Who Pays My Medical Bills as a Result of my Car Accident?

If you have been injured in a motor vehicle accident, perhaps the most important question you may have is who will pay for my medical bills and lost wages.  Florida is a No-Fault state.  All motor vehicles licensed for operation on our highways are required by law to have minimum insurance that includes what is known as No-Fault Insurance.  Another name for No­-Fault insurance is Personal Injury Protection (PIP) insurance.  PIP insurance covers you and those members of your household to whom you are related by blood or marriage. No fault/PIP insurance may also cover any pedestrians or bicyclists that you are involved in an accident with if they do not have their own personal automobile coverage.

 

If you have been injured in a motor vehicle accident and you own a motor vehicle, your medical bills and lost wages MUST be submitted to your own insurance company in a timely period.  If you do not own a motor vehicle but reside with someone to whom you are related to by blood or marriage, your medical bills and lost wages MUST be submitted to the insurance carrier for your relative.  If you do not own a motor vehicle, and do not reside with someone to whom you are related that owns a motor vehicle, your medical bills and lost wages MUST be submitted to the insurance carrier covering the car in which you were a passenger at the time of the accident.  If you were a pedestrian or bicyclist at the time of the accident, the PIP coverage for the vehicle that struck you will be responsible for payment of your medical bills and lost wages if you do not have your own personal auto   policy.

 

If you have been injured in a motor vehicle accident, your medical bills and lost wages MUST be submitted to your own PIP insurance carrier for payment.  Even if you were only a passenger in someone else’s car, your PIP carrier has the primary responsibility for payment of your medical bills and lost wages.  If you have the misfortune of being struck by a car as a pedestrian or while riding a bicycle, the same is true.  I know what you are thinking, why should my insurance company pay for medical bills and lost wages that were caused by the negligence of someone else?  Although this may not seem fair, Florida law dictates how the bills must be paid.  There is no choice in the matter. 

 

Although the amount of coverage available on a PIP policy can vary, the typical PIP policy provides coverage of $10,000 per person, per accident.  PIP normally pays 80% of all medical bills that are reasonably related to an injury suffered through the use or operation of a motor vehicle.  PIP also pays 60% of a person’s lost wages incurred as a result of injuries suffered in a motor vehicle accident.  PIP is also responsible for paying a percentage of other charges such as prescriptions, lawn maintenance, household care and other expenses that a person incurs due to injuries from an auto accident. Additionally, PIP is responsible for reimbursement of your mileage expenses to and from a health care provider.

 

Some PIP policies are subject to a deductible.  This is not desirable because it means that until the deductible is met, your insurance company is not responsible for paying anything!  When purchasing automobile insurance it is wise to avoid deductibles for PIP coverage unless you have adequate health insurance to cover those bills.

 

To begin a claim for PIP benefits, you must notify your insurance company that you have been injured in an accident.  It is important that you notify your agent or the insurance company directly as soon after the accident as possible.  Most insurance companies require receipt of a properly completed form known as a “No-Fault Application for Insurance Benefits” before benefits will be processed.  The insurance company may also provide you with a form known as an “Attending Physician’s Report” to be completed by your health care provider.  This form should be taken to the doctor’s office for completion.

 

Your insurance policy requires you to cooperate with your PIP adjuster.  You may be required to provide a sworn statement to the adjuster.  Usually these are done over the telephone in an informal manner.  Because such a statement can have serious consequences later in your case, it is always wise to have an attorney present during the course of the interview. It is our recommendation that you do not ever give a recorded statement unless your attorney is present.

 

In order to receive lost wage benefits from your PIP carrier, you will have to provide the adjuster with a completed “Wage and Salary Verification Form that the carrier will provide you.  This form is completed by your employer and gives the insurance company the information that will allow it to calculate your average weekly wage before the accident.  The insurance carrier will also require a note from a physician excusing you from work before it will pay lost wages.  Once the adjuster has this information, your lost wages should be processed within 30 days.  If you continue to miss work, you are entitled to be paid additional lost wages every 2 weeks.

