I’m a visual person and it helps me to understand things through either diagram or illustration. What I want to say is very general, this isn’t even attempting to be a complete explanation or discourse on what happens in an automobile accident, but this would help me if I were involved in an accident and this was my first experience with this. And I’ll try to kind of speak as if I was talking to my wife, because my wife’s not even sure who’s our insurance company! A lot of people don’t even know! They know they have to have insurance, but what happens if you’re involved in an accident?
Well, the first thing you *have* to know, is that we live in the beautiful state of Florida, but Florida is a “No-Fault” insurance state.
What does that mean?
It means it makes absolutely no difference who’s at fault. Your own insurance company is the primary payor. They’re the first insurance company that has to do something. I mean, if you’re stopped at a red light, and someone rear ended you, you would initially think, “Well, their insurance company’s gotta start doing something for me.” That’s not the law. It’s your insurance company, regardless of who’s at fault. Your insurance company is the first person you talk to.
It helps me to put a T-square up here.
Let’s put over here “You” and your insurance company. What are they supposed to do for you? Well you’ve paid them a premium! They make their money by taking your premium and putting it in their bank account! And some insurance companies are not so willing to say, “Oh thank you so much for premium. This is what the law says I’m supposed to do for you.” We get involved in a lot of what we call “first-party” lawsuits, because an individual’s own insurance company is not doing what they should.
But*some* things that they would do, is that they are supposed to pay for your medical bills, and depending on your policy, how much they pay… And by the way! You can decide who you go to! It’s an interesting little tiddy! The insurance company doesn’t *tell* you where you’re supposed to go. You initially can decide who you want for medical care.
If you’re unable to work because of your accident and injury, [and] the doctor confirms that, they’ve got to pay you lost wages. There’s a percentage, but you don’t get a full paycheck. But you paid a premium, and if you can’t work, you ought to be able to get that from your insurance company. There are other benefits. They got to pay you mileage to your doctor!
Some insurance companies won’t tell you all those things, thus, that’s what we’re supposed to do in helping you through this. Well, you have these benefits up to certain amounts…
…but when do you get to collect from the person who actually caused the accident??
Let’s say, over here, this is the dividing line… Now let’s just say this represents the defendant, or the party who is at fault. You would *hope* in our state, that they have insurance, or some kind of financial ability to help you. That’s a tricky thing because in Florida (and Florida’s in a minority), you don’t have to have liability coverage to drive your car. When you go register your car or get your license you have to show proof of insurance, but you have to show proof of PIP coverage, not liability. And I expect that there’s a huge percentage, 35 (maybe even more than that) 40% of people are driving around out here, with this coverage which protects them, but they don’t have the kind of insurance to protect you in case they hit you and it was their fault.
Now Florida does provide you an opportunity to have (over here) what we’ll call uninsured or underinsured motorists coverage. You can go to your insurance company and say, “I don’t want to take a chance. If I’m hit by somebody who was at fault and has no insurance I want to protect myself.” The premiums for this are cheap.
If there’s a little bit of advice that I hope you’ll remember is, if you don’t have uninsured or underinsured motorists coverage, call your agent and get this coverage for you. We have lots of people who come to us and they weren’t at fault, but the person at fault has no insurance and they have not gotten this.
Well, let’s assume that you have an injury (a legitimate injury), [and] you’re getting medical care. When *do* you get to collect from this insurance company? You got to cross this line. You got to get over here. If you can’t get across this line, you get nothing. What does it take to get across this line?
Well, some of the obvious ones are:
Death – If you die, as a result of an accident, you’ve automatically crossed what we call the tort threshold, and you have a chance, depending on who’s at fault and lots of other factors, to collect from this insurance.
Another possible way to cross this line is if you have scarring. If there’s some visible scarring as a result of the injury (obviously you’d have it if there were surgery, but) if you had scarring without a surgery, you’d possibly have an opportunity to cross this line and get to this.
The other, and this is where most of these cases are tried, are “Do you have a (we’ll just abbreviate this as [P.I.]) a permanent impairment.” What is a permanent impairment? I can’t give you a permanent impairment. A medical provider– it can be a chiropractor, it can be an orthopedic, neuro, any doctor!– They have to conclude that, in their opinion, and within reasonable medical certainty and probability (these are the kinds of standards they have to say) you have some kind of permanent limitation, some permanent impairment as a result of the accident. If they’re willing to make that statement then you have an opportunity to cross this line, and possibly obtain some of this money if there is any.
Now, that’s kind of been a horribly rudimentary nutshell of some facts that will at least help you understand how this works. There are exceptions to it. One exception would be if they have no insurance, and you have got to go to your uninsured motorists coverage, your own carrier… does not really want to pay you, because that takes away from the premiums they’ve collected. So sometimes you’re a little bit at odds with your own insurance company because they’re wanting to save their premium dollars.
If there’s a little bit of advice that I hope you’ll remember is, if you don’t have uninsured or underinsured motorists coverage, call your agent and get this coverage for you.
Again, another reason why you need an attorney, at least in my opinion. You ought to have an attorney who is experienced, who’s done these thousands of times, or certainly be capable and has the ability to butt heads (if necessary) with the insurance company, to try the case if it’s necessary, and have the skill to do that in the courtroom.
This might be the only case you’ll ever have and you’ll need a lawyer, so just make sure that you’ve got somebody who knows what he’s doing.
It isn’t complicated! It sounds a little bit that way, but if you’ve got an attorney you’re comfortable with, and he’s doing what he should and there are a lot of good lawyers like that, you’ll be in good shape. But don’t be worried about how it works and who pays what. This *might* help you a little bit, and we would certainly invite you or anyone to come to our office and meet us and we’re happy to sit down and give you more detail about it.
– Ranier Munns is an experienced personal injury attorney and managing shareholder of Bogin, Munns & Munns, a full service law firm with offices in Orlando, Clermont, Kissimmee, Orange City, Daytona Beach, Ocala, Melbourne, Gainesville, and Leesburg. Mr. Munns works out of the Orlando office and welcomes questions and comments regarding the above. He can be reached at [email protected]
NOTICE: The article above is not intended to serve as legal advice, and you should not rely on it as such. It is offered only as general information. You should consult with a duly licensed attorney regarding your Florida legal matter, as every situation is unique. Please know that merely reading this article, subscribing to this blog, or otherwise contacting Bogin, Munns & Munns does not establish an attorney-client relationship with our firm. Should you seek legal representation from Bogin, Munns & Munns, any such representation must first be agreed to by the firm and confirmed in a written agreement.