If someone’s negligence caused your injury in a Florida car or truck crash, you want to get your medical bills paid.
Article Applies to Florida (Each State has Different Laws)
Each state has different laws that determine how to get your medical bills after a car accident. This article applies to Florida car accidents.
Notification of PIP Benefits Form Explains Your PIP Benefits
The Notification Of Personal Injury Protection Benefits is a paper written by the Florida Office of Insurance Regulation. It talks about your personal injury protection (PIP) rights and benefits under the Florida Motor Vehicle No-Fault Law.
It talks about:
- two things that the Florida Motor Vehicle No-Fault Law does
- who is covered
- medical payments
- disability benefits
- death benefits
- optional deductibles and limitations.
Notification of PIP Benefits Doesn’t Explain Limited Right to Sue
That article does not explain the limited exception from liability for injuries caused to others in an automobile accident.
It doesn’t explain how a careless party can sometimes be exempt from liability for injuries caused to others. Here, I discuss a huge amount of info that you need to know about getting your medical bills paid after a Florida auto accident.
Personal Injury Protection (PIP) or No-Fault Coverage
Personal Injury Protection (PIP) is also known as No-Fault Coverage. It is found in Section 2 of many Florida family automobile insurance policies.
PIP Applies Regardless of Fault
If you are covered by PIP, it pays benefits regardless of whether you are at fault. Even if you were at fault (or received a ticket for a moving violation) for causing the auto accident, PIP will still pay your medical bills.
What Are The Minimum Limits for PIP?
If you were hurt in a motor vehicle accident and you’re covered by Florida PIP, then the minimum limits for no-fault personal injury protection benefits are:
$10,000 for Medical Bills
a. $10,000 per person for loss resulting from bodily injury, sickness, or disease arising out of the ownership, maintenance, or use of a motor vehicle if a physician, dentist, physician assistant, or advanced registered nurse practitioner has determined that the injured person had an emergency medical condition,
$2,500 for Medical Bills if You Don’t Have an “Emergency Medical Condition”
b. $2,500 per person for loss resulting from bodily injury, sickness, or disease arising out of the ownership, maintenance, or use of a motor vehicle if a physician, dentist, chiropractic physician, physician assistant, advanced registered nurse practitioner, physical therapist or person licensed to provide emergency transportation and treatment has determined that the injured person did not have an emergency medical condition,
Lost Wages up to $10,000
c. Disability benefits, which combined with medical benefits cannot exceed $10,000; and
$5,000 Death Benefit
Send a Letter to PIP Insurer Asking for PIP Defenses
The best way to find out whether the PIP insurer believes that you’re covered is to send an email, fax and mail a letter to the 1rst party auto insurer, which asks them to disclose certain insurance information.
A PIP insurer in Florida must disclose this information.
Are You Covered by PIP in a Florida Car accident?
Find out who is covered by Florida’s Motor Vehicle No-Fault Law (PIP). Most motor vehicles in Florida are covered by PIP, but there are many exceptions.
For example, Uber currently won’t pay you PIP benefits. However, starting on July 1, 2017, you may be covered by Uber’s PIP in some situations. Lyft currently has PIP, but this is set to change in some circumstances beginning July 1, 2017.
Will PIP Pay My Medical Bills if I Don’t Own a Car in Florida?
Give PIP Info to All Your Medical Providers, Or PIP Won’t Pay Health Insurance Lien
Give the proper PIP claim info to all of your medical providers. Otherwise, the PIP insurer may argue that they do not have to pay your health insurer or any other of your first party insurers who pay your bills. State Farm Mut. Auto. Ins. Co. v. Pressley, 28 So.3d 105, 108 (Fla.1st DCA 2010).
PIP Pays 80% of Reasonable Medical Bills
The bad news about PIP is that it only pays:
80 percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital and nursing services.
PIP Only Pays Bills if You Get Care Within 14 Days of Car Accident
Medical benefits are only paid by PIP if you receive initial services and care within 14 days after the motor vehicle accident.
PIP Doesn’t Pay for Massage or Acupuncture
Medical benefits do not include massage or acupuncture, regardless of the person, entity, or licensee providing massage or acupuncture and a licensed massage therapist or licensed acupuncturist may not be reimbursed for medical benefits.
If No Emergency Medical Condition, PIP Only Pays $2,500
If you are not diagnosed with an emergency medical condition, your PIP insurance will pay up to $2,500 of your medical bills.
What is the Formula to Determine How Much PIP Pays?
