Who Pays for the Medical Bills After a Car Accident in Boca Raton?

In almost all cases, insurance will pay for the majority of medical bills after a car accident. But you and the driver that caused the car accident might also need to contribute to the cost. The amount will depend on the medical bills and the nature of your injuries.

Florida uses a no-fault insurance system. Florida’s legislature passed a bill repealing no-fault insurance in 2021. But Florida’s governor vetoed the bill, preserving the no-fault insurance system for at least another year.

Here are the important facts about who pays for medical bills after a car accident under Florida’s no-fault insurance system.

No-Fault Insurance in Florida

Thirty-eight states use fault-based insurance. Under this system, vehicle owners must purchase liability insurance. After a car accident, the insurer for the driver who caused the accident will pay the medical bills for all of the injured drivers and passengers.

States created no-fault insurance in the 1970s. Insurance premiums had skyrocketed in New York and other major cities in the US. Insurers developed no-fault insurance as an alternative for covering the damages caused by car accidents. Florida was the second state to adopt no-fault insurance.

How No-Fault Insurance Works

As its name suggests, no-fault insurance pays benefits regardless of who causes an accident. Under the no-fault system, each injured driver files an injury claim with their own vehicle’s insurer. Passengers also file with the insurer of the vehicle they were riding in.

The insurer does not determine fault. Instead, the insurer only determines whether the car accident caused the injuries and whether the treatment received for those injuries was reasonably necessary. 

Everyone riding in an insured vehicle will receive payments for their medical bills, including the driver who caused the accident.

Benefits of No-Fault Insurance

No-fault insurance provides many benefits over traditional fault-based insurance, including:

  • Faster insurance benefits payments
  • Fewer lawsuits
  • Everyone who has insurance receives medical benefits

Ironically, the intention of no-fault insurance to lower premium costs did not happen.

Drawbacks to No-Fault Insurance

No-fault insurance increased costs to auto owners and insurers. Fraudulent claims resulted in many more insurance payments than insurers expected. 

To cover the costs of these fraudulent injury claims, insurers had to increase premium rates. As a result, no-fault insurance did not fulfill the promise of lower premiums.

It also doesn’t provide the same benefits that fault-based insurance can in other states. Liability coverage pays all of the damages reasonably caused by the accident without requiring the injured person to pay a deductible or copay.

But the unexpected costs associated with no-fault insurance pushed the Florida legislature to limit the benefits provided under Florida’s no-fault insurance system.

Limits on Florida No-Fault Insurance

The personal injury protection (PIP) coverage in your auto insurance policy will pay your medical bills after a car accident. But it does not pay all of them. Under Florida law, PIP coverage only pays 80% of your medical bills.

Florida requires you to buy at least $10,000 in PIP coverage. If you buy the minimum policy and suffer a serious injury that maxes out your policy limits, your insurer will pay $10,000 of your first $12,500 in medical expenses. 

In other words, to get the full value of your medical coverage, you will need to pay $2,500 of your medical bills.

This mandatory copay creates unfairness in the no-fault system. The 80% rule applies even if you have paid all of your premiums. It applies if you were the innocent victim of someone else’s negligence. The only way to escape this problem is to buy additional insurance coverage or sue the driver who caused the accident.

Other Sources for Paying Medical Bills After a Car Accident

You have a few options for covering the portion of your medical bills that PIP coverage fails to cover.

Med Pay Coverage

You can buy optional coverage with your auto insurance policy called med pay. Med pay usually has no deductible but it does have low limits. Like PIP benefits, your auto insurer pays med pay benefits without regard to fault. 

Med pay also covers passengers in your vehicle and pedestrians in a pedestrian accident.

Med pay supplements your PIP coverage. You can use med pay coverage to pay the bills that PIP does not cover, including your 20% share of medical expenses.

Health Insurance

Your health insurance should pay the 20% of medical expenses left unpaid by PIP coverage. In a typical case, your healthcare provider will bill your health insurance for your medical care. Your health insurer can then seek reimbursement from your auto insurer.

Depending on your health insurance policy, you might prefer to use med pay coverage first, then health insurance. Med pay usually does not require a deductible or copay, unlike most health insurance policies.

Personal Injury Lawsuit

In most circumstances, Florida restricts your ability to file a lawsuit against the at-fault driver. No-fault insurance provides your exclusive remedy unless you fit into a statutory exception to the no-fault system.

To opt out of the no-fault system, you must have medical expenses that exceed your PIP policy limits. If you bought the minimum PIP coverage allowed in Florida, you can file a lawsuit if your medical expenses exceed $10,000.

Accident victims can also file a lawsuit regardless of the amount of the medical expenses when one of the following conditions is met:

  • Death
  • Significant and permanent loss of a bodily function
  • Permanent injury
  • Significant and permanent disfigurement or scarring

If you successfully sue the at-fault driver, you can recover compensation to cover all of your medical expenses. If you suffered a permanent injury, you might also recover compensation for pain and suffering.

Exercising All Your Options

You do not need to choose one of these options over the other. Instead, you will probably use all of the options that apply to your accident.

Initially, you will use your health insurance and PIP coverage to pay your medical bills. If you have med pay coverage, you might exhaust your med pay benefits before using your health insurance.

But as your medical bills grow, you may need to consider filing a lawsuit against the at-fault driver. Your PIP and med pay benefits only go so far, and you will need to pay deductibles or copays if you use your health coverage. 

Filing a lawsuit could prove to be the only option to recover all your expenses after the accident.