Does Health Insurance Cover Car Accident Injuries? [Florida]

Car accidents are difficult and stressful experiences, especially when injuries are involved. In Florida, where approximately 400,000 crashes occur annually according to the Florida Department of Highway Safety and Motor Vehicles, understanding how medical bills will be covered is often confusing. Many accident victims find themselves wondering does health insurance cover car accident injuries or if auto insurance is the primary source of coverage. This uncertainty can add unnecessary stress during an already challenging time.

Will My Health Insurance Cover My Car Accident Injuries?

Yes, health insurance can cover car accident injuries in Florida, but it typically acts as secondary coverage after your auto insurance’s Personal Injury Protection (PIP) benefits are exhausted. Under Florida’s no-fault insurance system, your PIP coverage must be used first to pay for 80% of your medical expenses up to your policy limit (usually $10,000) regardless of who caused the accident.

Understanding how these insurance systems work together can help you maximize your coverage and minimize out-of-pocket expenses during your recovery process. Let’s examine the relationship between auto insurance and health insurance in Florida to give you a clearer picture of what to expect.

Understanding Florida’s No-Fault Insurance System

Florida operates under what’s known as a “no-fault” insurance system. This means that regardless of who caused the accident, each person involved must first turn to their own auto insurance policy for coverage of medical expenses and certain economic losses.

Under Florida law, all registered vehicle owners must carry a minimum of $10,000 in Personal Injury Protection (PIP) coverage and $10,000 in Property Damage Liability (PDL) coverage. The no-fault system was designed to reduce litigation and ensure prompt payment of medical bills following an accident.

The practical effect of this system is that your initial medical treatment after a car accident will be covered by your own auto insurance, not your health insurance, and not the at-fault driver’s insurance. This is true even if another driver clearly caused the accident. The no-fault system essentially separates immediate medical treatment from the question of fault.

Personal Injury Protection (PIP) Coverage in Florida

Personal Injury Protection is the cornerstone of Florida’s no-fault system. Here’s what you need to know about how PIP works:

• PIP covers 80% of all reasonable and necessary medical expenses related to the accident, up to your policy limit (typically $10,000). This coverage applies to:
  • Emergency transport and treatment
  • Hospital stays and services
  • Surgical procedures
  • Diagnostic tests (X-rays, MRIs, CT scans)
  • Follow-up doctor visits
  • Physical therapy
  • Prescription medications
  • Medical equipment
• PIP also covers 60% of lost wages if your injuries prevent you from working, and provides $5,000 in death benefits if a crash results in fatality.

One important aspect of Florida’s PIP coverage is the “14-day rule.” You must seek initial medical treatment immediately within 14 days of the accident for your injuries to be eligible for PIP coverage. Failing to see a doctor within this timeframe can result in your insurance company denying your claim entirely.

Another limitation is that PIP only covers 80% of your medical expenses, leaving you responsible for the remaining 20% unless you have additional coverage.

When and How Health Insurance Gets Involved

Your health insurance generally becomes relevant in car accident cases in three scenarios:

1. After your PIP benefits are exhausted
2. For the 20% of medical expenses not covered by PIP
3. For treatment sought after the 14-day window has passed

When your $10,000 PIP limit is reached—which can happen quickly with serious injuries—your health insurance typically becomes the next source of payment for ongoing medical treatment. However, this transition isn’t always automatic.

You should notify your health insurance provider about the accident as soon as possible. Most health insurance policies have coordination of benefits provisions that require you to inform them about any other insurance coverage that might be responsible for your medical costs.

When submitting claims to your health insurance after PIP is exhausted, you’ll need to provide:

• Proof that PIP benefits have been exhausted
• Documentation from your auto insurer showing the final payment
• A letter of exhaustion from your auto insurance carrier

Remember that when your health insurance kicks in, your regular deductibles, copays, and coinsurance will apply. This means you may still have significant out-of-pocket expenses despite having both auto and health insurance. Also, health insurance may extend in limited cases where timely treatment is not achieved within the 14-day window.

Coverage Gaps and Out-of-Pocket Expenses

Even with both PIP and health insurance, you may face several gaps in coverage:

• The 20% gap in medical expenses not covered by PIP can add up quickly. For example, if you incur $10,000 in medical bills, PIP covers $8,000 (80%), leaving you with $2,000 to pay through other means.
• Health insurance deductibles and copays can be substantial, especially for high-deductible plans. If your health insurance has a $3,000 deductible, you’ll need to pay that amount before your health insurance begins covering your ongoing treatment.
• Some specialized treatments, experimental procedures, or certain types of therapy might not be covered by either insurance.
• Out-of-network provider costs under your health insurance plan can substantially increase your financial responsibility.
• For serious injuries requiring long-term care, the combined limits of PIP and health insurance might be insufficient to cover all expenses.

These coverage gaps highlight why many Florida residents choose additional protection beyond the minimum required insurance. Understanding these potential expenses in advance can help you make informed decisions about your insurance coverage and financial planning for recovery.

Medical Payments Coverage (MedPay) as a Supplement

Medical Payments Coverage, commonly known as MedPay, is an optional add-on to your auto insurance policy that can help fill the gaps left by PIP and health insurance. While not required in Florida, MedPay can provide valuable additional protection.

