Articles Posted in Personal Injury Protection (PIP)

The Supreme Court of Nebraska recently released a decision in which they upheld a lower court’s ruling that granted summary judgment to a drinking establishment in a negligence lawsuit that had been filed by a man who was injured after a disgruntled patron returned to the bar after being forcibly ejected and struck the plaintiff with his vehicle, causing serious injuries. The plaintiff had alleged that the bar owners failed to uphold their duty to protect him from the conduct of the disgruntled patron, although the lower court disagreed. As a result of the appellate ruling, the plaintiff will be unable to recover damages from the drinking establishment, although he may still hold the disgruntled patron accountable for damages that resulted from the assault.

Parking LotThe Plaintiff Was in the Wrong Place at the Wrong Time and Suffered Serious Injuries as a Result

The plaintiff in the case of Pittman v. Rivera was a patron at a drinking establishment owned by the defendant, and he was struck by a car in the parking lot as he left the bar. Although the plaintiff had not been involved in any initial confrontation, the vehicle was being driven by a man who had been forcibly ejected from the bar for fighting earlier in the evening. According to the the facts recited in the appellate opinion, the driver of the vehicle was involved in an altercation with another patron and was thrown out of the bar by security and driven home by a designated driver, only to return shortly thereafter in his own vehicle. The driver was again escorted off the premises by security, after which he entered his vehicle and began driving recklessly, eventually driving toward a crowd of people that included the plaintiff. The plaintiff was warned verbally by security to get out of the way, but he was unable to avoid being hit by the speeding car.

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file9041284658924 morguefile cohdraIn AA Suncoast Chiropractic Clinic, PA v. Progressive America Ins. Co., a group of Florida chiropractic clinics filed a class action lawsuit against an insurance company, claiming the insurer breached its contract when it failed to reimburse the medical providers for the care each provided following various motor vehicle collisions.

Under Florida law, motorists are required to carry no-fault personal injury protection (PIP) coverage of $10,000 in order to pay for emergency medical treatment. According to the group of chiropractic clinics, the insurer reclassified the treatment each insured person at issue received as non-emergency care after the insureds were treated. As a result, the insurance company allegedly opted to reduce the PIP policy limits to $2,500, pursuant to Section 627.736 of the Florida Statutes. After doing so, the insurer denied full payment to the clinics. In their complaint, the group of clinics sought both declaratory and injunctive relief.

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DSC06084-B2-1 morguefile DodgertonSkillhauseIn Mercury Insurance Co. v. Emergency Physicians of Central Florida, a Florida woman was injured in a car accident. At the time of the traffic wreck, the woman carried $10,000 in personal injury protection (“PIP”) benefits that she purchased from her auto insurer. As part of the PIP policy, the woman elected a $500 deductible. Following the collision, the woman sought medical treatment from an emergency clinic. Within 30 days of the accident, the clinic submitted a bill for $191 to the woman’s PIP insurer. After that, no further bills were received by the insurance company.

More than two months later, the emergency clinic submitted a statutory demand letter seeking payment for the care it provided to the insured woman to her insurance company. The insurer ignored the demand letter, and the clinic filed a lawsuit against the company in a Florida county court. According to the insurance company, it was not required to pay the medical bill because the amount was well below the deductible provided for in the PIP policy.

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DSC00503 morguefil DMedinaIn State Farm Mutual Automobile Insurance Company v. Gonzalez, a pedestrian was apparently struck by a car in Florida in May 2001. Following the incident, the injured woman was treated at a local emergency room. The woman’s health care insurer later paid the hospital $685 for the woman’s treatment. The hospital did not send a bill to the woman’s auto insurer.

More than six months later, the pedestrian’s attorney sent a letter of representation and a copy of the accident report to the woman’s liability insurer. The lawyer also requested certain insurance information from the company. Despite the correspondence, the woman’s counsel failed to include a hospital bill or request payment from the auto insurer. After that, the insurance company allegedly made numerous unsuccessful attempts to contact the injured pedestrian’s lawyer regarding her harm. The insurer ultimately closed the woman’s claim in August 2004.