The formula to determine how much PIP pays is:
PIP Pays = 80% x total bill
Here is a basic example.
Example – $5,000 bill, You Have an Emergency Medical Condition
You’re driving a car and a careless driver hits you. Your hospital bill is $5,000.00. State Farm insures your car.
State Farm Will Pay the Hospital $4,000
If the hospital states that you have an emergency medical condition, State Farm will pay the hospital $4,000. You would then owe the hospital $1,000.
I got this amount by using the formula that I just mentioned.
PIP Pays = 80% x total bill
= 80% x 5,000
Here, PIP will pay $4,000.
You Can Still Sue the Careless Driver and Others
You can still make a claim against any liable parties for the outstanding medical bills of $1,000. However, depending on the county where the crash occurred, the tortfeasor may be entitled to a PIP credit if you are uninsured under Florida’s No Fault Law.
You also have a claim for bodily injury, any resulting pain and suffering, disability and physical impairment, disfigurement, mental anguish, inconvenience or loss of capacity for the enjoyment of life experienced in the past or to be experienced in the future.
This is subject to certain exceptions and which is outside the scope of this article.
Same Example Except No Emergency Medical Condition; PIP Only Pays $2,500
If the hospital does not state that you have an “emergency medical condition”, your car insurance will only pay the hospital $2,500. You would owe the hospital $2,500.
Example #2: $15,000 hospital or doctor bill
You were driving a car or were a passenger in a car involved in a car accident, and the other driver received a ticket for careless driving.
Your hospital bill is in the amount of $15,000.00. Let’s say that the hospital states that you have an emergency medical condition. In this case, your car insurance will pay the hospital $10,000.
PIP Pays = 80% x total bill
= 80% x 15,000
Here, PIP will pay $12,000.
But PIP Only Pays Up to $10K
You would then owe the hospital $5,000. If you want to make a claim for lost wages from your car insurance policy, your auto insurance company will not pay you anything because your PIP insurance is exhausted.
You can make a claim against the at fault driver’s bodily injury (BI) liability insurance for the outstanding medical bills of $5,000 in addition to lost wages and pain and suffering.
If the hospital does not state that you have an emergency medical condition”, your car insurance will only pay the hospital $2,500. You would then owe the hospital $10,000.
You can make a claim against the at fault driver’s BI liability insurance for the outstanding medical bills $10,000 in addition to lost wages and pain and suffering.
Parent, Not the Child, Has the Claim for Medical Bills
If a minor child is in a car accident, and has medical bills that PIP doesn’t pay, then the parent has a claim for the medical bills. Florida Standard Jury Instructions – Civil Cases 501.2(e).
The minor’s parents are entitled to get compensation for the reasonable value of hospitalization and medical care for the child from the date of the crash until the child reaches the age of (legal age). The current legal age is 18.
In Wilkie v. Roberts, 91 Fla. 1064, 109 So. 225, 227 (1926), the court said the father could recover medical expenses for the child’s medical treatment. The father’s right of to bring a lawsuit is separate from the child’s right.
Once the child turns 18, all medical bills incurred from that date forward are the child’s responsibility.
How a PIP Deductible Works in a Florida Auto Accident Case
When Won’t PIP Pay Your Medical Bills? (Issues with Application, Etc.)
The most common reasons for a PIP insurer refusing to pay your medical bills are:
- The name insured made a material misrepresentation in the auto insurance policy application.
- The name insured and/or you failed to cooperate with the PIP insurers investigation. (This may include failing to attend an examination under oath or attend an independent medical examination (IME).
- You did not receive medical treatment within the fourteen (14) days following the accident.
- A doctor does not state, in writing, that you had an emergency medical condition.
- The PIP policyholder failed to tell the PIP insurer about additional people who reside in the household after the policy was purchased.
- The medical bills are not related to your injuries from the accident. (The PIP insurer may argue this in a minor impact collision.)
- The medical treatment is not necessary.
- The medical provider did not submit your medical bills to the PIP insurer within the applicable time frame.
Tip: The medical provider may be able to sue the PIP insurer. A jury will then decide if a PIP insurer should’ve paid the medical bills.
Medical Payments Coverage (“Medpay”)
If you’re an insured under an auto insurance policy with Medical Payments (“Medpay”) coverage, it may pay any bills that PIP doesn’t pay up. It pays up to the Medpay limit on the policy.
Will Workers’ Compensation Pay Your Medical Bills from a Florida Car Accident?
