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Home :: FAQ :: Personal Injury

Who will pay my medical bills and lost wages?

If you are an injured driver or passenger in a motor vehicle accident in the State of Florida, unbelievably it is your own auto insurance carrier, through your own Personal Injury Protection Benefits who is responsible to pay 60% of your lost wages, and 80% of your medical bills.  This is true no matter who is at fault, and is payable up to an aggregate of $10,000.00 even if you were at fault, hence the somewhat misleading term “No Fault” insurance.

During the course of your treatment, you may exhaust your PIP benefits.  This usually happens when the total of your bills exceeds $12,500.00.  So if you have health insurance, Medicare or Medicaid as well as PIP/no-fault benefits, please let your health care providers know and give them all the information necessary to bill that co-provider.  Remember, your PIP/no-fault benefits only pay 80% of your bills up to a total of $10,000.00 coverage.  The 20% is payable by your co-insurer (example: Automobile Med-Pay, Blue Cross/Blue Shield, Aetna, Humana, Medicare, Medicaid)) or by you out of pocket or eventually from your recovery should there be one in your case.  As a consequence, it is always wise after you are injured to check in with your family doctor to apprise him of your treatment.  It is important not to have him or her “out of the loop” since not only he/she is one of your most valuable witnesses if suit is filed, he/she may be called upon to make the appropriate referral for you to a specialist once your PIP/no-fault benefits are exhausted and payment for your medical bills is taken over by your co-insurer/health insurance provider.

Attorneys who practice personal injury law and put the client first, have found it financially favorable for our clients in the long run to obtain medical care through their co-insurer once PIP/no-fault benefits are exhausted.  Even though your health insurer maintains a lien on your recovery, the lien is much reduced because of the lower cost of medical attention, surgery, hospital care and pharmaceuticals that the co-insurers have negotiated with providers.  This results in a greater net recovery for you out of an eventual settlement.  (For example : surgical facilities will bill you $10,000.00 per day if you are self-insured, but only bill a health insurance carrier or medicare between $750.00 and $1,000.00 for the same facility.)  Additionally, I have seen surgical bills of $30,000.00 paid at a rate of $3,500.00 by a health insurance carrier.  The choice of where to get medical care and how to have it paid for is your decision.  Please try and be wise with your choices and check on your potential bills for services and on your total bill from your providers so you know what your bills are.  Your attorney should ask your PIP/no-fault carrier to advise him and you and to copy you with a Notice of Exhaustion of Benefits if and when your PIP benefits run out.

Additionally, you should confirm whether or not your health care providers are going to accept your private insurance, Medicare or Medicaid after your “No Fault” benefits are exhausted.  If not, let your attorney know in writing so that he or she can advise you of your options.