The law in Florida per section 627.733, which is titled Required Security, states that all motor vehicle owners must have “no fault” (called PIP or personal injury protection) insurance which pays 80 percent of medical bills and 60 percent of wages. We see a number of cases where the injured person DOES NOT have insurance on their car for one reason or another (policy was cancelled, never obtained insurance on the car, etc.). The question in those cases is: does the person that caused the accident owe ALL OF THE MEDICAL BILLS or does the person that caused the accident owe ONLY THE AMOUNT OF MEDICAL BILLS THAT WOULD BE OWING IF MY CLIENT HAD THE REQUIRED CAR INSURANCE (NO FAULT COVERAGE)?
To use an example: Mary gets into an accident. The accident was caused by John. Mary’s car insurance was cancelled on the day of the accident. Mary incurs $10,000 of medical bills. Because she didn’t have car insurance on the day of the accident, none of her bills were paid. If Mary had insurance, the insurance would have paid $8,000 to the medical bills, leaving her with only $2,000 due and owing. Thus, the issue is: does John legally owe her $2,000 towards the medical bills or $10,000 towards the medical bills.
The answer to this question is complicated because under the law, as of 2019, the answer depends on where you live. We have five legal districts of appellate judges. Those judges make the law for the lower courts in their respective districts. The trial judges in each district have to follow the law of the applicable appellate court. When there is a conflict between the different district courts of appeal, then the Supreme Court of Florida can resolve the conflict, which of course if binding on all of the appellate district courts and the lower courts. On this issue, there is a conflict between the districts, which has NOT been resolved by the Florida Supreme Court, as follows:
- First District Court of Appeal (1st, 2nd, 3rd, 4th, 8th and 14th Circuits)
- Second District Court of Appeal (6th, 10th, 12th, 13th and 20th Circuits) Jedlicka v. Proctor, 724 So.2d 668 (Fla 2d DCA 1999)
- Third District Court of Appeal (11th and 16th Circuits) – Cases v. Gray, 894 So.2d 268 (Fla 3d DCA 2004) (Miami-Dade and Monroe County)
- Fourth District Court of Appeal (15th, 17th and 19th Circuits) Holt v. King, 707 So.2d 1141 (Fla 4th DCA 1009) (Broward, Palm Beach, Indian River, Martin, Okeechobee and St. Lucie Counties)
- Fifth District Court of Appeal (5th, 7th, 9th and 18th Circuits) Stephens v. Renard, 487 So.2d 1079 (Fla. 5th DCA 1986)
So in the Second District Court of Appeal and the Fifth District Court of appeal, these courts allow the injured person to recover damages from the person that caused the accident that the No Fault/PIP would have paid had the injured person had insurance and the Third and Fourth District Court of Appeals do not allow the injured person to recover damages from the person that caused the accident that the No Fault/PIP would have paid had the injured person had insurance.
I primarily practice in the Third and Fourth District (which encompasses much of Southeast Florida) where, under the cases, the law is not favorable to the injured person who did not have insurance on the date of their accident as the at fault driver (through their insurance company) only owes medical bills and lost wages to the extent AFTER PIP PAYS OR WOULD HAVE PAID IF THE PERSON HAD THE REQUIRED INSURANCE.
How does all this map out in the context of an injury case?
If there is a large injury with 100k of medical bills and there is plenty of insurance on the other side to pay for the injuries, this law does NOT play a large role. So the person that has the PIP insurance would be able to sue the at fault person for 90k in medical bills (10k paid by PIP) plus future medical expense if applicable and past and future pain and suffering (and lost wages or loss of earning capacity). This case may be worth 200k or 300k or 400k, etc., depending upon the injury, the age of the client, how it’s affected their life and so forth. The person whose PIP insurance was cancelled and lives in a district where they cannot collect to the extent that they had the PIP, would owe 100k in medical bills but only be able to sue the at fault person for 90k in medical bills. Assuming the case is worth 200k or 300k or 400k, then it’s not going to make a huge difference in the case as there is plenty of recovery to pay the medical bills and still put plenty of money in the client’s pocket.
However, in a smaller accident where there is 10k in medical bills. The person that has the PIP insurance would have 8k paid by the PIP insurance and thus be able to sue the at fault person for 2k plus future medical bills (in small cases this is less likely), plus past and future pain and suffering (which is possible but in smaller accidents these are more difficult to prove). Thus, often times these sort of cases can be worth 5k or 10k or 15k, etc., depending upon the nature of the accident, injuries etc. If we use a smaller number like the case is worth 5k, you can really see the problem with this law in the districts where the law does not allow the injured person with cancelled insurance to collect all the medical bills. So in each case (when the injured person has PIP and does not have PIP), the injured person is able to sue for 2k in medical bills. So for the person that has PIP and there are 10k in medical bills but 8k are paid, then at a 5k settlement, the person will get money in their pocket after the medical bills are satisfied. However, if there are 10k in medical bills owing because the injured person did not have PIP and the case resolves for 5k, then you can see the problem: there are more in medical bills owing than the amount of the settlement!
I am not discussing medical bill reductions in all of this and clearly a large part of the injury lawyer’s role is to get medical bill reduced once a cases is resolved. I have handled cases in the scenario described just above (case resolves for 5k with 10k in owing medical bills because the injured person did not carry the requisite PIP insurance) and the client does generally net some money in their pocket; however, the client clearly would have netted more money in their pocket had they had the required no fault PIP insurance on the day of the accident.
Other things that that are worth discussing is how does health insurance play into all this. This blog has written about health insurance and how it plays out in a Florida car accident, so you should reference those blog posts. However, generally the automobile insurance (PIP) is the primary insurance to pay medical bills. I have seen cases where the health insurance refuses to pay the hospital bill because of a policy exclusion that denies payment when the person does not have the requisite car insurance. However, usually the health insurance will pay hospital bills in this scenario in my experience. But note that if the auto insurance PIP pays the hospital bill we do NOT have to pay the auto insurance back from a settlement but we DO have to pay the health insurance back from a settlement. Further, after the hospital, you may want to see doctors that are on your health insurance plan if you are concerned about the medical bills. Some doctors however will not bill the health insurance in car accident cases, even if they are on the health insurance plan.
There are 20 judicial circuits in Florida. They are:
First Circuit – Escambia, Okaloosa, Santa Rosa and Waltson
Second Circuit – Franklin, Gadsden, Jefferson, Leon, Liberty and Wakulla
Third Circuit – Columbia, Dixie, Hamilton, Lafayette, Madison, Suwannee and Taylor
Fourth Circuit – Clay, Duval an Nassau
Fifth Circuit – Citrus, Hernando, Lake, Marion and Sumter
Sixth Circuit – Pasco and Pinellas
Seventh Circuit – Flagler, Putnam, St. Johns and Volusia
Eighth Circuit – Alachua, Baker, Bradford, Gilchrist, Levy and Union
Ninth Circuit- Orange and Osceola
Tenth Circuit – Hardee, Highlands and Polk
Eleventh – Miami Dade
Twelfth Circuit – DeSoto, Manatee and Sarasota
Thirteenth Circuit – HIllsborough
Fourteenth Circuit – Bay, Calhoun, Gulf, Holmes, Jackson and Washington
Fifteen Circuit – Palm Beach
Sixteenth Circuit – Monroe
Seventeenth Circuit – Broward
Eighteenth Circuit – Brevard and Seminole
Nineteenth Circuit – Indian River, Martin, Okeechobee and St. Lucie
Twentieth Circuit – Charlotte, Collier, Glades, Hendry and Lee
