Who Pays Medical Bills in a Car Accident?

March 10, 2020
Who Pays Medical Bills in a Car Accident?

Florida Car Accident Medical Bills

There were 402,592 car accidents in Florida in one recent year, which resulted in 254,873 injuries, according to the Florida Highway Safety and Motor Vehicles Department. If you or a loved one are one of those more than a quarter-million injured people, who are you planning to pay your medical bills? It's an excellent question, given that healthcare costs across the country are high and rising. In fact, you may receive several answers, depending on how much your medical bills are, how serious your injuries are, whether you have car insurance and health insurance, and whether someone else was at fault for your accident. If you retain us, we will go through all of the potential parties that may face liability for your injuries so that no one is left out of your claim.

Florida Is a No-Fault State: Your PIP Coverage Kicks in First

As many Floridians know, Florida is a no-fault state for car insurance and car accidents. That means exactly what it sounds like. Initially, fault for a car accident isn't addressed when it comes to paying medical bills. In other words, anyone injured in the state of Florida turns first to their own car insurance to pay their medical bills, without regard to who was at fault for the collision. One way to understand this is that, in fault states, an injured driver can seek to have the at-fault driver pay their medical bills from the beginning. In Florida, this path is only open to you if certain conditions, discussed below, are met.

Florida Personal Injury Protection

Because everyone turns first to their own insurance, the state requires that everyone who registers a car get insurance coverage in case of a car accident. This is the personal injury protection (PIP) coverage you may remember purchasing or that a family member purchased. PIP coverage will pay 80 percent of your medical bills, up to a maximum of $10,000. This may immediately raise two questions in your mind. One, who pays the other 20 percent, and two, what happens if your medical bills are more than $10,000? In today's world, frankly, $10,000 of medical coverage doesn't go very far. Medical bills in a car accident can be extensive. You may have incurred emergency services treatment for an ambulance or emergency room, doctor's visits, hospitalization, surgery, prescribed medications, rehabilitative therapy, and costs for retrofitting your home or convalescent equipment, such as canes. Your PIP coverage can also be used by anyone living in your house who is injured or anyone driving your vehicle.

Your Own Health Insurance

Generally, the remaining 20 percent of your medical bills are paid by your health insurance. If your medical bills exceed $10,000, your health insurance will pay for that as well.

Who's Liable for a Car Accident?

Once you move to your own health insurance, however, the question of who was at fault for the car accident that injured you does become relevant. It may not be relevant when you first access your PIP coverage, but it will become relevant if PIP doesn't cover the full extent of your medical costs. If another party was at fault for your accident, your health insurance company may well seek to have that person's insurance pay your medical bills. Your own company may pay the bills initially, so you aren't on the hook when the bills arrive, but it will likely seek reimbursement from the at-fault party's insurance company.

Determining Car Accident Fault

Fault in a car accident is determined by reviewing what caused the car accident. Drivers owe what is termed a “duty of care” by virtue of having a license. The duty of care is owed to the public and encompasses factors like making prudent decisions while driving and following all traffic laws and regulations. A violation of this duty of care constitutes negligence. Negligent behavior means that the person or entity who acted negligently is responsible for your injuries, and liable for the costs associated with them. The liable party must pay. In other words, if a driver rear-ended you, he or she is highly likely to be found negligent. Why? Because drivers owe all others on the road a duty of care to drive safely and prudently, and that includes taking care to leave sufficient space between vehicles.

Non-Driver Car Accident Fault

It is not always another driver who caused a car accident, of course. What if a car ran into you because the driver became unable to control the car after a tire blowout? Blowouts can make cars difficult to steer and maintain in one lane. That could seem like driver negligence, but what if that driver establishes that the tires were defective, and the defect caused the blowout? In such a case, the manufacturer could be deemed negligent and thus liable for your injuries. Why? Because manufacturers too owe a duty of care to the public; they are responsible for ensuring that their products are safe. If products placed in cars, or cars themselves, demonstrate repeated safety problems, the National Highway Traffic Safety Administration (NHTSA) may issue a recall. Manufacturers are responsible for communicating recalls to people who have purchased cars affected by the recall. Recalls recommend repairs of the defective item that are necessary to make the car safe to drive or replacement of the item. If your accident is caused by poorly maintained roads, such as deep potholes or uneven pavement, the entity responsible for repairing and maintaining the roads could also be deemed liable and thus negligent. The bottom line? If another party caused your accident, and the accident was the proximate cause of your injury, that party can be deemed negligent and thus liable for your injuries. This means that party may be responsible for your medical bills. Furthermore, your health insurance company may go after the at-fault party's insurance. This is called pursuing a third-party claim.

Can You Pursue a Third-Party Claim?

Florida Truck Accident LawyersIf your injuries are severe, you may be wondering if can you pursue a third-party claim. Can you contact the at-fault party's insurance company and file to have your medical bills paid? Individuals in Florida can only pursue a third-party claim if they have received a serious injury. Serious injury is defined to be a minimum of one of the following:
  • Broken bone(s)
  • Significant disfigurement
  • Significant limitation of use of a body function or system
  • Permanent limitation of use of a body organ or member
  • Substantially full disability for 90 days
If your injury qualifies as serious, then the law allows you to pursue damages not only from a third-party insurance claim, but also from a personal injury lawsuit. This is called “stepping outside of no-fault,” because you are allowed to pursue medical bill compensation outside of the no-fault system.

