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Does Car Insurance or Health Insurance Pay for Medical Bills After a Car Accident in Florida?

on  Car Accidents

Dealing with life after a car accident in Florida can often be as challenging as the incident itself, especially when it comes to handling medical bills. After a car accident in Florida, does your car insurance or your health insurance pay for your medical bills?

The answer is complex, but essentially, both might handle a portion or all of your medical expenses after an auto accident. Because Florida is a no-fault state, you will need to turn to your Personal Injury Protection (PIP) insurance policy first before your health insurance will cover expenses. 

Florida auto drivers typically have $10,000 in PIP benefits. You’ll apply this to the first $10,000 in medical expenses. If your medical bills exceed that, you’ll turn to your health insurance policy to cover the rest. You’ll be responsible for deductibles and copays during that time according to your health insurance policy details.

Since handling insurance companies is difficult, especially when you’re injured, you need an experienced Florida car accident lawyer on your side. Your attorney can help you make the most of your insurance policies and explore other legal options that may be available to you, such as filing a personal injury lawsuit. 

Understanding Car Insurance in Florida

In Florida, car insurance is not just a recommendation. It’s a legal requirement. Every motorist must understand the state’s specific mandates to ensure they are adequately covered. 

Firstly, Florida law requires that all drivers carry Personal Injury Protection (PIP) coverage. This form of insurance is pivotal as it provides the insured party with immediate medical coverage, irrespective of who is at fault in an accident.

Personal Injury Protection, commonly referred to as PIP, is designed to cover medical expenses, lost wages, and certain other losses up to a specified limit, regardless of fault. In Florida, the minimum PIP coverage required is $10,000. This coverage is critical because it allows for prompt medical treatment without the immediate concern of determining fault, which can often be lengthy.

However, it’s important to note that PIP has its limitations. While it provides immediate coverage, it does not cover all medical expenses or scenarios. In many cases, PIP coverage includes a $1,000.00 deductible and just pays for 80% of the contracted billing rate. This leaves the patient responsible for outstanding medical expenses in the vast majority of situations. Understanding these limits is essential for all Florida drivers, as it influences whether to rely solely on PIP or seek additional coverage through health insurance, supplemental auto insurance policies, or personal injury lawsuits.

When a claim exceeds your PIP, your Florida car accident lawyer can help you decide what to do next. You shouldn’t get stuck paying out-of-pocket after getting into a car accident that was not your fault. Your attorney can guide you on recovering maximum compensation and moving forward after a crash. 

Role of Health Insurance in Car Accidents

In Florida, where car accidents often lead to significant medical expenses, health insurance becomes increasingly crucial. After the Personal Injury Protection (PIP) coverage is exhausted, typically at the $10,000 limit, health insurance steps in as a critical safety net. This transition is especially important in severe accidents, where the costs quickly surpass the PIP cap.

Health insurance policies are designed to cover a wide array of medical needs. This includes, but is not limited to:

  • Extended Hospital Stays: In cases of serious injuries, prolonged hospitalization may be necessary. Health insurance helps in covering these extended stays, which can be financially overwhelming.
  • Specialized Medical Treatments: Post-accident care might require specialized treatments or surgeries not covered under PIP. Health insurance can provide coverage for these specialized medical services.
  • Rehabilitation Services: Recovery from car accident injuries often involves extensive rehabilitation, including physical therapy, occupational therapy, and other forms of rehabilitative care. Health insurance plays a vital role in financing these long-term recovery processes.
  • Prescription Medications: The cost of prescription drugs, especially for long-term medication regimens, can be substantial. Health insurance helps in managing these costs effectively.
  • Follow-up Care and Specialist Consultations: Continuous medical attention and consultations with specialists are crucial for complete recovery. Health insurance ensures that these necessary follow-up treatments are financially accessible.

It’s important to understand the specifics of your health insurance policy, including deductibles, co-pays, and coverage limits. These factors significantly influence the out-of-pocket costs you may face after a car accident. In essence, while PIP provides immediate, essential coverage, health insurance is pivotal for comprehensive, long-term financial protection against medical expenses resulting from a car accident in Florida.

Differences Between Health Insurance and Car Insurance Coverage

Understanding the differences between health insurance and car insurance coverage is key to effectively managing medical expenses following a car accident. The primary distinction lies in the scope and application of these policies:

  • Coverage Trigger: Car insurance, specifically PIP, is designed to cover medical expenses regardless of who is at fault in the accident. Health insurance, conversely, is not contingent on the cause of the medical need.
  • Coverage Limits: PIP coverage in Florida is capped at $10,000, which can be quickly exhausted in serious accidents. Health insurance typically offers broader coverage, subject to deductibles and policy limits.
  • Scope of Coverage: PIP covers specific post-accident expenses like lost wages and death benefits, which are generally outside the purview of health insurance.
  • Deductibles and Co-Pays: Health insurance plans often include deductibles and co-pays, which are the insured’s out-of-pocket expenses. PIP coverage, while immediate, may not cover all expenses fully, leaving room for health insurance to fill these gaps.

