Insurance Questions
This section will give you some information concerning Florida 's No-Fault law which applies to motor vehicle accidents in the State of Florida . It is not exhaustive of the entire No-Fault Act, but is designed to give you a few of the most important points you will need if you have decided to try to settle your own claim.
For your purposes as a claimant in a Florida automobile accident case, two important things to understand are: Personal Injury Protection, and the "Permanency Threshold."
Personal Injury Protection
If you are operating a motor vehicle in Florida , it is required to have insurance. One of the coverages you are required to carry is Personal Injury Protection (PIP). PIP coverage is there to pay for your medical treatment up to $10,000, at a rate of 80% as the bills come in. This is partly where the concept of "no-fault" comes in: Even if the wreck is not your fault, YOUR auto insurance company will pay your initial medical expenses, up to $10,000, minus the deductible. This bothers and confuses some people. They'll say, "Why should my company have to do anything; It was his fault!" Well, that is because under Florida 's No-fault Act, your company must pay at least the first $10,000.00. If you need treatment that exceeds $10,000.00, the at-fault party and/or his/her insurer is responsible for that. Even if your treatment costs are less than $10,000.00, there was still 20% not covered (remember, PIP pays out at only 80%), as well as deductibles, so the at-fault party should be responsible for this.
Personal Injury Protection coverage is mandatory. So, if you have auto insurance, you have PIP. You may also have Medical Payments coverage, which is not mandatory. Medical Payments Coverage is good because it helps to fill in the gaps of what is not covered by PIP.
Your doctor will likely bill your automobile insurer for payment from the PIP coverage. If he does not, that could make it tough on you because you might have to front the money and get reimbursement later. Many doctors will also wait for payment of the 20% not covered, which you pay when you settle your case.
One other point to make is that if you have lost wages following an accident, your Personal Injury Protection can also be used to cover 60% of your losses. Keep in mind that anything paid out for wage loss will also use up coverage that would go towards medical treatment. So, if you used $4,000 for wage loss, that would leave you only $6,000 in PIP for medical treatment (assuming no deductible).
The "Permanency Threshold"
When Florida injury attorneys talk about the "permanency threshold", we are referring to that part of the Florida No-Fault Act that requires a showing that a client has a permanent injury before he/she will qualify for non-economic damages. This is a very important concept, and if you are going to try to settle your case on your own, you need to understand this. Let's use the following hypothetical scenarios to help illustrate some points I want to make.
Hypothetical One: Jane, a forty year old female, is in a traffic accident that is the other person's fault. Jane has neck pain, and for three months she goes to her chiropractor. After three months, her chiropractor tells her that she is fine, and that her neck sprain has healed. Jane feels great, just like she did before the accident, and her doctor says there will be no need for future treatment. She had $4,000.00 in medical treatment, and 80% of that was covered by her personal injury protection (PIP). However, because PIP only pays out at 80%, she has a balance of $800 that is still owed.
Hypothetical Two: Craig, a 28 year old male, is also in a traffic accident that is not his fault. He has neck pain, shoulder pain, and lower back pain. It is determined that he has a torn rotator cuff, and surgery is performed. After the surgery, and six months of treatment, his doctor renders an opinion that he will have permanent damage to that shoulder. Furthermore, he is more prone to arthritis in the shoulder. Craig had $34,000 in medical bills, and his doctor believes future care will cost about $2,000 per year.
As discussed above, there are a various types of damages that you will want to include in your demand for payment when you go to settle your case. Some of these damages do NOT require a permanent injury. In Jane's case, above, although she does not have a permanent injury, she still has a claim for any uncovered medical expenses. The at-fault party is responsible for those damages. If she had lost wages, she would also be eligible to recover those damages. But the main point is this: Since she does not have a permanent injury, she is NOT entitled to make a claim for pain and suffering. This is true even if she had horrible pain for three months, before she healed. You might think, "Can she at least make a claim for past pain and suffering?" The answer is "no," she cannot make that claim. This, in a nutshell, is the permanency threshold. This is a major point, because as I pointed out before, the pain and suffering component of damages is frequently the most substantial item that will drive up the value of a claim, because it is such an uncertainty (for both the plaintiff and the defendant) as to what a jury might award.
In hypothetical number two, Craig does have a permanent injury. Consequently, his claim is now qualified to make a demand for pain and suffering, mental anguish, etc., because there will be residual or permanent problems into the future.
One other point to make here: Just because your doctor says that your injuries are permanent, do not expect the insurance company to just accept his/her opinion. To the contrary, insurance claims adjusters frequently dispute the claimant's doctor's opinion on permanency. This is especially common in the case of an accident with a low impact, and/or if the claimant has a history of similar physical problems. Therefore, you may be disappointed in the reply to your demand by an adjuster who is treating your claim as non-permanent.
Return to Home Page