If you slip and fall at a premises in Florida, you may be wondering who pays your medical bills. Let’s take a look. When I use the word “premises”, I am referring to a business such as a store, supermarket, hotel, restaurant, mall, business and many other locations.
So the word “premises” applies for Florida hotel injury claims. It also applies to accident claims against the other establishments listed above.
This article does not apply if you only have a workers compensation claim and don’t have a personal injury claim. This article applies if you are hurt while working and you also have a personal injury claim.
Below are the possible sources that may be your medical bills after a Florida slip and fall.
1. Health Insurance (or other first party coverage)
If you slip and fall in Florida, and you want immediate treatment than you should provide your health insurance to the hospital or other medical provider. If you were working at the time of the accident, then you should report the claim to your employer.
Be sure to also give your workers compensation information to the hospital or the medical provider to whom your employer send you to get medical treatment.
If you were not on the job at the time of the fall, your health insurance or other first party coverage (e.g. Medicare, Medicaid, or other first party coverage, etc.) should pay your medical bills. They may have a right to be repaid for any amounts that they pay and that you recover from the owner or operator of the premises.
2. Owner or Operator of the Premises
If you have a deductible or co-pay on your health insurance, then you should immediately send written notification to the premises owner and operator of your fall. This letter, email and/or fax should request (among other things) for the owner and operator to preserve any video footage of the fall.
This letter should include any medical records and bills, including but not limited to ambulance, hospital and doctor bills that you have as a result of the fall. You should also ask for a certified copy of their business liability insurance policy.
Hopefully you reported your fall to the owner or operator immediately after it happened. If 911 was called, then this may be enough documentation to confirm that the fall happened on the premises of the owner or operator. A simple call to 911 can be a huge factor in valuing an injury case.
You should also send your medical bills to the claims adjuster for the premises owner and operator. There are 2 sources from which you may be able to receive payment from the store or business owner or operator’s insurance policy.
A. Medical Payments Coverage
If you slipped and fell at a store or business that had “medical payments coverage” in their business liability insurance policy (CGL), then the “medical payments coverage” will pay for your medical bills if you were an invitee at the premises.
I mentioned above that you should send you records and bills to the premises insurer. Once the premises insurer receives your medical bills, the clock starts ticking for them to pay them. If they don’t pay within a reasonable amount of time, you can sue them for attorney’s fees, costs and the amount of the bills.
If the claims adjuster does not pay the bills within a reasonable amount of time, you can also file a consumer complaint against the liability insurer or civil remedy notice. But you get more bees with honey, so it may be best to give the adjuster a couple of reminders with deadlines before filing a consumer complaint or civil remedy notice.
Keep in mind, if you also have a personal injury case (discussed below) then you want the adjuster on your good side. You want the adjuster to be arguing, for you, and not against you, to his supervisor. While you should not trust what an insurance adjuster says, you still want to have friendly relationship with them.
Warning! Most business liability insurance policies that have “medical payments coverage” have a 1 year time limitation (written into the policy) within which you must submit your bills to the insurer. Don’t blow this deadline. In other words, you must give them your medical bills within one year (or the policy’s time requirement) or be forever barred.
Don’t expect medical payments coverage to pay for your future medical expenses. I have never seen a liability policy that provides “medical payments coverage” for future medical bills.
Let’s take a look at an actual case where I received medical payments coverage. My client, a hotel guest, slipped and fell on water in a hotel lobby in Doral, Miami-Dade County, Florida. My client claimed that as a result of the fall, she suffered a quadriceps (upper leg muscle) tear.
We submitted over $5,000 in medical bills to the hotel’s insurer and they offered the $5,000 limits from the “medical payments coverage” of the policy.
They offered $5,000 under the “medical payments coverage” because my client was an invitee, she fell on the hotel’s property and we submitted the medical bills in time.
Even if my client was 100% comparatively negligent for the accident, the insurer should still pay these bills under the “medical payments coverage.” Medical payments coverage applies regardless of fault.
Fun fact: Florida attorneys, myself included, do not and should not take a fee on any money recovered under the “medical payments coverage” unless it needs to be litigated (sued upon). So when you are weighing your option of whether or not to hire a lawyer, this is one of the 11 reasons to hire a Florida injury lawyer in a slip and fall case.
B. Personal Injury Claim for Medical Bills
If the premises where you fell does not have “medical payments coverage” in its insurance policy, or even if it does, you may want to make a personal injury claim in addition to the “medical payments coverage” claim.
The standard to get your medical bills paid under the liability coverage is more difficult than making a claim under the “medical payments coverage” in the premises owner or operator’s insurance policy.
If a premises owner or operator’s negligence caused your injury, they are owe you economic damages.
In a Florida slip and fall case, there is one more element that can provide a big challenge. The owner or operator must have had actual notice or constructive knowledge of the substance before you fell.
In my case example above, our client slipped and fell. Moments later, after her fell, her friend told her that she saw an employee mopping the lobby before the fall. After speaking with the witness, I prepared an affidavit for the witness to sign. She signed it, had it notarized and sent it back to me.