It should. If workers’ compensation pays your medical bills from a Florida car crash, you should use your PIP insurance to pay off the workers’ compensation lien.
This may put more money in your pocket.
Other First Party Coverage (e.g. Health insurance, Medicare, Medicaid, etc.)
You should use any available first party coverage to pay your medical bills. Health insurance, Medicare and Medicaid are secondary to any PIP coverage to which you are an insured and which PIP should pay.
This means that PIP should be billed and pay your medical providers before the health insurance, Medicaid or Medicare is billed and pays.
You Owe Full Medical Bills Once PIP is Used Up
After PIP pays the maximum policy limits, you are responsible for paying the medical provider’s full reasonable charges. Florida Statute 627.736(5)(a)4.
(This assumes that you don’t have health insurance.) You don’t get the benefit of any discounted rate that your doctor must accept from PIP.
You can make a claim with any responsible parties who may be liable.
Health Insurance Pays Medical Bills After PIP Pays
Once PIP pays a medical bill from a Florida car or truck crash, the medical provider (e.g. hospital, ambulance, ER physicians, etc.) should submit the medical bill to the health insurer.
PIP may pay more than the health insurer’s allowable rate. You can find the health insurer’s allowable rate by looking at the explanation of benefits (EOB) that they are required to send you.
If PIP pays more than the health insurer’s allowable rate, the medical provider should waive the balance.
Why must the medical provider waive the balance?
Because the injured person should not penalized (financially) because he/she was an insured under a PIP policy that paid benefits.
Medical Provider Should Bill Health Insurer After PIP is exhausted
Once PIP is exhausted (used up), the medical provider should immediately bill the health insurer. You should be sure to immediately send your health insurer a letter from the PIP insurer stating that PIP is exhausted.
I’ve had many clients who did not give the hospital and/or doctor both their auto and their first party coverage at the time of their medical visit.
Sometimes, by the time the first party coverage provider receives the medical bill, they deny the bill due to it being submitted too late. If that happens, the patient may be stuck owing the bill. The patient can send an appeal to his or her health insurer.
What if Your Health Insurer Isn’t Paying Your Bills Because It Says You Were in a Car Accident, But There is No PIP?
Assume Rob is driving an uninsured car that Rob’s girlfriend’s dad owns. Rob doesn’t own a car. Rob doesn’t live with any relatives.
Another car, heading in the opposite direction, makes a left hand turn carelessly crashes into Rob. In this instance, Rob is not entitled to PIP.
This is because Uber’s insurance policy with (James River Insurance Company) doesn’t have PIP because Rob had accepted an Uber ride (e.g. had a passenger).
If Rob got medical treatment at the hospital, the hospital may have billed Rob’s health insurer. Rob’s health insurer may deny paying the hospital and say that the bill needs to be resubmitted with a primary explanation of benefits (EOB).
In this case, an explanation of benefits (commonly referred to as an EOB form) is a statement sent by a car insurance company to covered individuals explaining what medical treatments were paid for on their behalf.
However, here, there is no primary car insurance company to bill. To get his health insurance to pay the hospital bill, Rob can file a grievance against his health insurance company.
However, some “health insurers” like some Medicaid plans may take up to 90 days to respond to a grievance. That is a long time to get the hospital bill paid.
Thus, it can delay Rob’s personal injury settlement. And that’s not an option because Rob wants to get his money. Pronto.
Thus, if the health insurer won’t pay Rob’s hospital bill, he can file a consumer complaint with the Florida department of insurance.
This will get another set up eyes, at the health insurance company, to look at his claim. Hopefully, it will quickly get the health insurer to quickly pay the hospital bill.
Then Rob will know how much he has to reimburse (pay back) his health insurer. Likewise, he will know how much his case is worth. Then, he can settle his injury case with the careless driver’s insurer.
What Happens if You Own a Car in Florida That Wasn’t Insured, and Your Hurt in an Accident in Florida?
I Owned a Car But Didn’t Have Auto Insurance. I Was Driving My Employer’s Vehicle. Does My Employer’s PIP Have to Pay My Bills?
No. If you let your car insurance expire, or simply didn’t have your car insured, you cannot get PIP benefits from your employer’s vehicle that you were driving at the time of the crash. You can still make a workers’ compensation claim.
You can also still make a claim (for your medical bills) against the driver whose negligence caused your accident (and injury). The amount that the at fault driver owes will depend on the county where the crash happened.
