Does having insurance mean that all my medical bills will be covered?
In the event that you or a loved one were visiting the Florida Keys, and are the victim of a motor vehicle accident, you no doubt have many questions, and fears. While your health and making a speedy recovery are the primary concerns, the eventual mounds of paperwork forthcoming by your own insurance company, or the at-fault party’s insurance company, can be very confusing. I will provide a broad overview of the various types of insurance available and how these insurances work with respect to a car accident you have suffered in the Florida Keys.
PIP (Personal Injury Protection) & Bodily Injury Liability Insurance (BI)
PIP, otherwise known as Personal Injury Protection, is mandatory minimum insurance that is required to be carried by the owner of a vehicle registered in the State of Florida. Generally speaking, PIP provides benefits in the amount of $10,000.00 per person and $20,000.00 per accident (“10/20”). PIP is insurance that is available to you or a passenger in your car, or the other vehicle, who has suffered a loss as a result of the car accident. This insurance is available regardless of fault. Meaning, even if you were at fault for the car accident, you still have PIP benefits available. Generally, PIP provides money for lost wages, pays your medical bills, hospital stays, transportation to health care providers, and prescription medication, etc. While you have to jump through several hoops (i.e. paperwork) to receive these benefits, they are very helpful in providing you with the initial medical care you need immediately after the accident. What is particularly helpful in maximizing your recovery and ability to recover for a lawsuit, is the immediate documentation of injuries, and complaints.
Once those PIP benefits have been exhausted, your medical bills will need to be paid for by your medical insurance (i.e. BlueCross BlueShield, United, Humana, etc.) or the at-fault party’s bodily injury (BI) liability insurance. The PIP insurance is primary, meaning that your medical health insurance does not come into play until the $10,000.00 in benefits has been spent. If your medical bills and future medical care exceed the PIP benefits, and you do not have health insurance, then you will be limited to making a claim against the negligent party’s BI liability insurance. The amount of insurance coverage varies in each state. In Florida, the lowest amount of coverage that an owner of motor vehicle may carry is 10/20. This means, that the injured party who was without fault for the car accident will only have an additional $10,000.00 of insurance money available to him or her to pay for their past or future medical care. With the ever-increasing cost of health care, it is fairly easy to incur $20,000.00 in medical bills and future care. While many driver’s carry a sufficient amount of BI liability insurance (i.e. $100,000.00), you do not want you ability to be compensated for your injuries to be limited by the at-fault party’s decision to only carry minimal BI liability insurance and have no other assets available in which to make a claim.
Uninsured/Underinsured Motorist Coverage (UM)
If your bills exceed the available amount of insurance (between PIP and BI liability insurance), then your only other available insurance coverage is in the form of uninsured or underinsured motorist insurance, commonly referred to as “UM insurance”.
UM is insurance that many people routinely deny, even though it is very important. A common misconception that I face is that a client believes that he has UM coverage because he has “full coverage”. Although an insurance agent indicates that you have “full coverage”, you should verify that not only do you have a sufficient amount of liability insurance to cover the value of your family assets, but that you also have UM coverage. This insurance will come into play if the injuries you have suffered, and the associated medical bills, exceed the amount of PIP and BI liability coverage held by the negligent driver.
Imagine the scenario where you have $50,000.00 in medical bills due to hospitalization, and follow up medical care, only to find out that the at-fault driver either had no insurance, or the $10,000.00 statutory minimum amount of (BI) liability coverage. Once PIP ($10,000) and BI liability insurance ($10,000) have been exhausted, and assuming you do not have medical insurance, who is going to pay the $30,000.00 of medical bills you now owe? While negotiating with the hospital for a reduced rate, or seeking bankruptcy protection, are viable alternatives, these stressful decisions could have been eliminated altogether had the client purchased a sufficient amount of UM insurance. UM coverage is available in amounts beginning at $10,000.00 up through, and exceeding, $1,000,000.00. Many clients of our office have purchased UM insurance in the amount of $100,000.00 The importance of UM insurance is that with this type of coverage, you are purchasing protection which will directly benefit you! On the other hand, liability insurance is purchased which is only available to the other driver, in the event you were at fault for the car accident.
Although I do not sell insurance, I often advise clients who have substantial assets that are not already protected by a trust or jointly held with a spouse, to purchase the appropriate amount of BI liability insurance, including as at least $100,000.00 worth of UM insurance. The protection and peace of mind that is provided by appropriate levels of BI liability and UM insurance, far outweighs the nominal increase associated with your monthly premium.
If you have UM insurance, the procedure in which to invoke those benefits is a bit of a dance between the insured, BI liability insurance carrier, and UM insurance carrier. First, once a claim has been opened with PIP, your attorney should place the BI liability carrier and UM carrier on notice that the injured party’s medical bills may be in excess of the amount of BI liability insurance available. In addition, the UM carrier should be placed on notice that a claim may be made against the policy so the UM carrier is under an affirmative obligation to fully evaluate your claim once it has received all of the relevant materials.
If the injuries suffered by the plaintiff exceed the amount of BI liability insurance coverage available, then you must receive permission from the UM carrier to accept the tender of the policy limits of the BI liability carrier. You cannot accept the policy limits from the liability carrier without first obtaining approval from the UM carrier. Once you put the UM carrier on notice of the BI liability carrier’s tender, then the UM carrier has 30 days as per Florida Statute to provide you with permission to accept the tender.
Now that you have received permission to accept the tender, you must turn your attention to the UM carrier. At this stage, you must then negotiate how much money the UM carrier will provide you under the terms of the insurance policy in order to compensate you for the shortfall between the amount of BI liability insurance available relative to the injuries you have suffered arising out of the car accident.
I recognize that much of the law and procedure surrounding insurance coverage from a car accident in the Florida Keys is confusing, but the law firm of Hutchison & Tubiana, PLLC can be your advocate in order to help you successfully charter these uncertain waters. Whatever you deicide to do, please be sure to contact an attorney who is licensed to practice law in the State of Florida. If you or a loved one have been involved in a auto accident in the Florida Keys, please do not hesitate to contact our office for a telephone consultation to determine your rights and what type of compensation you may be entitled.