 

Because your insurance policy requires you to cooperate with your PIP carrier, you may be asked to submit for a compulsory medical examination with a doctor selected by the insurance company.  Such an examination is not scheduled because your insurance company is concerned for your welfare.  Compulsory medical examinations are the insurance carrier’s way of obtaining a more favorable opinion so that it can terminate your right to further care.  There are limits to what an insurance company can force you to do in such an examination.  If your insurance company schedules you for a compulsory medical examination, you should consult with an attorney who specializes in handling personal injury cases immediately.

 

An insurance adjustor who feels he or she can contact you before you’ve had an opportunity to consult with a lawyer may be able to subtly ask suggestive questions and may persuade you to make ill-advised statements that will later damage your claim.

 

Future Treatment

You are entitled to payments for future expenses as long the insurance company agrees to it and as long as it is taken into account prior to settlement. Anytime that you have an injury and you are looking at settling, you must account for future medical treatment. You must be able to estimate the cost of future care and medication that you will incur after the claim is settled.

 

Remember that once you settle, the insurance carrier will have no obligation to you in the future. If you think that you might have an injury or there might be a possibility of future expenses and medical care, then you must account for that before you settle the claim. It is our recommendation that you contact an experienced attorney like the ones at Rue and Ziffra to help you get a fair settlement.

 

The value of future treatment is hard to determine. How much treatment are you going to need eventually? Insurance companies have creative ways around this issue so they do not have pay (or at least not on the spot) for future medical treatment.

 

 

How do they reach a number for future treatment?

Insurance adjusters can look at the treatment that you did receive and forecast what your treatment could be in a worst case scenario and their experience handling other similar claims.

 

Remember that most injuries heal with time, so treatment would decrease month by month. But the numbers that claim adjusters look at are dubious at best. The data is given to them and there is no double checking or ensuring that the data is correct.

 

In many occasions the insurance carrier does not allow their own adjusters to have access to these numbers or the sources. If you are dealing with a permanent injury, then the best way to evaluate and truly estimate your future treatment expenses is by hiring an experienced personal injury attorney like the ones at Rue and Ziffra.

 

Your attorney will have the resources available, medical experts and economists, to do a more accurate forecast.

Medical Bills, Medicine, and Other Expenses

You are covered by your own insurance company as long as you have (PIP)

About 99% of the time your medical bills are covered by your own auto insurance company. The normal process of the medical bills, medicine, and other medical-related expenses is as follows:

 

Your insurance company pays your medical provider (as long as it is reasonable and necessary treatment under the Personal Injury Protection terms of the policy).

 

They will wait until you settle your claim with the insurance company of the responsible party. Once you settle, your carrier may subrogate or go after the payments for bills paid under the medical payments portion of your policy against the insurance company of the at-fault party.

 

The insurance company of the person that caused the accident will not pay for the medical bills until you settle. Therefore, if you do not carry PIP and/or Medical Payments coverage on your policy, you could end up paying for your medical bills out of your own pocket.

 

If you do have insurance, remember that your insurance company has only agreed to pay for medical bills, medicine, wage loss and other related expenses under PIP coverage, but they have not agreed to pay for pain and suffering. Therefore, you need to settle the pain and suffering portion of the claim with the other insurance company separately.

 

The law of torts and equities and remedies has divided damages into many categories; but the ones that pertains the most to car accidents are: Compensatory Special Damages and Compensatory General Damages. You are entitled to both.

 

Compensatory Special Damages will provide coverage for those that are tangible or those that we can figure out easily. Medical expenses, medicine, wage loss and related bills are considered Special Damages. We can add up how much your medical care and expenses cost.

 

Compensatory General Damages are those damages that flow generally from the tort (negligence is a tort). Pain and suffering, loss of quality of life (hedonic damages), future income loss, etc., are very difficult to figure out. These damages are subjective and should be discussed with an experienced personal injury attorney like the ones at Rue and Ziffra.

 

Some policies are not paying for loss wages (a special damage), or damages that are easy to figure out (like mileage and gas to go to and from the doctors).

 

You need to read your policy to see if your own insurance company will pay for wage loss, mileage, and or gas, in the event of an accident. If they only cover medical expenses, then you must pay for those bills and add them to the general damages negotiations with the insurance company of the person that caused the accident.

 

Remember that medical bills are subject to the “reasonable and necessary” standard, which means the insurance companies will average the market rate for the same medical expenses and pay the average.

