Under Florida No-Fault auto insurance coverage, your insurance company is required to pay 80% of your accident related medical bills. If you are covered by optional auto insurance Medical Payments Coverage, most policies require payment of 100% of your accident related medical bills. The total amount owed is up to the limit of the coverage amount under the insurance policy. Most policies have a $10,000 limit.
What many insurance companies won’t tell you, is that they are also required to pay the cost of your transportation to and from medical providers and pharmacies. If you travel by your private car the reimbursement rate is in the range of 52 cents per mile, payable to you at 80% like other medical benefits. You should submit a list of miles traveled to your insurance company. They have 30 days from receiving your list to issue payment to you. If you took a taxi, uber, or bus, submit your receipts and receive 80% reimbursement.
You are also entitled to be reimbursed for prescription expenses and the expense of over the counter medicine and supplies. Supplies may include braces, wound care items, a cervical collar, a TENS unit, a special pillow, or even a special mattress if prescribed by a physician due to your accident related injuries. Submit your receipts and you should be reimbursed within 30 days.
If because of your injuries you miss time from work, you are entitled to be reimbursed at 60% of your average wage. You will need a physician’s note confirming you missed work due to your injuries and you will need to verify the amount of your income from work. If you use sick time or personal days or vacation days you are still entitled to be reimbursed by auto insurance, as you have lost the benefit of that sick time or vacation time due to your accident. The amount you are entitled to be reimbursed is 60% of the “gross income” you would have made had you not missed work due to your injuries from the accident. “Gross income” is income before deductions are taken. The payment of income loss benefits under your auto insurance is not taxable. Income loss payments should be made to you by your auto insurance coverage within 15 days of your insurance company’s receipt of proof of your claim.
If because of your accident related injuries your physician prescribes household help, your auto insurance company is required to pay 100% of that cost. For example, an at home aide, or even a housekeeper or someone to perform yard work, are all considered household help. If the insurance company receives a note from a physician that the household help is necessary due to your injuries and you provide receipts, the insurance company is obligated to pay that expense.
Medical benefits, wage loss benefits, and household help are all part of the No-Fault insurance coverage for your accident related injuries. If you have a $10,000 coverage limit, once your insurance company pays a total of $10,000 in benefits the insurance company has satisfied its obligation under the insurance policy. If another party is at fault for causing your injuries, you may be able to recover from that other party’s liability insurance coverage for the amount of your losses that your No-Fault coverage has not paid.
If you have any questions about what insurance benefits you are entitled to receive under your auto insurance coverage, please call me and I am happy to answer your questions.
How Does No-Fault Auto Insurance Coverage Work When You Have Health Insurance?
Almost all health insurance polices have language that states if there is other insurance available then you must use the other insurance and not the health insurance. This is called a “coordination of benefits” clause.
But health insurance is obligated to pay what your auto insurance does not pay, subject to any deductible. So once your auto insurance pays its limit of coverage, your accident related medical bills can then become payable by your health insurance. The 20% of your bills not paid by your No-Fault auto insurance coverage can also be submitted to your health insurance. It would help to provide your health insurance with a copy of proof of what your auto insurance has paid and has not paid. Your auto insurance can supply that to you. It’s called the auto insurance payments listing.
What then occurs is your health insurance processes the bills not paid by your auto insurance in accordance with your health insurance’s medical bill fee schedule. Everyone with health insurance has received in the mail the forms from their health insurance showing the bill amount and what health insurance actually pays and what the patient then owes. It is typical to see a $1,000 bill get reduced to $300 and then either the health insurance pays the $300 or tells you that is what you owe because you have not met your deductible. The benefit to you is if the doctor or medical provider is in the health insurance network you should not be “balance billed” above the amount the health insurance form states that you owe. A second benefit to you is every bill applied to your health insurance deductible brings you closer to satisfying the deductible.
If you have any questions about issues with auto insurance or health insurance, please call me and I’m happy to try and help you.
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My father and mother taught me to always treat people the way you would want them you treat you. To put yourself in the other person’s shoes to understand the way they see things. To try to do your best at everything you do. To make as many friends as you can, because you never have too many.
My first job after law school was with the Public Defender’s office in Sanford and then in Orlando. I was in court every week the five years I was an assistant Public Defender. Some of the best trial lawyers get their start as assistant Public Defenders. You learn trial skills, effective communicating, and you develop your reputation in the legal community. The downside is as you become better and better as a Public Defender, you are called upon to represent those accused of more serious and heinous crimes…
Voted by peers as “Best of the Bar” in Insurance Law (Orlando Business Journal)
Voted by attorneys in Florida for recognition as a “Legal Elite” attorney in Civil Trial Law and Insurance Law (from Florida Trend Magazine).