In Florida, auto insurance companies will almost always pay for medical bills after a car accident. But which insurance will pay, how much they’ll cover, and what your share will be can depend on many factors. These factors include the optional coverage you have on your policy, whether you have health insurance, and the final amount billed.

The main factor that will determine who pays for medical bills after a car accident is the status of Florida’s no-fault insurance laws. Florida’s legislature passed a bill repealing the no-fault system, but Governor DeSantis has vetoed the bill. 

The bill will now go back to the legislature. If it becomes law, Florida’s entire auto insurance system will change. The determination of who pays the medical bills after a car accident will also change.

Here are the things to note about Florida’s no-fault insurance system and the way that this system addresses medical bills.

Florida’s No-Fault Insurance Laws

Thirty-eight states require drivers to buy liability insurance in anticipation of car accidents. In these states, a driver’s liability insurance pays for accident victims’ medical bills and property damage when the driver causes a car crash.

In Florida and 11 other “no-fault” states, auto insurance works differently. Accident victims must file claims with their own insurance to recover compensation for medical bills after a car wreck—regardless of who was at fault. 

For example, suppose that two cars collide in an intersection when a red car runs a stop sign and hits a blue car. In a fault-based state, the insurer for the red car’s driver must pay the medical bills for the driver of the blue car and the passengers in both cars.

In a no-fault state, the insurer for the red car pays the medical bills for the driver and passengers in the red car. The insurer for the blue car driver pays the medical bills for that car’s driver and passengers.

Limits on No-Fault Insurance

Florida’s no-fault insurance has two important limits:

Policy Limits

Florida requires all car owners to buy $10,000 of personal injury protection (PIP) coverage. This coverage pays medical bills and lost wages for the people inside of the covered driver’s car during an accident.

The policy limits will cap the insurer’s liability for medical bills and lost wages. If an injury victim’s expenses total more than $10,000, the insurance will not cover the excess amounts.

80% Rule

Under Florida’s no-fault law, insurers only need to pay 80% of the medical bills submitted. If you buy the minimum policy with $10,000 in PIP benefits, this means your insurer will pay up to $10,000 of the first $12,500 in medical expenses you incur. This rule effectively imposes a 20% copay on all medical expenses covered by PIP.

Other Forms of Insurance

The medical bills that remain unpaid by PIP insurance pose a problem for many injured drivers. Fortunately, other forms of insurance may cover these bills.

Medical Payments (Med-Pay) Coverage

Auto insurers in Florida offer optional med-pay coverage to cover these unpaid medical bills. Insurers offer med-pay as an optional add-on, so you might not have med-pay on your policy.

But if you do have med-pay, the insurer will pay med-pay benefits without regard to fault. The insurer will apply PIP benefits first; then, they will apply any optional med-pay coverage.

Health Insurance

If you have health insurance, your health insurer will pay for any bills that PIP and med-pay will not cover. When you have med-pay coverage, you should use your med-pay benefits before resorting to your health insurance coverage. Med-pay has no deductible or copay, unlike most health plans.

The At-Fault Driver

Under Florida’s no-fault system, you can sue a driver who caused an accident if you can satisfy two conditions:

  • Your damages exceed the limits of your PIP coverage
  • You suffered permanent injury

If you satisfy both these conditions, Florida law releases you from the no-fault system. This allows you to file a claim against the at-fault driver’s liability insurance or file a lawsuit against the at-fault driver.

Permanent Injury

Florida’s law identifies four types of permanent injuries that qualify for a no-fault exemption. These include:

  • Death
  • Significant and permanent loss of an important bodily function
  • Significant and permanent scarring or disfigurement
  • Permanent injury other than scarring or disfigurement

Under Florida’s law, you must allege facts that support the claim of a permanent injury. Before trial, a judge will hold a hearing to verify that you meet the law’s requirements.

Damages

If you meet the requirements and prove the driver’s fault, a jury could award significant damages.

Economic Damages

Your economic damages will include unreimbursed medical bills and lost wages. Under Florida’s no-fault laws, PIP coverage pays 80% of your medical expenses and 60% of your lost wages. Your damages in a lawsuit will include the 20% of medical expenses and 40% of lost wages that your PIP coverage left unreimbursed.

Your damages will also cover any amounts over the PIP limits. Importantly, PIP limits apply to medical expenses combined with lost income. If your medical bills exceed $10,000, you will only receive reimbursement for your medical bills before you exhaust your PIP benefits. As a result, you will not receive any reimbursement for lost income.

Non-Economic Damages

The biggest difference between a PIP claim and a liability claim is that PIP does not cover non-economic damages like pain and suffering. But you can get damages for pain and suffering if you file a lawsuit.

Pain and suffering damages could exceed your economic damages. By law, Florida only allows pain and suffering damages for permanent injuries. You will likely suffer considerable physical pain and mental anguish with a permanent injury.

Process for Claiming Medical Expenses After a Car Accident

Under Florida’s no-fault law, you will need to start with a claim for PIP benefits. If your PIP benefits do not cover all your medical bills, you should consult a lawyer to determine whether your injuries meet the permanency requirements for a lawsuit.

If you meet the statutory requirements, you will notify the auto insurer for the at-fault driver to see if the driver had liability coverage. Liability coverage will pay for your medical expenses. But since Florida uses a no-fault insurance system, the state does not require drivers to purchase liability insurance.

This could leave a lawsuit as the only option for recovering compensation for your unreimbursed medical expenses.

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