Personal Injury Insurance Claims After a Car Accident

Personal injury claims seek compensation for injuries to the person that result from another person’s negligent conduct. Personal injuries are usually physical injuries, although they include the emotional consequences (including mental injuries such as depression or post-traumatic stress disorder) that accompany a physical injury.

Car insurance policies generally refer to the related concept of “bodily injuries.” They are injuries to the body, although they also include injuries to the mind that are caused by an insured event that injures the body. The insured event is generally a collision.

The nature of car accident insurance claims for bodily injuries depends on the insurance policy that covers the injury. Under Florida’s “no fault” law, claims are typically made against the injury victim’s own PIP coverage. When injuries are serious, an accident victim may also be entitled to bring a claim against a driver whose negligence caused the collision. That claim will be covered by the driver’s liability insurance if the driver purchased coverage. If the driver is uninsured, underinsured, or fled the scene of the accident, the injury victim can bring a claim against the victim’s own uninsured/underinsured motorist coverage.

Florida PIP Insurance Claims

Florida law requires owners of vehicles that have at least four wheels to purchase Personal Injury Protection (PIP) insurance in addition to property damage insurance. Property damage coverage pays for damage to other vehicles caused by an insured driver’s negligence. However, another driver’s negligence has no relevance to PIP coverage.

Florida’s PIP requirement is a form of no-fault insurance. A vehicle owner who buys a PIP insurance policy and is injured in a collision must bring a PIP claim for compensation against the injury victim’s own insurance. The insurance company pays that claim regardless of fault. However, the amounts that a PIP insurer must pay are quite limited. The required coverage limit for a Florida PIP policy is just $10,000. The policy must also provide a rather miserly death benefit of no more than $5,000.

Compensation available from PIP coverage includes reimbursement of the insured’s medical expenses, lost income caused by an injury-related inability to work, and the cost of hiring someone to perform services that the injury victim cannot perform. No compensation is available for pain and suffering. For that reason, PIP never pays full compensation for accident injuries.

In addition, PIP insurance in Florida pays only 80% of the injury victim’s medical expenses. If the injury does not require emergency treatment, PIP insurance covers only $2,500 in medical expenses. The coverage pays only 60% of lost wages, again subject to the $10,000 maximum payment. 

Accident victims don’t qualify for any medical benefits at all unless they receive medical care within 14 days of the accident. Follow-up services are not covered unless the healthcare provider that first treated the injury either provides the follow-up care or refers the victim to another provider. The insurance company can contest coverage if the new provider treats an accident-related condition that does not fit the specific diagnosis rendered by the initial provider.

Personal Injury Claims

Fortunately, although they need to jump through some hoops to do so, victims of serious injuries are allowed to bring a negligence claim for personal injury compensation against the driver who caused the collision. An exception to the “no lawsuit” rule exists when car accident causes an injury victim to experience:

• significant and permanent loss of an important bodily function;
• a permanent injury;
• significant and permanent scarring or disfigurement; or
• death.

Most personal injury claims are filed because the injury victim has a permanent injury. The victim must support that claim with medical evidence establishing that the injury is probably permanent — that is, that healing has progressed as much as it ever will and the victim still has some degree of pain or physical impairment. Insurance companies often dispute the permanence of injuries, but if medical evidence supports the claim, it is usually up to a jury to decide whether the injury is permanent.

When a personal injury claim can be filed against the other driver, the limitations imposed by PIP coverage do not apply. The injury victim is entitled to seek recovery of his or her full wage loss (not just 60%) and full medical expenses. The injury victim is also entitled to compensation for pain, suffering, and emotional distress caused by accident injuries. When an injury victim recovers compensation from a negligent driver, the compensation that the driver received from his or her own PIP policy is deducted from the recovery. 

When injuries are catastrophic, it is quickly apparent that the victim will have a significant and permanent loss of an important bodily function. When injuries are serious but do not necessarily involve the loss of a bodily function or significant scarring, whether the victim will have a permanent injury might not be immediately clear. Whenever an accident victim believes that an injury might be serious, it makes sense to seek prompt legal advice to protect the right to seek maximum compensation from a PIP claim and a personal injury claim.

Uninsured/Underinsured Motorist Coverage

A large percentage of Florida drivers do not maintain bodily injury coverage. It is possible to bring a personal injury claim against uninsured drivers, but they are often uninsured because they don’t have funds needed to purchase insurance. Collecting a judgment against uninsured drivers can be challenging.

Car owners can protect themselves from serious injury liability claims by purchasing liability (bodily injury) coverage in addition to the PIP coverage. When they do so, they should also purchase uninsured and underinsured motorist coverage. 

Uninsured motorist coverage allows injury victims to bring the same claim against their own insurer that they would be entitled to bring against an uninsured driver. It also covers injuries caused by unidentified hit-and-run drivers.

Underinsured motorist coverage provides a source of additional compensation when an insured driver’s coverage is inadequate to pay full coverage. A combination of uninsured and underinsured motorist coverage is the best protection against drivers who only purchase PIP coverage.