 

For example, if the average chiropractic visit is $75 per hour, and your doctor is charging $100, then the insurance company will pay $75. What will happen to the other $25? This is when it would behoove you to make sure you have medical payments coverage to pay the other 20% of your bills and additional protection in the form of uninsured/underinsured motorist coverage and health insurance to pay any out of pocket expenses not covered by PIP.

 

You must talk to your medical providers about the payment and make sure they do not send it to collections. It is true that in the advent of a dispute, most medical providers will reduce the medical bills to the amount that insurance allows, but this does not mean that all of them will. Talk to your provider and find out what is exactly going on with your bill.

 

If your insurance company is paying for the medical bills, then you are bound by “reasonable and necessary” clauses of the policy. But if you are dealing with the insurance company of the negligent party and they are paying for your medical bills in advance (like in the state of Montana), then you are not bound by any policy language. Either they pay the full amount or you present a lawsuit against their client.

 

Reasonable and necessary medical expenses will almost always be covered by your insurance company if you have personal injury protection and if the bills are below your policy limit. This is the reason why you should make sure to carry PIP and medical payments coverage PIP on your policy.  We do not encourage you to have a deductible on those coverages unless you have good health insurance that will pay your bills up to the amount of your deductible.

Loss of Quality of Life

A claim the injured party can make for having his/her enjoyment of life decreased

Loss of quality of life has the same characteristics as bodily injury claims. Most people can see value on the loss of the ability to lift one’s child or on being unable to perform those tasks that you used to do before your injuries sustained in your motor vehicle collision. The question is how much value these activities could improve or decrease in someone’s life. The correct answer is only given by a jury.

 

Insurance companies and personal injury attorneys normally try to settle loss of quality of life claims before they go to court. Because the fact is, it is anyone’s guess as to how 7 people on a jury will evaluate your case.  Often times claim adjusters and plaintiff attorneys do not see eye to eye regarding this type of claim because the value is purely subjective.

 

The real reason why there is great disagreement over the value of someone’s loss of quality of life is because this type of claim is really a “gamble”. The insurance company will always be taking a big calculated risk when putting their attorneys forward to defend this claim.

 

Taking these claims to court is a calculated risk because even in the worst case scenarios the insurance policy has a limit. The insurance carrier knows what is the most they would have to pay on this type of claim if they lose.

 

Defense attorneys know what the policy limits are (you must request this in writing to get an insurance company to disclose the limits), but even in this case, the lawyer does not know how low the claim award will be, making it a risky move.

 

The value of the claim according to the jury could be less than the legal fee or the experts’ cost. This is why a loss of quality of life claim is sometimes taken to court with other claims (pain and suffering, medical bills, wrongful death, etc.).  Making a successful loss of quality of life claim could be very difficult because the insurance company will tend to focus on your inability to anticipate what your settlement will be and the legal costs, fees, and experts’ testimony involved.

 

To be successful you must have to prove two things. You must prove that your quality of life is reduced because of the accident and that the cause is directly related to the accident. This sounds easy, but it could be quite complex.

 

Insurance companies have the right to impeach testimony, and they can do that by deposing and interviewing those closest to you, such as your family, friends, co-workers and other witnesses.  Our research has now shown they may be investigating injured claimants through social media, such as Facebook, My Space, Twitter and Google.

 

You will be surprised to learn what the insurance company’s attorneys will put you through. Your life and reputation will be on display for everyone to see and comment about and this can be very embarrassing for you. Their job is to focus on the negative aspects of your case and attack your credibility.

 

Unfortunately, sometimes the most difficult aspect of the loss with the loss of quality of life claims is that the injured or victimized person will end up defending themselves in their own trial. The insurance company’s attorneys will prosecute the injured party to win any argument at any cost.

 

The plaintiff attorney can spend of dollars to defend the victim’s reputation. However, how much more value this is adding to a loss of quality of life claim is very questionable. It is arguable that there would not be much of an award left for the victim after legal fees and costs are taken into account.

About the author

Allan L. Ziffra is a founding partner and President of Rue & Ziffra, P.A. Connect with Allan Ziffra onGoogle+ or Find us on Google+

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