Advantages to Stepping Outside of No-Fault

Stepping outside of the no-fault system offers several advantages.
  • First, an insurer other than your own will pay your medical bills. Large medical bills can raise your premiums, and if another party was at fault, it is only fair that he or she pay your medical bills. In addition, of course, many people must pay copays and deductibles. For a serious injury, these can add up to significant amounts of money. In a serious injury, you may have prospective medical bills as well as ones you're already incurred. A personal injury or third-party claim can include damages for future medical bills as well as current ones.
  • Second, if you have significant medical bills from a car accident, it is likely that your financial life has been impacted in other ways, as well. A common occurrence is the need to take time off from work, to see the doctor, have surgery, and recuperate in a hospital, or recuperate at home, until your injuries heal. PIP is designed to pay 60 percent of your income lost from work in a car accident. But if you pursue either a third-party claim or a personal injury claim, you can pursue damage compensation for all your income lost from work. Similar to medical bills, you can also pursue expected future loss of income.
  • Third, stepping outside of no-fault allows injured people to seek damages for noneconomic losses, such as pain and suffering. If you stay within the no-fault system, you are not allowed to seek non-economic damages from an at-fault driver.

Can a Third-Party Deny Your Claim?

While it may be advisable to pursue a third-party claim, insurance companies may try to deny your claim. This doesn't mean that denial has any merit, though. Insurance companies, unfortunately, are in the business of making money, just like other businesses. Insurance companies make more money if they deny a claim than if they pay it out. Consult an attorney if you are thinking of pursuing a third-party claim. Attorneys can negotiate with insurance companies and, because they are familiar with the types of arguments insurance companies use, more successfully counter those arguments.

Insurance Company Claim Denial

An insurance company may, for example, try to indicate that you are partly at fault for the accident, or even completely at fault. Its representatives may misstate facts and even hire their own investigators. Insurance companies may try to say that your injuries are less serious than you claim. They can argue that the recommended treatment method of your doctors isn't the right one and try to get you to settle for another, less expensive course of treatment. They may try to turn words like “I'm sorry” blurted in the aftermath of a traumatic accident into an admission of guilt. Perhaps worst of all, they often try to offer a settlement that is too low for the injuries suffered. Frankly, they know that you likely need to pay your bills to avoid notices or carrying expensive credit card debt. They prey on your need to pay your bills to make you a low ball offer. Having an attorney to negotiate can make insurance companies more likely to offer a fair settlement.

Establishing Guilt in a Personal Injury Claim

If the insurance company doesn't offer a fair settlement, a personal injury claim is always an option. It's important, of course, to establish the defendant's guilt in causing the car accident. An attorney can help here, as well. Attorneys work with investigative teams to establish the causes of car accidents. They can interview eyewitnesses, access surveillance camera footage if it is available, and engage forensic analysts who can review the scene to reconstruct what occurred. These teams can also work with you to establish evidence. If you are in a crash in which someone is injured, complains of injuries or discomfort, or dies, you must report it to the police by law. The resulting police report can be a prime piece of evidence in a legal or insurance case, because law enforcement will note facts regarding the crash, interview all drivers and eyewitnesses, and note injuries. Be sure to get a copy of the police report following your accident. You should stay at the scene unless your injuries are sufficient to require an ambulance. If you are carrying a smartphone, it's a prudent idea to take multiple pictures of the scene. Pictures are also evidence of what happened. Take pictures of the surrounding areas that are relevant, the cars or other vehicles involved (all sides), and your injuries. If you are injured, your health comes first. The doctor's reports are also evidence in establishing your injuries directly after the accident and what occurred. Even if you don't feel injured, it's a good idea to go to the doctor. They can give you a thorough check-up and note any regimen to follow. Many injuries don't have symptoms, or the symptoms may not show up immediately.

What if an Uninsured Motorist Hits Me?

About 25 percent of Florida drivers don't have insurance, a figure that makes us number two in the nation for uninsured drivers. One option is to purchase uninsured/underinsured motorist coverage when you pursue your own insurance. This form of insurance can reimburse you for medical bills, as well as wages lost from work and pain and suffering, if you are injured by an uninsured or underinsured driver. Another option is to pursue a personal injury suit against the at-fault driver, since there is no insurance carrier to pursue a third-party claim toward. Unfortunately, this is only likely to be successful if the driver has meaningful assets. If you have further questions about who pays your medical bills after a crash, contact a car accident lawyer today. Dolman Law Group Accident Injury Lawyers, PA 800 North Belcher Road Clearwater, FL 33765 (727) 451-6900 https://www.dolmanlaw.com/florida-car-accident-lawyer/

Matthew Dolman

Clearwater Personal Injury and Insurance Attorney

This article was written and reviewed by Matthew Dolman. Matt has been a practicing civil trial, personal injury, products liability, and mass tort lawyer since 2004. He has represented over 11,000 injury victims and has served as lead counsel in over 1000 lawsuits. Matt is a lifetime member of the Million Dollar Advocates Forum and Multi-Million Dollar Advocates Forum for resolving individual cases in excess or $1 million and $2 million, respectively. He has also been selected by his colleagues as a Florida Superlawyer and as a member of Florida’s Legal Elite on multiple occasions. Further, Matt has been quoted in the media numerous times and is a sought-after speaker on a variety of legal issues and topics.

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