If you are involved in an automobile accident in Florida, you will face some difficult decisions. In addition to the duress of your personal injury, the worry of whether or not you will be compensated for your medical expenses will be an added burden.
Florida is a “No-Fault” insurance state for automobile insurance policy holders. Most Florida motorists are confused as to what this actually means. It does not mean that you will have nothing to worry about if the accident was your fault. Anyone can still have a claim filed against them even if they are at fault.
Auto Insurance Law in Florida
Florida drivers must have at least $10,000 of PIP (Personal Injury Protection) coverage. This special coverage is used to cover medical expenses and lost wages a driver may incur as a result of an accident, regardless of who is at fault.
Because Florida is a “No-Fault” state, after an automobile accident occurs, all involved drivers must file a claim with their insurance provider in order to ensure that medical and any other costs are covered. Florida is different from other states where a driver may file a claim with another driver’s insurer, or sue the other driver for causing the accident to resolve the question of who is responsible for paying the damages.
No-Fault Exceptions
Under certain circumstances, a driver can directly sue the other driver if the other driver is at fault. If the driver suffers a permanent injury as a result of the accident, they are sometimes exempt from the “No-Fault” statute. This means they may be able to file a claim against the other motorist for medical expense, lost wages, and other intangible damages like pain and suffering.
What is an IME?
An Independent Medical Evaluation is a tool used by insurance providers in Florida to investigate and evaluate if a policy holder requires medical treatment.
An independent medical examination (also known as a compulsory medical examination) is common in all kinds of personal injury cases in Florida. Insurance providers that face personal injury lawsuits in Florida have the right to request that a policyholder undergo an independent examination by a physician or other healthcare provider. However, they get to choose who conducts the IME.
A completed IME is supposed to provide the insurance provider an objective view regarding the extent and validity of injuries sustained in an automobile accident. It is intended to offer a realistic and independent overview of the situation arising from the accident.
The problem is that sometimes an IME is done in a fair way and other times it is biased in favor of the insurance company.
Is an IME is Required to File a Claim
In Florida, filing a claim will require providing an IME as well as your personal injury policy (PIP) to support your case. This is often a troublesome reality that goes hand-in-hand with legalities currently in place. Insurance companies have the right to assign the doctor that will conduct your IME. Unfortunately, often they are biased to find a reason to place your claim in one of the following three rejection categories.
- The car accident was not the cause of your injuries.
- You have not been injured.
- The accident may have caused you personal injuries but your injuries are not as serious as you claim.
Therefore, the IME is commonly used by insurance companies to deny benefits. This means that although you are in good standing and have made car insurance payments regularly, they can legally refuse to pay your PIP benefits.
How Does Your Insurance Provider Select a Doctor for the IME in Florida?
Insurance companies in Florida are required to randomly choose the doctor who will conduct an IME. They do this generally through a rotation system performed by certified vendors within a 10 mile radius of the insured person's residence. This vendor is required by law to randomly choose from the pool of doctors to perform the IME. This provides the insurance company with the argument that they ultimately have no control over the doctor that is chosen.
The current Florida statute is flawed and many motorists find this process rather sketchy. Many policyholders believe that some doctors participate in this IME vendor process because they provide the type of answers that the insurance company is looking for. The underlying motive for the insurance company is to find a legitimate reason to cut-off the driver's benefits, so they do not have to pay the claim. There are good reasons to support this skepticism as there are many recorded cases where a doctor gets taken out of IME rotation if they return too many recommendations to continue coverage. Doctors that are being used for IMEs are being paid by the insurance company to give them the answers that allow them to discontinue benefits.
How can I benefit from an IME?
In Florida, all drivers are required to cooperate with the insurance company's request to get an independent medical evaluation. Under the law, the patient is allowed to have someone accompany them to the examination, including their own doctor and/or attorney. The patient is also allowed to have the examination videotaped. You can benefit a lot by documenting the procedure and video recording it in order to back your claim. This can be a big advantage and help ensure you are not taken advantage of.
Typical Process of an IME
After an accident, your insurance provider will send you a notification of your PIP benefits in the mail. This letter is an explanation of how they will pay your medical expenses and lost wages. However, it is essentially a very basic explanation. Moreover, it may take some time to get this letter while most injured parties will want to know right away how their expenses will get paid.
The first thing the letter from your insurer will explain is how PIP will apply in your case, regardless of fault.
Coverage
There are typical limits in PIP coverage in Florida. If you have not sustained an emergency medical condition, the basic limits on medical coverage are generally around $2,500 and up to $10,000 for lost wages. Within these limits, PIP will usually pay 80% of your total medical expenses. These amounts will of course vary depending on your insurance agreement. If you have an emergency medical condition, the amount can be higher. Because there are many variables to consider, including your independent medical exam, getting the right information from an expert will be your best bet.
The 14-Day Rule
Under Florida’s no-fault system, you have 14 days to seek medical attention after a car accident. The time deadline is a requirement to make a claim for compensation through your no-fault, personal injury protection insurance.
If you do not get treatment within 14 days of an accident in Florida, your PIP insurer will not be legally required to pay you any compensation.
What if I don't get an IME?
If you refuse to provide an IME, your provider will cut-off your benefits for failure to comply. This means your medical and lost wages expenses would not be paid.
It is best to get a consultation from a personal injury attorney who has experience and a successful track record if you wish to refuse an IME.
Should I Get Legal Advice?
An experienced Florida personal injury attorney will help you navigate the traps that are designed to block you from receiving your rightful compensation.
The entire process of PIP involves a very technical area of Florida law. You can benefit greatly from an experienced professional. Thankfully, there are attorneys in Florida who are highly qualified and able to handle all kinds of PIP claims.
If you are having some difficulty dealing with an insurance provider and feel insecure moving forward with your claim, DOCS4PI can help. DOCS4PI is made up of an entire community of medical and legal professionals in Florida that can help people in need.
