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Orlando PIP & No-Fault Insurance Attorneys

Are you hoping to avoid Personal Injury Protection (PIP) insurance disputes? PIP laws in Florida changed in 2012. Now more than ever, you should understand the laws that govern your ability to recover your PIP benefits.

PIP laws are part of Florida’s no-fault car accident system. The Florida Legislature aimed to provide a swift, virtually automatic system for paying medical expenses and lost wages related to an Orlando auto accident. Unfortunately, through years of legislative infighting and consistent and protracted PIP insurance disputes, the system has become anything but effective and often ends up hurting victims like you.

Get the justice you deserve by hiring an Orlando PIP & no-fault insurance attorney to assist you in settlement negotiations following severe accidents and injuries.

The Florida Legislature enacted PIP laws to limit the number of occasions on which people will be filing lawsuits against other drivers. The only way you can now sue another driver following a car accident is when your injuries and damages exceed the $10,000 PIP coverage maximum. This law means that when you suffer injuries in a car accident and have $100,000 in medical bills, you can sue the other driver for the remaining $90,000 that PIP insurance does not cover.

Some victims can also sue other drivers for pain and suffering or other non-economic damage claims, but these can be more difficult to pursue. Always consult a lawyer when considering any additional action relating to a PIP claim.

What is PIP Insurance?

Florida requires Personal Injury Protection car insurance. It compensates victims for injuries sustained in a car accident. It typically covers the policyholder, their relatives in the same household, passengers without PIP coverage, and other authorized vehicle drivers. It covers occupants of the insured vehicle and policyholders and their immediate family members if they are riding in another vehicle or if a car hits them when they are a pedestrian.

PIP insurance disputes arise when you are trying to recover PIP benefits after an accident and are unable to do so. There are bound to be many more cases where insurers deny Florida residents’ claims as they try to recover benefits thanks to recent changes in the PIP laws in Florida. 2012 saw some legislative changes that may make PIP insurance disputes more common in car accident cases.

Many medical expenses have coverage under PIP policies, with some exceptions for specific, less-common medical practices. PIP may cover medical services, medication, surgery, hospital expenses, rehabilitation costs, and ambulance rides.

The catch to the Florida PIP system is that only 80 percent of medical costs get coverage under PIP, meaning that if you have $10,000 in medical bills, PIP only covers $8,000 of that amount. When an injury does not require emergency treatment, a person can only recover $2,500 worth of benefits.

When injuries result in time away from work, Florida PIP pays for up to 60 percent of your lost wages with a $10,000 limit. The amount may also include household services a person typically provides but cannot because of an accident.

When a PIP policyholder loses their life, PIP pays for funeral and burial expenses and many of the above benefits. A party can recover $5,000 for such costs.

New PIP Laws Passed in Florida in 2012

During the 2012 legislative session, the Florida Legislature passed HB119, which dramatically alters PIP payments and benefits to insureds and medical providers.

 

Before these changes, the law required Florida drivers to purchase the minimum $10,000 PIP coverage. Victims expected to receive compensation if injury-related expenses were within the coverage limits.

 

Under the new rules, all Florida drivers who own vehicles must still purchase a $10,000 PIP policy. However, most auto insurance companies will only voluntarily pay $2,500.00 for medical claims under that policy. That’s right—you most likely are only going to get only 25 percent of the benefit of your insurance policy without some fight. At a minimum, you must prove you have an emergency condition to receive additional benefits.

 

Florida Statute § 627.732(16) defines an emergency medical condition as one involving acute symptoms of sufficient severity, which can include severe pain, such that the absence of immediate medical attention might result in:

  • Serious jeopardy to patient health
  • Severe impairment to bodily functions
  • Serious dysfunction of a bodily organ or part

 

When you do not have an emergency medical condition, you cannot recover more than $2,500 in benefits.

 

What does the law consider emergency medical conditions? A car accident injury claim is your word against the insurance company’s—unless you have solid medical evidence and the legal know-how to fight the adjusters.

 

The only solution to PIP insurance disputes such as these is legal action. Orlando car accident attorneys have spent months reviewing these new PIP laws and are ready to help clients keep their rightful benefits.

You must follow specific rules when filing a PIP claim in Florida. One of the most critical provisions relates to medical treatment for any injuries, as treatment needs to occur within two weeks of a car accident for you to be eligible for PIP reimbursement.

Claims are not accepted for medical treatment when it happens following two weeks. This limitation is also known as the 14-day rule.

People with minor injuries or who do not think they are hurt still must seek medical attention in accident cases. Again, you cannot seek compensation if you see a doctor after more than two weeks. The medical provider you see will only be acceptable under PIP insurance if they satisfy specific requirements, namely that they are either a licensed physician or advanced practice registered nurse.

When an initial assessment with a medical professional requires you to seek further medical attention from a specialist or a health care clinic, PIP insurance may cover certain medical specialties. These include general medicine, radiography, orthopedic medicine, physical medicine, physical therapy, physical rehabilitation, prescribing or dispensing outpatient prescription medication, and laboratory services.

An insurer has up to 60 days to investigate any PIP claim for false claims but still has to pay damages within 30 days, even when the insurance company suspects fraud. When it comes to benefits related to lost income, a victim will have to submit a wage and salary verification form that an employer will complete. Verification forms should document a victim’s wages 13 weeks before an accident.

An insurance company has a right to request that a victim undergo an independent medical examination, which is an examination performed by a doctor of their choosing. Since the insurance company will pay the doctor, you should know that they are unlikely to offer an unbiased medical opinion and will likely try to tell the insurer what it wants to hear.