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40555_rear_view_mirror sxchu username iboffIn Government Employees Insurance Company v. Kisha, a Florida couple purchased automobile insurance from an insurer for a designated policy period of December 2010 through June 2011. In lieu of making one premium payment, the couple opted to make recurring monthly payments to the company. After the couple failed to pay their March 2011 premium, the insurer mailed them a notice of cancellation for nonpayment effective April 20. In addition, the notice stated the company would not cancel the couple’s auto policy if the past due premium was received or postmarked by this date.

The husband apparently wrote a check to the couple’s insurer on April 17, but the past due payment did not reach the postal service until April 25th. On May 8th, both members of the couple were apparently hurt in a rear-end car accident. Following treatment, each filed a claim for personal injury protection (“PIP”) benefits from the auto insurance company. Next, the insurer sent each member of the couple a reservation of rights letter stating they lacked motor vehicle insurance coverage on the date of the collision due to nonpayment. In response, the wife filed a lawsuit against the auto insurer.

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OLYMPUS DIGITAL CAMERAIn Echo v. MGA Insurance Co., Inc., a Florida woman purchased an automobile using another individual’s name. Despite doing so, she obtained a motor vehicle insurance policy on the vehicle in her own name. In her application, the woman stated she was the owner of the insured vehicle and the only licensed driver in the household. About one year after purchasing the insurance policy, the woman was involved in a traffic wreck while driving the car. Following the crash, the woman apparently sought medical care from a number of physicians. After that, she submitted a personal injury protection (“PIP”) claim related to her medical expenses to her auto insurer.

In response to the woman’s medical benefits claim, the auto insurer denied coverage as a result of the purportedly material misrepresentation she made on her vehicle insurance application. According to the insurance company, it would have chosen not to issue the automobile policy or it would have charged a higher premium if the woman had been truthful on her application. In addition to denying the woman’s accident claim, the insurer stated the policy was void ab initio, or from the beginning, and refunded all premiums that were paid to it by the woman. The woman apparently did not cash the refund check.

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car-accidents-by-vward-5-145316-m freeimages victorwardIn Moody v. Dorsett, a man was hurt in a motor vehicle collision that a jury determined was caused by another driver. As a result, jurors returned a verdict of about $11,000 against the negligent woman. Prior to trial, the man received approximately $5,500 in personal injury protection (“PIP”) benefits from his automobile insurer. After the jury returned its verdict, the negligent driver asked the court to offset the award by the amount of PIP benefits that were received by the injured man. The trial court refused, and the woman filed an appeal with Florida’s Second District Court of Appeal.

In the State of Florida, drivers must maintain $10,000 in PIP insurance protection. This coverage allows a motorist or other individual to collect up to $10,000 in order to pay for any immediate medical expenses regardless of fault. In order to recover under a PIP policy, current Florida law requires an individual who was injured in a motor vehicle collision to seek medical care within two weeks of the traffic wreck. A PIP policy will typically pay for 80 percent of an accident victim’s medical costs up to the policy’s limit of liability. A Florida motorist may increase that coverage to 100 percent of his or her accident-related medical expenses by purchasing an optional extended PIP policy.

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Airbag morguefile dodgertonskillhauseIn Geico Indemnity Co. v. Gables Ins. Recovery, Inc., a woman was hurt in a motor vehicle collision. Following the accident, she obtained medical treatment and assigned the personal injury protection (“PIP”) benefits provided by her car insurance company to the business that performed her x-rays. The company then assigned the woman’s PIP benefits to a medical insurer. After the medical insurer submitted a request for payment to the woman’s motor vehicle insurer, it received less than the total bill.