Real-World Scenario: Car Insurance vs. Health Insurance

Sarah is involved in a major car accident in Florida with medical expenses totaling $20,000. Her car insurance’s PIP coverage initially covers Sarah’s immediate medical expenses. In Florida, PIP is designed to quickly provide funds for medical care, irrespective of who caused the accident. Sarah’s PIP coverage pays up to its $10,000 limit, the typical cap for most basic PIP policies in the state.

The severity of Sarah’s accident, however, results in medical expenses that surpass the PIP cap. Additionally, Sarah’s $1,000.00 PIP deductible as well as the 20% balance on every bill that her PIP coverage did not pay for leaves her with substantial out of pockets for bills that she thought had been paid for in full. This is a common occurrence in major accidents, where emergency care, surgery, hospitalization, and initial rehabilitation costs can escalate rapidly. In Sarah’s case, these costs amount to $20,000, doubling her PIP limit.

Her health insurance will take over once Sarah’s PIP coverage is exhausted. This transition is crucial, ensuring continued financial support for her medical care. However, the coverage is subject to the terms of her health insurance policy. This may include:

  • Deductibles: Sarah must pay out-of-pocket for some of the medical expenses before her health insurance coverage kicks in.
  • Co-pays: Fixed amounts for certain services or prescriptions under her health insurance plan.
  • Policy Limits: Maximum amounts her health insurance will pay. Sarah may have to pay the difference if her medical costs exceed these limits.

Steps to Filing a Claim with PIP and Health Insurance

Filing a claim with either car or health insurance following a car accident in Florida is a critical step in managing medical expenses. 

Step 1: Seek Medical Treatment. In Florida, a critical aspect of utilizing Personal Injury Protection (PIP) coverage after a car accident is the 14-day rule. This rule stipulates that you must seek medical care within 14 days of the accident to be eligible for PIP benefits. Failure to adhere to this timeline can result in the denial of PIP coverage for your medical expenses, regardless of the severity of your injuries or the circumstances of the accident.

Step 2: Report the Accident to Your Car Insurance Provider. The process begins with promptly reporting the accident to your car insurance provider. This involves providing detailed information, including the police report, accident scene photos, and witness statements. Completing and submitting the necessary claim forms is essential during this step. This initial claim is typically filed under your Personal Injury Protection (PIP) coverage, a mandatory component of car insurance in Florida, which covers medical expenses regardless of who is at fault.

Step 3: Call the Health Insurance Company. Once your PIP coverage limit is reached — often capped at $10,000 — the next step is coordinating with your health insurance provider. This involves informing them about the accident and your need for additional coverage. Providing your health insurance with detailed medical records and bills associated with the accident is crucial for processing your claim. Be sure you understand the details of your health insurance policy, including any deductibles and co-pays you’re responsible for, as these factors will influence the out-of-pocket costs you may incur.

How a Florida Injury Attorney Can Help

After suffering an injury in a car accident in Florida, a personal injury attorney can be invaluable, particularly when handling insurance claims and ensuring maximum compensation. 

An experienced attorney can meticulously review your insurance policies, both car and health, to identify all potential sources of coverage. They understand the nuances of Florida’s insurance laws, including the critical details of PIP coverage and the implications of the 14-day rule for seeking medical treatment. By managing the filing and negotiation process, a Florida car accident attorney can alleviate the burden of dealing with insurance companies, ensuring that all necessary documentation is properly submitted and deadlines are met. Their help streamlines the claim process and positions you to receive the fullest compensation under your policies.

Moreover, a Florida injury attorney can assess the broader legal implications of your accident, exploring whether you’re eligible to file a lawsuit beyond claiming insurance benefits. This is particularly pertinent in cases where the accident results from another party’s negligence, leading to significant injuries or damages that exceed your PIP coverage. 

A car accident lawyer can evaluate the circumstances of your case, determine liability, and estimate the potential compensation for damages such as medical expenses, lost wages, pain, and suffering. If a lawsuit is viable, they will guide you through the legal process, from filing the suit to representing you in court if necessary.

Contact Our Florida Car Accident Attorneys Today

If you or someone you love suffered an injury in a car accident in Florida, we can help. At Prosper Shaked Accident Injury Attorneys, PA, we are here to guide you through the steps after a serious collision. We know the ins and outs of insurance issues in Florida and can help you recover the compensation you need to recover. 

While your auto and medical insurance may cover some of your medical expenses, the best way to cover your hospital bills, X-rays, surgeries, medical devices, and rehabilitation may be to file a lawsuit.  Contact personal injury lawyer Prosper Shaked today at (305) 694-2676 for a free consultation on your case.