MedPay typically covers:

• The 20% of medical expenses not covered by PIP
• Your health insurance deductibles and copays
• Medical expenses after PIP benefits are exhausted

Unlike health insurance, MedPay has no deductibles or copayments. It pays 100% of the covered medical expenses up to your policy limit, which typically ranges from $1,000 to $25,000 depending on the coverage you select.

MedPay premiums are relatively affordable compared to the potential out-of-pocket expenses you might face without this coverage. Many insurance professionals recommend adding MedPay to your auto policy, especially if you have a high-deductible health insurance plan.

Bodily Injury Liability Claims for Serious Injuries

For cases involving serious injuries, Florida law allows you to step outside the no-fault system and pursue a claim against the at-fault driver. This becomes relevant when your injuries meet Florida’s “serious injury threshold,” which includes:

• Significant and permanent loss of an important bodily function
• Permanent injury within a reasonable degree of medical probability
• Significant and permanent scarring or disfigurement
• Death

If your injuries meet this threshold, you can file a bodily injury liability claim against the at-fault driver’s insurance. This claim can seek compensation for:

• Medical expenses beyond what PIP and health insurance cover
• Full lost wages (not just the 60% covered by PIP)
• Pain and suffering
• Long-term care needs
• Loss of enjoyment of life

Florida applies a comparative negligence standard, meaning your compensation may be reduced by your percentage of fault in causing the accident. For example, if you’re found 30% at fault, your recovery would be reduced by 30%.

Health Insurance Subrogation Rights

When your health insurance pays for medical treatment related to a car accident, they typically have “subrogation rights.” This means your health insurer can seek reimbursement from any settlement or judgment you receive from the at-fault party.

Subrogation works like this:

1. Your health insurance pays for your medical care after PIP is exhausted
2. You pursue a claim against the at-fault driver and receive a settlement
3. Your health insurer asserts a lien against your settlement for the amount they paid for your treatment

Your health insurance contract likely contains provisions requiring you to cooperate with their subrogation efforts. Failing to account for these liens can create serious legal and financial problems.

Many personal injury attorneys negotiate with health insurers to reduce these liens, allowing you to keep more of your settlement. The reduction is often based on the concept that the health insurer should share in the costs of obtaining the settlement, including attorney fees.

Special Considerations for Medicare and Medicaid Recipients

If you’re covered by Medicare or Medicaid, there are additional considerations regarding car accident injuries:

Medicare follows the “Medicare Secondary Payer” (MSP) rules, which dictate that Medicare is generally the secondary payer when other insurance is available. This means:

• PIP coverage pays first
• Medicare pays second for services covered by Medicare

Medicare must be notified of any car accident claims and potential settlements. Failure to properly report and address Medicare’s interests can result in significant penalties, including Medicare refusing to pay for future treatment related to your injuries.

Medicaid, like private health insurance, has subrogation rights and will place a lien on any settlement you receive. In Florida, the Medicaid lien is limited by statute and cannot exceed a certain percentage of your total recovery.

Both Medicare and Medicaid recipients should work closely with an attorney familiar with these programs to ensure compliance with all reporting requirements and proper resolution of any liens.

Steps to Take After a Car Accident to Maximize Coverage

To ensure you receive the maximum insurance coverage for your injuries, follow these steps after a car accident:

1. Seek medical attention immediately, and certainly within 14 days, even if injuries seem minor
2. Report the accident to your auto insurance company as soon as possible
3. Maintain detailed records of all medical treatments, including dates, providers, and costs
4. Ask for copies of all medical records and bills
5. Notify your health insurance provider about the accident
6. Keep track of all correspondence from both auto and health insurers
7. Document any work missed due to injuries
8. Consult with a personal injury attorney before providing recorded statements or accepting settlement offers

When selecting medical providers, verify that they accept both your auto and health insurance. Some medical providers are experienced in treating car accident victims and understand the insurance nuances involved, which can simplify the billing process.

Resolving Insurance Coverage Disputes

Insurance disputes are common after car accidents. Claims may be denied for various reasons:

• Treatment deemed not medically necessary
• Pre-existing conditions allegations
• Treatment sought after the 14-day window
• Policy exclusions or limitations
• Coordination of benefits issues between auto and health insurance

If your claim is denied, you have several options:

1. Request a detailed explanation of the denial in writing
2. Submit an internal appeal with your insurance company
3. File a complaint with the Florida Office of Insurance Regulation
4. Consult with a personal injury attorney about legal remedies

For complex cases involving serious injuries or large medical bills, seeking legal representation early in the process can be invaluable. In such situations, you might consider contacting a car accident attorney to help navigate the complicated relationship between PIP, health insurance, and potential third-party claims.

If you’re struggling with insurance coverage after a car accident, the Florida Department of Financial Services offers free insurance consumer assistance through their Division of Consumer Services. They can answer questions and help mediate disputes with insurance companies.

Remember that insurance companies, whether auto or health, are primarily concerned with their bottom line. Having knowledgeable advocacy on your side ensures your medical needs remain the priority throughout the claims process.

Speak with an Orlando Car Accident Lawyer Today

If you have been injured in a car accident due to another driver’s negligence, it is essential that you consult an experienced Orlando car accident attorney. An attorney will make sure that your rights are protected, and they will work to get you the compensation you deserve for your injuries.

You should not have to go through the aftermath of a serious car accident alone. Auto Justice Attorney Michael T. Gibson is on your side and is ready to help you navigate the process of filing a personal injury claim so that you can focus on your recovery. Contact us today at 407-422-4529 or on our website to schedule a free consultation.