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 type of coverage you are required to purchase 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.
UPDATE AS OF 2013: This section used to be far longer, as the basics of PIP Coverage had not changed for many years. That changed as of January 1, 2013, due to radical changes to the Florida PIP Statute. In general, here are some major changes as to persons injured in an automobile accident:
- All benefits may be forfeited if medical treatment (called “Initial Services) is not sought within 14 days from the date of accident;
- Assuming medical treatment is obtained within 14 days from the accident, then PIP will provide only $2,500.00 in coverage unless the injured person is deemed by a specifically licensed provider to have an “Emergency Medical Condition” (EMC).
- The full $10,000.00 of PIP will be available if the injured person does have an EMC.
There are far more changes included within the new PIP law, none of which favor the injured victim (or, for that matter, an injured person who causes an accident). Given the changes in the PIP law, it is now more important than ever that someone injured in a motor vehicle accident contact an experienced and well-qualified attorney as soon possible after the accident.
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. 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.
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 his 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.
Looking at Jane’s hypothetical, please note that 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 not covered by PIP. If she has 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 or future economic damages. 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, and other future damages, because there will be residual or permanent problems after the claim is resolved.
One other point to make here: Just because a doctor says that your injuries are permanent, do not expect the insurance company to just accept that 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. Consequently, an experienced, well-qualified attorney is essential to your claim. I have been handling personal injury cases for over 17 years, and it is 100% of my practice.
Please feel free to contact me.