While you may have to attend this medical exam, you should never sign any paperwork besides a sign-in sheet. First, speak to a lawyer who can accompany you to the appointment. When you arrive with legal counsel, you can better protect your rights moving forward.

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Car Insurance Coverage Is Critical in a Car Accident Claim

In Florida, car insurance coverage is your first resource for seeking compensation after a severe car accident. Because of Florida’s no-fault laws, your car insurance will serve as your initial form of compensation for your damages. When you recover your PIP benefits, you can only claim for up to the coverage limits you approved when you purchased your car insurance policy.

Do not believe you will get good results simply because you are working with your own insurance company rather than another driver’s insurance. All insurance companies aim to reduce costs to bolster profits. Insurers are just as likely to pay reduced claims when compensating their clients as when they compensate drivers insured by other companies.

What Is the Minimum Required Insurance Coverage in Florida?

Florida’s minimum insurance laws stipulate you must maintain $10,000 in PIP coverage, but it may be in your best interest to carry a higher amount. Consider the cost of medical care after a severe accident—a hospital visit alone can amount to several thousand dollars. Surgery, even outpatient procedures, rarely cost under $10,000. If you do not have enough PIP insurance coverage, you may have to pay the additional costs out of pocket.

Aside from medical expenses, your PIP benefits also can defray the losses you incur from being unable to work after an accident. Your PIP limits should cover the lost wages during this time, but if you do not have enough coverage, you may feel financial pressure from a lack of insurance again. After a severe car accident, it’s too late to add more coverage to your policy—once reported to the insurance company, you cannot change your policy until your claim resolves.

This fact is why you must evaluate your policy regularly. Make sure you have the proper coverage limits from the start, rather than lamenting your lack of coverage later after an accident. When you purchase a PIP policy in Florida, you can choose a higher deductible and whether you want to cover work loss. Drivers who pay higher deductibles get to pay lower premiums.

Additional Options After a Car Accident

While car insurance is essential, it is not your only recourse after a severe car accident. You can often file a personal injury lawsuit in PIP insurance disputes and claims involving uninsured motorists or underinsured policyholders. This matter is one best left to those experienced in this form of law—personal injury attorneys.

Once you exhaust your PIP benefits, or if you end up in PIP insurance disputes, you may need to take your injury claim to the next stage. A personal injury lawsuit will require legal counsel to bring your case to court.

In some cases, you can sue the other driver for insurance benefits. Not all accident cases will find resolution with a lawsuit, so it is an option you will want to discuss with an attorney before bringing the idea to fruition. Insurance and injury laws can be complex, and changes to these laws are not uncommon, such as in the recent changes to the PIP laws in Florida in 2012. Skilled lawyers have studied these new laws and can represent your interests in an insurance dispute or lawsuit.

Another possible problem with settlements or agreements reached with insurance companies is that insurers only must pay up to the limits of a policy, so people who have damages exceeding the policy limits may have to pursue further legal action against other drivers. These cases can be complicated because it may be possible that a negligent driver is not a person with significant assets or maybe even has no assets.

In these cases, a victim may have to take other actions to fully recover complete damages. These actions can involve you placing a lien on specific assets or getting that negligent party’s wages garnished. Such actions will involve other kinds of court actions, and they are not necessarily the final word on damages when a negligent party does not have the financial means to pay judgments.

You will want to be sure you are working with an experienced car accident attorney who will know the best way to make sure you can recover every last dollar you need and deserve.

Who I Am and How I Can Help You With PIP Insurance Disputes

Orlando Insurance Dispute Lawyer, Michael T. Gibson

Since 2010, I have devoted countless hours out of my practice away from my family to help lobby for true auto insurance reform. My goals have been to lower consumer insurance rates and help good and honest doctors receive fair payment.

In fact, I do not believe Florida should keep PIP! Unfortunately, with the new state laws, PIP is here to stay, so let’s deal with it.

My experience in Tallahassee seeing, literally, how this statute came into effect benefits me as I fight for my clients. Courts must construe and interpret legislative history to make important decisions under this new law. It helps to have a lawyer on top of every legislative hearing in the two years leading up to the PIP law change in Florida in 2012.

Based on this knowledge, I believe HB119 is an epic failure by the Florida legislature. I also believe it will fail because it will cause dramatically more PIP insurance disputes, defeating the purpose of PIP/No-Fault in the first place.

If you are an insured individual trying to recover PIP benefits or a doctor treating a PIP-insured patient in PIP insurance disputes, you need to learn quickly. Here’s a hint—under the PIP laws, you only have 14 days to act! That’s right—a mere two weeks can pass quickly when you’re busy recovering from a severe injury.

My law firm and I want to ensure this never happens to another Florida family now that the PIP laws in Florida changed in 2012. With our knowledge of the nature of PIP insurance disputes, we can assist you in recovering PIP benefits.

To get started on the right path without running into PIP insurance disputes, we suggest you:

  1. Order your free copy of The NEW ‘PIP.’
  2. Visit our article library and FAQ section to learn more about the PIP claims process and what you should expect during an insurance claim settlement.
  3. Contact my office to schedule a free, no-obligation consultation regarding your situation. Our attorneys and staff will answer your questions.
  4. Hire a personal injury attorney who understands the new PIP laws in the state.

You owe it to yourself to get peace of mind by hiring a personal injury attorney to assist you in settlement negotiations following any accidents that cause injuries. You don’t want a mere $2,500 settlement just because you couldn’t convince the insurance company that you had an emergency medical condition.

Michael T. Gibson, P.A., Auto Justice Attorney

2420 S. Lakemont Avenue
Suite 150
Orlando, FL 32814
Phone: 407-422-4529