How Does Florida’s No-Fault System Affect Car Accident Claims?

Car insurance requirements vary by state. Anyone who owns a vehicle with four wheels that is registered in Florida is required to purchase personal injury protection (PIP). This is a type of no-fault insurance that pays out benefits regardless of who caused the crash. If you were injured in an accident, it is likely that you would bring the claim against your own PIP policy rather than the at-fault party’s liability insurance unless your case meets the “serious injury threshold.”

Below we’ve answered a few FAQs about Florida’s no-fault car insurance system:

What Does Personal Injury Protection Cover?

PIP covers 60% of lost income resulting from the accident and 80% of reasonable medical expenses. Domestic help and other reimbursement services may also be covered. PIP does not pay for pain and suffering. When a person dies in a crash, PIP may cover funeral and burial expenses up to $5,000.

PIP benefits are limited to $2,500 unless your physician determines that you have an emergency medical condition (EMC). Pursuant to Florida Statute 395.002(8), an EMC is a medical condition that manifests acute symptoms of sufficient severity such that foregoing medical care would result in:

A serious risk to the patient’s health,
Significant impairment of a body function, or
Significant disfunction of a body part or organ.

PIP not only covers the policyholder while they are driving but also covers them when they are passengers in other people’s vehicles, pedestrians, or riding a bike. These policies also cover blood relatives and spouses who live in the policyholder’s household.

If you were injured as a passenger in someone else’s vehicle and neither you nor an applicable relative in your household has a PIP policy, then the PIP coverage of the host vehicle may apply. If you were injured as a pedestrian or bicyclist and neither you nor an applicable relative in your household has a PIP policy, then the PIP coverage of the at-fault driver may apply.

Personal injury protection covers the initial care and services provided within the first 14 days of injury. Such care may be provided by emergency medical personnel, a hospital, facility owned by a hospital, dentist, chiropractor, and other medical providers; however, acupuncture services and massage therapy are not covered.

What Are the Criteria for Meeting the Serious Injury Threshold?

As previously mentioned, people who are injured in auto accidents have the right to bring a claim against the liable party if their case meets the serious injury threshold. If this applies to you, it may be possible to obtain compensation for pain and suffering and other non-economic damages in addition to economic losses such as medical care and lost income.

To meet Florida’s serious injury threshold, it must be shown that the collision caused at least one of the following:

Permanent loss of a bodily function,
Permanent injury to a reasonable degree of medical probability,
Permanent and significant disfigurement or scarring, or
Death.

If you’re not sure whether your case meets one of the above criteria, contact a car accident lawyer to discuss your situation. A seasoned personal injury attorney will understand the case law and statutes that apply to your claim and can help you identify all potential sources for pursuing compensation.

What Evidence Might Be Used to Prove the Severity of My Injuries?

If you intend to bring a claim against the liable party or their insurance company, you must be able to prove that your case meets the serious injury threshold. Your lawyer may need to bring in a medical expert to provide deposition regarding your diagnosis and prognosis. Other valuable evidence would include your medical records such as diagnostic images and lab test results.

When Might an Auto Insurance Company Dispute a Third-Party Claim?

If you file a third-party insurance claim—i.e. if you bring a claim against the liable party’s insurance company—you should expect the insurance adjuster to look for weaknesses in your case that can be exploited to undervalue your claim or deny it outright. To prevent disputes and complications, it is important that you have strong evidence to prove liability, causation, and damages. Your legal team can help you obtain this evidence by performing a thorough investigation.

Here are a few reasons why disputes arise in these cases:

Shared Liability: Even if another party did in fact contribute to the accident, the insurance company may still assert that your own negligence played a role. This might happen, for example, if you were speeding or breaking another traffic law in the moments leading up to the collision. In Florida, personal injury victims can pursue damages even if they were 99 percent liable, but their financial recovery is reduced by their percentage of fault. This standard is called “pure comparative negligence.” An attorney can help you overcome or counter this defense by gathering all available evidence of negligence and liability. Examples of such evidence include photos of the scene, dashcam and surveillance footage of the crash, the deposition of eyewitnesses, the deposition of an accident reconstruction expert, the police report, cell phone records, black box data, and the toxicology report. Sometimes the plaintiff is not liable at all but fault is shared by multiple defendants. This, too, could result in a dispute over how fault is apportioned. Here again, your lawyer can try to streamline the proceedings and prevent complications by conducting a thorough investigation and gathering all available evidence to support your claim.
Failure to Mitigate Damages: Even if you have strong evidence to prove liability, causation, and damages, you may still face a dispute if you do not take reasonable steps to minimize your healthcare expenses and other losses. This is called “failing to mitigate damages.” From the insurance company’s point of view, they should not have to pay for costs that would have been avoided had the claimant been responsible. To avoid this dispute, you should follow your doctor’s orders and do everything you can to facilitate the healing process.
Disagreement Regarding Damages Calculations: Determining the value of damages is not always straightforward. Two patients with the exact same injury might respond very differently to treatment, meaning that one patient might incur far steeper medical costs than the other. If your injuries will diminish your ability to earn the same level of income, your lawyer may need to use complex formulas to approximate a fair value for loss of future earnings. It is often necessary to bring in medical, financial, and vocational experts to provide deposition regarding the value of past and future damages. Sometimes the experts for the plaintiff and defense disagree regarding the damages calculations. For this reason, it is important that you enlist the help of a well-credentialed litigator who works closely with credible experts who have the qualifications to provide objective and evidence-based deposition.
Exacerbation of a Preexisting Condition: We’ve already mentioned that “causation” is one of the elements that must be proven to prevail in a personal injury claim. In other words, your car accident attorney must show how your damages would not have accrued but for the crash. If the accident exacerbated a preexisting medical condition, the insurer might contend that you are attempting to claim medical costs and other damages that were not caused by the wreck. Evidence to counter this defense may include medical expert witness deposition and your medical records from before and after the accident.

What Can I Do to Strengthen My Car Accident Claim?

Whether you intend to bring a claim against your PIP policy or the liable driver’s insurance company, there are steps you should take to improve the chances of winning a fair settlement. Those steps include:

Seeking Medical Care Right Away: If you want to bring a PIP claim, you will have to seek medical care within 14 days of the accident. Visiting a doctor immediately can also serve to document your injuries and may help your lawyer tie them to the accident and prove causation. It will also demonstrate that you are mitigating the damages, which could prevent a dispute.
Creating a Personal Injury Journal: The first entry should be a detailed recollection of everything you remember about the accident and your statements and actions since. Subsequent entries can profile your symptoms, their severity, and how the injuries are affecting your quality of life.
Disabling Your Online Profiles: This could prevent the insurer from using your own social media posts to dispute the claim.
Letting Your Attorney Handle Dialogue with the Insurer: This will ensure you don’t provide statements that lead to a dispute.

Contact Us Today to Speak with a Car Accident Lawyer in West Palm Beach

If you or someone you know was hurt in an auto accident, contact Donaldson & Weston for representation. Our personal injury attorneys in West Palm Beach have helped hundreds of accident victims fight for the compensation they deserve. We have the experience and resources to take on even the largest insurance companies. Call 561-299-3999 or send us a message to set up a free consultation.