25 percent at fault will be responsible up to $500,000. Any person between 26 and 50 percent at fault will be responsible for up to $1 million of your damages. And, if a person is found to be more than 50 percent at fault, he or she will owe up to $2 million of your damages.
Do I Need to Retain an Attorney?
Possibly. Insurance companies have an obligation to operate in “good faith”, but that doesn’t mean that they always do so. Often, it’s okay to try negotiate with insurance companies on your own behalf. If at any time, you feel that the insurance companies are being less than cooperative, you have the right to hire an attorney and file a lawsuit. After an injury, there is a four-year window in which to file a lawsuit. Once a case is filed, it cannot be dismissed without eventually being heard, and a judgment rendered.
Is There a Time Limit to File a Case?
The “Statute of Limitations” or deadline by which to file a personal injury lawsuit in Florida is four years from the date of the injury. If you do not file within this time, you give up your right to sue.
What is a Contingency?
Many attorneys take cases on a contingency basis which means that they do not ask for an up-front retainer fee, but will take a percentage of any proceeds you collect. This means they will be financially motivated to take only solid cases and will be frank with you about your ability to file a successful claim.
Do Lawyers Always Increase the Value of a Settlement?
No. In some cases, it may not be possible. There are some specific situations where the opposite may be true. It is entirely possible to reach a better settlement for yourself without legal representation. Generally, attorneys are retained on a contingency fee basis which entitles them to a third of the final settlement. Once the case is settled, the attorney will attempt to negotiate a fee reduction from all medical service providers. If the Doctor agrees to reduce his medical bills, more funds remain to be divided between the patient and the attorney. This only occurs if the attorney is willing to reciprocate in similar fashion, otherwise the Doctor may feel that the attorney is being unjustly enriched and will refuse to participate. Regardless of the outcome of trial, health care professionals are entitled to have their bills paid in full since they don’t work on a contingency.
Independent Medical Examinations (IME)
Under Florida law, car insurance companies have a right to request that you undergo an Independent Medical Examination” performed by a doctor of their choosing. Because this doctor is paid by the insurance company, he or she may not necessarily render an un-biased medical opinion in assessing your injuries. During this medical exam, it is important that you do not sign any paperwork, other than a sign-in sheet. It is also important that you do not speak to the IME doctor about insurance companies, settlements, or any other legal matters during the course of the IME.
What is an Examination Under Oath (EUO)?
An EUO is a mandatory investigatory tool in which the insurance company takes their insured’s statement under oath. Failure to comply with an EUO demand constitutes a material breach of contract which renders the insurer void of liability for the presented claim. Always attend EUO’s.
The materials provided are for educational and informational purposes only and not for the purpose of providing legal advice. Reliance upon the aforementioned materials does not constitute nor imply an attorney-client relationship. Although we have gone to great lengths to ensure the accuracy of our information, we recommend consulting a lawyer for specific legal advice.