Will My PIP Policy Cover My Medical Bills Following an Accident?

After getting in a car accident, unexpected medical bills can add insult to injury. Unfortunately, many Florida drivers have found themselves in this exact position after their insurance company paid less than expected for their medical bills following a car accident. It is very important to retain an attorney such as the lawyer Tampa FL residents trust.

In Florida Wellness & Rehabilitation v. Allstate Fire & Casualty Insurance Company, the Third District Court of Appeals heard the consolidated appeals from five lower court cases involving suits by medical providers (on behalf of the insurance policy holders) against Allstate for failure to fully pay medical expenses covered by the insureds’ PIP policies. Rather than pay the full medical costs, Allstate utilized the fee schedules set out in Florida Statute 627.736 (5)(a)(2)(f) and paid only 80 percent of 200 percent of the Medicare Part B Schedules–significantly less than the full medical expenses.

Allstate asserted that the language in the PIP policies in question–which stated that any covered medical bills “shall be subject to any and all limitations” provided by Statute 627.736 (5)(a)(2)(f)–was clear enough to alert the insured of the limitations of coverage. The medical providers argued that the language was intentionally vague, but the lower courts all found in favor of Allstate.

The appellate court agreed with the lower courts, as well as the decisions of the First and Second District Courts of Appeals in similar cases. The court noted that they are required to interpret the policy’s language in according with its plain meaning, and the phrase “subject to” was deemed sufficient to alert any insurance policy holder to limits of liability provisions.

The Third District Court of Appeals’ ruling in this case comes after thousands of similar cases were filed in courts across Florida. The Florida state legislature has taken steps to clarify the issue, passing a law in 2013 that makes the use of Medicare fee schedules standard for all PIP policies. However, many Florida drivers who are still facing unresolved medical bills from accidents before 2013 should pay close attention to the Third District Court’s findings.

McKinney Law GroupA special thanks to our partners at The McKinney Law Group for their high level expertise in Insurance Law.