“I was in a car accident. Who pays for my medical bills and lost wages?”

Every car registered in Florida must carry No-Fault insurance. This coverage is also known as PIP, or personal injury protection coverage. No-fault pays 80% of your reasonable medical expenses and it also pays 60% of your lost wages if you are unable to work due to injuries suffered in the accident. The maximum amount payable, for both medical bills and lost wages, is $10,000.

A few years ago the legislature made substantial changes to Florida’s No-fault law. Most significantly, in order to be eligible for No-fault benefits, you now must receive medical care within 14 days from the accident or you are ineligible for benefits. In addition, if you do not have an “emergency medical condition,” you will not be able to receive more than $2,500 of the $10,000 in benefits. Florida law defines “emergency medical condition” as a medical condition that requires immediate medical attention and could reasonably be expected to result in serious jeopardy to the patient’s health. Another change made by the legislature to the No-fault law was to exclude coverage for acupuncture and massage therapy. These services used to be covered by PIP.

The good thing about No-fault is that (as the name implies) it doesn’t matter who was at fault in causing the auto accident. Your own insurer is responsible for paying your medical bills and lost wages, even if the other driver caused the accident. Certain conditions must be met, but generally speaking, the medical bills and lost wages must be paid within 30 days of the insurer’s receipt of the bills or documents substantiating the wage loss. Most medical providers have patients sign paperwork authorizing and directing the insurer to pay the medical provider directly, as opposed to sending a check to the patient.

In order to receive benefits for lost wages, most insurers require that a “Wage & Salary Verification” form be completed by the injury victim’s employer. The form asks the employer a number of questions related to the victim’s employment and also asks the employer to verify the employee’s salary for the 13 weeks preceding the accident. The form then is submitted to the insurer, who calculates the victim’s average weekly wage for the 13 weeks before the accident and benefits are paid at 60% of the average weekly wage. The insurer will also require documentation from the injury victim’s treating doctor verifying that the victim is unable to work due to injuries suffered in the accident.

If you have an additional coverage under your automobile insurance policy (usually called “Medical Payments,” “Med Pay” or “Extended PIP”), your insurer will pay 100% of your medical bills. This additional coverage will sometimes cover 100% of your lost wages, depending on the policy language. Different insurers offer different limits of coverage, but you can usually buy at least another $5,000 or $10,000 in coverage above the $10,000 in No-fault coverage. If you do not have this optional coverage, the 20% of your medical bills and the 40% of your lost wages that are not covered by your own PIP are recoverable from the driver and/or owner of the vehicle that caused the crash.

If you have been involved in an auto accident and you need help with your claim, please feel free to contact the Law Offices of The Law Office of Eric H. Luckman, P.A. at (561) 737-3133.