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Does my health insurance have to pay medical bills related to an accident case?

It is common that private health insurance, MEDICARE, and or Medicaid pays medical bills stemming from an accident. The good news is that since the bills are paid the client is obviously not put in collections by the provider. However, generally most health insurance policies have subrogation clauses. This means that when health insurance pays medical bills related to a case they are entitled to reimbursement to the extent that the client recovers money. If the client never recovers money or loses the case in court, then they don’t have to pay the money back. This legal process is called subrogation

I had 100 percent coverage with my Florida PIP and now i have to use some of my settlement to pay it back; why?

Generally, Florida no fault or PIP (personal injury protection) coverage pays 80 percent of medical bills up to $10,000.00. When your insurance pays that, there is no right of subrogation which means that they cannot ask you to repay the $10,000.00 or whatever the PIP paid and they cannot even ask for that money back from the other, at fault driver or the insurance of the at fault driver. The Florida PIP has to pay the bills and they do not get the monies back. Generally, to have 100 percent coverage you can purchase something called “medical payments” coverage. That pays the 20 percent balances at the doctors and any monies over and above the $10,000.00 limit (usually medical payment coverage provides an additional $5000.00 of coverage but can be a higher or lower amount). The insurer is allowed to seek subrogation or reimbursement for the medical payment coverage from their insured.

Why do I have to repay my health insurance (what they paid my doctors that treated me for the accident) from my Florida personal injury settlement?

Generally, if health insurance pays your doctors that treated you for an accident AND you make a claim against someone for that accident, you must also seek to get those medical bills paid in the case and must repay the health insurance. This subrogation right of the health insurance company is generally by contract or statute. With medicare or medicaid, for example, the right to reimbursement is by statute. With health insurance, the right to reimbursement is by contract. It is possible that the health insurance contract does not contact the proper language and if not then the health insurance is not entitled to subrogation generally but for the most part the health insurance contracts to have reimbursement provisions and thus entitled to repayment IF THERE IS A RECOVERY.

I am missing work due to pain from my Florida car accident; who is responsible to pay my lost wages?

Generally, in Florida, everyone that owns a car is required to have no fault or PIP (personal injury protection) insurance. That insurance pays for 80 percent of medical bills and 60 percent of wages, up to a total of $10,000. And since this is no fault insurance, it does not matter if you are at fault or the other car is at fault or there is a dispute as to fault. The bottom line is that your own insurance pays 60 percent of your lost wages, when sufficient proof is submitted (generally a disability note from your doctor and a wage verification form from your employer). If the other car is at fault, you can seek, as part of a settlement or verdict, the other 40 percent of unpaid wages.

Why do I need to go to a doctor to get money for a car accident in Florida? Doesn’t the other person owe me money solely because they caused an accident?`

Under Florida law, the person who causes an accident can be sued for damages. The damages that one can generally seek are medical bills past and future, lost wages past and future, and non economic damages (generally pain and suffering) past and future. If someone does not go to a doctor, then they would not have past medical bills and obviously obtaining future medical bills would be difficult in that scenario. If someone did not go to the doctor, they likely would not have lost wages. Most people focus on the “pain and suffering” or “inconvenience” when they ask this sort of a question. However, under Florida law, a permanent injury (or death, significant scarring or permanent disfigurement) is required to be entitled to any sort of non economic damages like pain and suffering. A permanent injury is generally proven by medical testimony and thus a doctor is necessary. Someone generally cannot prove a permanent injury with their own testimony. Thus, doctors and medical treatment is generally required to have a case for injuries in a car accident in Florida.