Next, the medical insurer filed a breach of contract lawsuit against the motor vehicle insurance company. According to the auto insurer, it paid the full benefits of $10,000 under the woman’s PIP policy to the plaintiff pursuant to Section 627.736(5)(a)2.f. of the Florida Statutes. The medical insurer argued that the PIP provider was required to pay 80 percent of the woman’s medical bills and filed a motion for summary disposition. The motor vehicle insurance company then filed a cross motion, stating all of the woman’s PIP benefits were exhausted. The trial court granted the medical insurer’s motion, and the PIP provider appealed the case to the Circuit Court of the Eleventh Judicial Circuit. After the appellate court affirmed the trial court’s order, the auto insurer filed an appeal with Florida’s Third District Court of Appeals.

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file000432821238 morguefile taliesinA Florida appeals court has ordered an automobile insurer to pay all of a car accident victim’s medical expenses pursuant to the terms of the extended personal injury protection (PIP) provision included in her policy. In Spaid v. Integon Indemnity Corp., a woman asked her auto insurer to pay more than $10,000 in medical bills for the injuries she suffered in a 2011 motor vehicle wreck. Although asked to pay all of her medical expenses, the woman’s insurer refused to pay for any medical costs that exceeded her basic PIP policy’s $10,000 limit of liability. In response, the woman filed a lawsuit seeking a declaratory judgment against her automobile insurer.

In Florida, motorists are required to maintain $10,000 in PIP accident protection. This insurance allows a driver or other individual to collect up to $10,000 in immediate medical coverage, depending on the type and extent of car accident injury treatment, regardless of fault. Under current Florida law, an individual who was harmed in an automobile collision must seek medical treatment within 14 days of the crash in order to recover under a PIP policy. Typically, a PIP policy will pay for 80 percent of an accident victim’s medical bills up to the policy’s limit of liability. An optional extended PIP policy will normally increase that coverage to 100 percent of an insured’s medical expenses. The question in this case was whether or not the woman’s extended PIP policy incorporated her basic PIP policy’s $10,000 cap.

Before a trial court, the insured woman claimed that the entirety of her medical expenses should be paid because the plain language of her extended PIP policy included no limit of liability. Instead, the declarations page stated “100% Medical,” on the extended PIP line. In contrast, the automobile accident policy expressly limited basic PIP to $10,000 for each person. Because of this, the woman argued the limits of her policy’s extended PIP were ambiguous. The insurance company claimed the optional extended coverage did not change the overall PIP limit of liability. In the end, the trial court sided with the insurer and the woman appealed her case to Florida’s First District Court of Appeal.

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Four children and one adult driver had to be taken to the hospital near Miami, Florida after a driver crossed the center-line and hit their shuttle van head-on. Two children were ejected from the vehicle, but were in stable condition, one child’s condition was unknown, and the fourth child and driver remained uninjured. The driver claimed he was having a heart attack, but that was subsequently shown to be untrue.

While the victims in this recent accident quickly sought needed medical attention, other insured Florida car accident victims may not think they need, or can afford, medical services. The latest version of the Florida Motor Vehicle No-Fault statute, recently made effective at the beginning of 2013, substantially changed the laws regulating Personal Injury Protection (PIP). Foremost among the changes, is the mandate for those injured to receive initial services and care within 14 days of the accident.

Follow-up care is allowed, but must qualify under the statute. The new version of the PIP guidelines delineates the medical care providers that can perform the initial evaluation and treatment. Massage therapists and acupuncturists were explicitly excluded. Once that treatment is administered, then follow-up care related to the underlying condition is permitted.

Paper pile.jpgThe amount of coverage you receive under Florida’s new PIP laws will depend on whether the condition is considered an “emergency medical condition”. If it is, then you can receive up to $10,000. If not, then the maximum coverage is $2500. An “emergency medical condition” must be so serious that without immediate care, serious jeopardy to the patient’s health, serious impairment to bodily functions, or serious dysfunction of a body part or organ will occur. The previous statutory coverage also went up to $10,000, but allowed up to 80% of all reasonable expenses for medically necessary services, 60% of disability for any loss of gross income and earning capacity per individual from inability to work that was proximately caused by the accident, and 100% of replacement services like lawn care or childcare.

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