February 6, 2017

How does health insurance work if you have been injured in a motor vehicle accident?  Many people do not realize that when you are injured in a motor vehicle accident in Florida, your health insurance is no longer your primary medical insurance coverage.

As we have previously discussed on the Corless Barfield Trial Group Blog, Florida is a “no fault” state.  “No fault” is a term used to describe the Personal Injury Protection Insurance (PIP) that every motorist in Florida is required to carry in order to own / operate a motor vehicle.  Like we discussed in the past, in general PIP insurance provides insurance for eighty percent (80%) of your medical bills incurred as a result of injuries sustained in a motor vehicle accident.  PIP coverage is afforded regardless of fault, hence the name “no fault.”  For more detailed information regarding PIP coverage see our previous blog posts.

So what does this mean if an individual is injured in a motor vehicle accident and that individual has both PIP insurance coverage and health insurance coverage?  In short, the PIP insurance becomes the primary insurance coverage for medical treatment related to the injuries sustained in the motor vehicle accident.  Generally, a health insurance provider (such as Blue Cross Blue Shield, Humana, United Healthcare, Aetna, etc.) will deny coverage for medical treatment incurred as a result of injuries sustained in a motor vehicle accident until the PIP insurance benefits are exhausted.

This predicament can cause many real world problems for an individual that is injured as a result of a motor vehicle accident.  First, with the PIP insurance coverage only paying 80% of the medical bills, the injured individual may be stuck paying 20% of their medical bills even if they have private health insurance coverage.  Second, many medical providers do not accept the PIP insurance coverage.  Many primary care physicians (and medical specialists) do not accept PIP insurance coverage and will not treat individuals injured as a result of a motor vehicle accident.  Last, the laws that govern the car insurance companies are vastly different than the laws that govern the major health insurance providers. A car insurance company affording PIP coverage may subject its insureds to a vast array of investigatory tactics.  The car insurance company uses these tactics to “determine” if the car insurance company is going to provide an insured medical coverage under the PIP insurance.  An insured may be subjected to recorded statements, examinations under oath (EUO), and/or a compulsory medical exam (CME, also know as a independent medical exam IME – this is a misleading name, because in our opinion they are generally not independent at all, but that is a topic for another day). 

Along with the life changing injuries, a motor vehicle accident with injuries can become an extremely complicated insurance matter.  It is extremely important that if you or a loved one were injured in a motor vehicle accident that you seek help from an experienced personal injury attorney.