On today’s Inside Look by Brooks, Steve Brooks talks about who pays your medical bills after you’ve been involved in a car accident.
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Good afternoon. Steve Brooks here with Friday’s Inside Look by Brooks. Welcome everybody. Today’s topic is a question that members of my law firm get asked very frequently: “Who pays for my medical bills after a car accident.”
In Florida, Florida is what we call a no-fault state. So you purchase PIP as your no-fault coverage, and PIP is going to be your primary source of coverage to pay your medical bills, it’s what we call primary, then there’s secondary, and below that. Usually PIP is $10,000 in coverage. With a $2,000 deductible and they pay 80% of your medical bills. You kind of got to separate your other insurance from your car insurance. On a normal insurance policy, everybody is going to purchase PIP, and not everybody is going to purchase liability coverage even though it’s on the same policy, it has nothing to do with your medical bills. Liability coverage covers you if you are at fault in an accident and the other driver sues you. Because Florida is a no-fault state, no matter who’s at fault when you’re in an accident, where you are at fault or the other drive is at fault, your own PIP coverage is going to pay for your own medical bills as your primary coverage.
Medical Payments Coverage
A third type of insurance that sometimes people buy on their auto insurance policy is called medical payments coverage. It is very similar to PIP, where it’ll pay for your medical bills, but it’s different in that if you ultimately sue the person who caused the accident and collect money from that person, then, most likely your auto insurance is going to have a lien on those proceeds and you’re going to have to pay back the medical payments coverage to your insurance company, or a portion of it, whereas PIP you do not have to pay back. It’s just coverage that is going to automatically cover you no matter who is at fault. Medical payments coverage, which is an over and above coverage, which you have to pay extra for, again will be on top of the PIP, but if you collect a settlement, then you’re going to have to pay some of the money back to your insurance company. The theory behind that is: your insurance company is sitting over here saying “We have to pay these medical payments coverage because Drive A ran a stop sign, hurt you, and caused us to have to pay this medical coverage. So if you get money from Drive A, then your insurance company has their hand out, saying “We want our fair share because we were harmed by this wreck, too.”
Separate and apart from your auto insurance policy is your health insurance coverage, so once you’ve exhausted PIP then your health insurance coverage, that your purchased as an individual policy through your business or employer, will pick up and like Medpay, your health insurance coverage will most likely have contract language that will give them a lien on any benefits they pay. On your behalf because of someone else’s negligence. So, if Drive A ran a stop sign, caused you to be hurt, caused you seek medical care, caused you to have a surgery that cost $30,000, and your health insurance covers that surgery, when you get money from Drive A for his negligence, then your health insurance company will probably have legitimate lien on those proceeds, and your attorney who’s handling your case will be legally obligated to repay or negotiate repayment of your health insurance company’s lien. Well, we face this issue on a regular basis, and we negotiate hard, which is part of you legal representation. Sometimes when it’s a complicated matter, we will bring in a third party who specializes in nothing, but negotiating liens, but that’s on a case-by-case basis.
A fourth potential source of coverage for your injuries, is if you’re driving your car on the job, doing an errand for your boss, and some other drive runs a stop sign and hits you. Your primary will be your PIP, and your secondary will probably be your health insurance, or your workers’ comp coverage. Maybe you have Medpay coverage, it would slide in there. You don’t have to pursue workers’ comp. In Florida, we find many times you don’t get to choose your workers’ comp doctor, so you report the claim to your workers’ comp and workers’ comp says you go to this doctor over here who we like and we trust, who we pay all the time. So, that doctor has a relationship with the workers’ comp company, and they kind of owe their allegiance to them. So, many times, we get the workers’ comp reports back, and many times they will not be written in favor of the patient. Many times, it will be like, “Patient A, who has a long history of back problems, was in a wreck, but this does not look like a traumatic injury. This looks like an old injury.” Because if a workers’ comp doctor does that, it takes the workers’ comp off the hook for paying your medical care. So, if we have a significant auto claim, many times we’ll tell our client not to pursue a workers’ comp claim because the worker’s comp records will poison the well. We’ll get those records and the liability carrier of the at-fault party will get those workers’ comp records and say “Look at these records. The workers’ comp doctor says that this is an old injury, not a new injury, so we shouldn’t have to pay.” So, unfortunately that’s the way the system works, just being real honestly, and if we have a client who has both a potential workers’ comp claim and a liability claim, we advise them if they pursue the workers’ comp claim the medical records, in many cases we’ve seen, can hurt you.
Those are the real sources of recovery and potential coverages for you if you’re involved in a car accident. Some people have policies like Aflac who will pay people a per day charge if they’re injured in an accident and I rarely see those types of policy. Normally, it’s PIP, Medpay, health insurance, workers’ comp. And in many case, PIP will cover most of it, and you don’t get above the $10,000 in PIP. If it’s a more serious injury that requires MRIs, surgeries, and extensive rehab then you’re definitely going to be getting into your health insurance, if you have it. I think that about covers the question today “After an accident, who pays for my medical bills?” I appreciate everybody showing up and viewing us today. If you are not watching this live, if you have any questions about what I’ve talked about, or have any questions in general, feel free to email me at [email protected]. That’s [email protected]. I’ll be glad to get back with you and discuss your questions. Thank you again for joining us and we look forward to seeing you again next Friday at 3:00. Thank you.