I sent it to the adjuster and this showed the adjuster that we may be able to establish that the hotel actually knew that water was on the floor from the mopping. It also showed that we were serious about the case.
Prior to submitting the witness affidavit to the hotel’s insurer, the adjuster told me that he believed their insured (the hotel) was not negligent.
Thus, he did not make an offer under the liability (personal injury) coverage. After sending them the notarized witness affidavit, the adjuster also offered $18,000 under the liability coverage in the insurance policy.
This $18,000 was in addition to the $5,000 medical payments coverage that I referenced above. The $18,000 check was to cover medical bills, lost wages and pain and suffering.
So how did the adjuster come up with the $18,000 offer under the liability coverage? First he calculated the full value of my client’s damages.
Let’s assume that her medical bills were $10,000 and that he thought her pain and suffering was possibly worth $50,000. So the full value of her damages is $60,000.
How did I pull out the $50,000 figure for the value of pain and suffering? I keep up with recent and past jury verdicts, particularly with the amounts awarded for the pain and suffering component of the claim.
I sometimes look at an article that contains different amounts that I use as a starting point for the full value of the pain and suffering component of a Florida injury claim.
Warning! That article contains amounts that I may use only as a starting point.
Then I factor that amount with the actual pain and suffering that my client experienced.
Back to the above example. I showed you above that my client’s full damages were $60,000. For simplicity, I am not getting into lost wages here.
So we can plug her full value of damages into the formula.
Settlement = ($60,000) x (100% – % Chance of Defense Verdict) x (100% – Your % of Fault)
Tip: Florida law is much more favorable to slip and fall victims than the law of some other states. Some other states laws say that if a claimant is more than 1% at fault, he or she gets nothing (other than medical payments coverage).
In Florida, an injured person can recover the full value of the damages minus their percentage of fault. So if you are 99% at fault, you can recover 1% of your damages. Which means you could recover 1% of your medical bills if you were 99% at fault.
However, keep in mind that slip and fall cases are difficult. That being said, we have settled many slip and fall cases.
Ok. Back to the formula.
The adjuster then estimates the percentage chance that a jury would find that the hotel did nothing wrong to cause your slip and fall. For example, perhaps the employee who allegedly mopped the area said that it was dry when my client fell.
On the other hand, we had a witness (who I mentioned above) who said the employee left the floor wet after she mopped it. Let’s say that the adjuster said that there was a 1 in 3 (33%) chance that a jury would find the hotel not negligent.
We then plug the 33% chance of defense verdict into the formula.
Settlement = ($60,000) x (100% – 33%) x (100% – Your % of Fault)
Now let’s say the adjuster thinks a jury would believe that my client was at fault for not looking where she was walking. Basically, he argued that if our client was looking where she was walking then she would not have fallen.
Our response to that argument is that God put our eyes in our head so we can see the big picture. If he wanted us staring at the floor when we were walking he would have put our eyes in our knees. Let’s say that he thinks that our client is 50% at fault for not looking where she was walking. He then plugs that percentage into the formula.
Settlement = ($60,000) x (100% – 33%) x (100% – 50%)
Warning! Before I calculate this formula I want to say that a slip and fall case is generally stronger if the color of the liquid blends into the floor.
If the water can easily be seen, then you should place more comparative negligence on the person who fell. If the water blends into the floor and is difficult to see, then you should place more comparative negligence on the injured person. Although not the norm, it is actually possible to have little to no comparative fault if the water cannot be seen on the floor.
So 2 people can have the exact same case except that the color of the floor tile is different, and the settlement offers may be totally different just based on the color of the floor.
Back to the settlement formula.
Settlement = ($60,000) x (100% – 33%) x (100% – 50%)
Settlement = $60,000 x (67%) x (50%)
Settlement = $60,000 x 33.5%
Possible Settlement = $20,100
So perhaps the adjuster felt that $18,000 (not too far off from $20,100) was a fair offer in addition to the $5,000 medical payments coverage offer.
In reality, you just don’t reduce the value of a case by only negligence and comparative fault. I was only using those factors here to keep it simple. There are actually over 87 factors that can affect the value of a Florida injury case.
If you slip and fall in Florida, the time limit to sue for negligence that caused your personal injury depends on the status of the premises owner or operator.
3. Other independent contractor (e.g. landscaper, etc.) of the premises
You may also have a personal injury claim against an independent contractor of the premises owner or operator. For example, you may have a personal injury claim against a janitorial service or a landscaping company who installed sprinklers that shoot water into the pedestrian walkway (e.g. sidewalk, etc.).
This article mainly focused on getting your medical bills paid after a Florida slip and fall accident. I wrote a broader article on whether you can sue if you’re hurt in a Florida slip and fall accident. The latter article talks about all the burden of proof and damages that you can recover. It is not limited to just medical bills.
Did a Florida premises’ negligence cause you to slip or trip, and fall, and hurt yourself? Were you hurt in another type of accident or somewhere else?
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