In some counties in Florida, if you owned an uninsured car and were in a crash, the at fault driver owes you 100% of your medical bills. These counties include Pasco, Pinellas, Hardee, Highlands, Polk, DeSoto, Manatee, Sarasota, Hendry, Hillsborough, Charlotte, Glades, Collier, Lee, Hernando, Lake, Marion, Citrus, Sumter, Flagler, Putnam, St. Johns and Volusia Counties, Orange, Osceola Counties, Brevard and Seminole.
In other counties, if you owned an uninsured car and were in an accident, the at fault driver gets a PIP credit on the first $10,000 of your medical bills. This is true even if you weren’t in your own car at the time of the accident. These counties include Miami-Dade, Monroe County, Palm Beach, Broward, St. Lucie, Martin, Indian River, and Okeechobee Counties.
In these counties, since the at fault driver gets a PIP credit, the at fault driver will owe you much less for your medical bills (and lost wages). Expect GEICO or any other car insurer to use this defense. This argument decreases settlement value of your personal injury case.
Will Medicare Pay Medical Bills from a Car Accident?
Although Florida hospitals and medical providers do not have to bill Medicare if someone’s carelessness caused your injuries in a car crash, most do. Medicare should be billed before Medicaid is billed.
There many reasons why a Medicare beneficiary should hire a lawyer if someone’s negligence caused his or her injury in a car or truck crash. Medicare will always reduce its lien by attorney’s fees and costs. This may result in a huge savings for you!
You may face criminal penalties, the loss of your Medicare benefits and/or Social Security if you do not satisfy Medicare’s lien after a car or truck crash after you reach a personal injury settlement.
Do medical providers have to bill Medicaid in car accident cases?
It depends. Unfortunately, in Florida hospitals don’t have to bill Medicaid if someone’s carelessness causes your injury and there is another party who is a primary payer.
An example of a primary payer is the insurance company for the careless person who caused your accident.
Do Medicaid beneficiaries have to use Medicaid to get medical treatment after a Florida car accident?
Repaying Medicaid After a Florida Car or Truck Accident
If settle your personal injury case and you try to stiff Florida Medicaid on the bills that they paid, you could face criminal penalties, and lose your Supplemental Security Income (SSI) and Medicaid benefits.
Tip: If you settle your Florida personal injury case with an attorney, you may have to repay Medicaid less money than if you are without a lawyer. This is because Florida Medicaid, in certain situations, reduces its lien by attorney’s fees and costs. This may result in a huge savings for you.
Who Pays Your Medical Bills That PIP Doesn’t Pay?
If someone else’s carelessness caused your injury, you can sue them for any bills that PIP doesn’t pay.
Florida law allows you to recover “the reasonable value or expense of hospitalization and medical and nursing care and treatment necessarily or reasonably obtained by the injured person in the past or to be so obtained in the future.” Fla. Std. Jury Instructions (Civil) 6.2b.
Ticketed Driver Doesn’t Automatically Have to Pay Your Bills
In Florida, the driver who was received a ticket for causing the crash is not automatically responsible for all of your medical bills.
The potential defendants are liable for the 20% of your medical bills that PIP doesn’t pay up to $10,000 if their negligence caused your injuries. If you want the potential defendants to pay 20% of your medical bills up to $10,000, you have to set up a claim with them.
The potential defendants may be liable for 100% of your damages – above the $10,000 – if their negligence caused your injury.
We generally email, fax and mail this letter to the potential defendant’s insurance company to request certain insurance information. The potential defendant is usually the negligent driver, or owner, of the vehicle that caused the crash.
Uninsured Motorist (UM) Insurance May Pay Your Medical Bills
If another driver’s carelessness caused your injury, then any policies of UM coverage to which you are an insured should pay for medical bills that aren’t paid under workers compensation, PIP, Medpay, or BI coverage.
Other Personal Injury Damages.
Medical bills are one of the many damages that you may be able to recover in a Florida auto accident case. I invite you to learn more about other types of recoverable damages, including money for pain and suffering if someone’s carelessness caused your injuries in a Florida car accident.
Who Pays a Pedestrian’s or Bike Rider’s Medical Bills if Hit by a Car?
- How a pedestrian gets his medical bills paid if a vehicle hits him or her in Florida
- Is a pedestrian hit by a motor vehicle in Florida is covered by PIP?
- Who pays a bike rider’s medical expenses after a Florida auto accident?
- Pedestrian hit by an Uber or Lyft driver.
Did someone’s carelessness cause your injury in a Florida car crash or other type of accident?
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Editor’s Note: This post was originally published on March 2013 and has been completely revamped and updated.