Many people often ask whether or not pursuing an injury claim is a process they want to go through with, and they often have questions about when they should retain an attorney in connection with the process. The sad reality is that an injury victim is often at a disadvantage when faced with the prospect of handling a claim directly with the insurance company. In many cases, the carrier will attempt to resolve these claims directly with the injured party, at a discounted rate, in an effort to close out the claim in a quick fashion. The problem with these expedited settlements is the simple fact that injuries after a trauma often don’t manifest until days or even weeks after an incident. It is difficult to determine the value of an injury claim until the entire nature and extent of one’s injuries is taken into account. In addition, often times the most critical pieces of evidence are gathered within the first few days after an accident. As such, it is critically important to retain counsel as quickly as possible after an injury to ensure all appropriate evidence is preserved in a timely fashion.
In assessing the value of a personal injury case, several different variables should be evaluated, and a multitude of data points analyzed. Every case is a unique set of facts with a unique set of important factors. Individuals who are injured as the result of the negligent or reckless actions of another have the right to receive potential compensation for the economic damages. In addition, the nature and extent of a client’s injuries, the impact on their personal and professional life, and other changes of life will ultimately affect an individual’s claim for non-economic damages as well.
A statute of limitations refers to the law regarding the amount time prescribed for an individual to present a certain type of legal proceeding. In Florida, that statute of limitations is governed under Section 95.11. Generally, the statute of limitations for a personal injury claim is four years from the date of the accident or when the injury was discovered. The statute of limitations for medical malpractice and wrongful death claims is two years. Each case is a unique set of facts. Depending upon the type of the case, the nature of the injury involved, and the age of the victim, there are several factors that could extend or decrease the time for filing a claim.
Personal injury protection, or PIP, is a certain type of no-fault auto insurance. PIP is mandated by State Law and is a requirement for all drivers to carry. The idea beyond this requirement is to provide injured drivers up to $10,000 in immediate medical coverage in the event of accident. As the term no-fault suggests, PIP was designed to make an injured party responsible for their own medical claims regardless of how the accident was caused or who was responsible for causing it.
The security requirement for personal injury protection benefits can be found under Florida Statute 627.736. The statute reads that an insurance policy complying with the security requirements must provide personal injury protection to the named insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in the motor vehicle, and other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle. The notion is to protect not only individuals who are listed as a named insured on an active insurance policy, but to also protect a ‘resident relative’ simply an individual related to by blood or marriage. That statute also helps to protect pedestrians and bicycles alike who also suffer automobile related injuries and may or may not be covered under a valid insurance policy.
The required personal injury protection benefits can be found under Florida Statute 627.736. The statute affords $10,000 in medical and disability benefits and $5,000 in death benefits resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle. The medical benefits under Florida PIP law are subject to certain conditions and can be limited or even eliminated in a number of various ways. For example, an individual, to qualify for medical benefits, has to seek initial medical care within 14 days of the motor vehicle accident. The carrier is required to pay eighty percent of all reasonable expenses for medically necessary and accident related medical services.
With respect to disability benefits, as per the Statute, the coverage affords allows for ‘sixty percent of any loss of gross income and loss of earning capacity per individual from inability to work proximately caused by the injury sustained by the injured person, plus all expenses reasonably incurred in obtaining from others ordinary and necessary services in lieu of those that, but for the injury, the injured person would have performed without income for the benefit of his or her household. All disability benefits payable under this provision must be paid at least every 2 weeks.
Finally, death benefits are $5,000 per individual. Death benefits are in addition to the medical and disability benefits provided under the insurance policy.
There are a number of different situations where an injury victim will be entitled to receive PIP benefits. The first inquiry is whether or not the injury victim received medical treatment within 14 days of the crash. If the answer is no, the injured party is not entitled to receive benefits. If the answer is yes, then we must determine whether the individual owned a motor vehicle at the time of the collision. If the answer is yes, the individual is entitled to file a claim for PIP benefits through their personal insurance policy.
If the individual did not own a vehicle at the time of the collision, nor where they listed as a named insured on any motor vehicle insurance policy, then the next inquiry is whether or not the injured party qualifies through a potential family member’s insurance policy. If the injured party lives with someone they are related to by blood or marriage, or resident relative, that person may qualify for benefits through their relative’s insurance policy.
Pedestrian and Bicyclists Accidents:
To determine whether or not a pedestrian or bicyclist, a similar inquiry is made. If they owned a vehicle at the time of the collision, they will be covered under their own policy. If they did not own a vehicle but lived with a resident relative who owned a vehicle, they will be entitled to benefits through the relative’s policy. If the victim does not own a vehicle or reside with anyone who does, they are still entitled to PIP benefits through the negligent driver’s insurance policy.
When a hospital, doctor, or other medical provider is assessing whether an individual has suffered an Emergency Medical Condition, or EMC, what injuries are the providers looking for in determining whether an accident victim has met the threshold? The short answer is that there is no set list of injuries that qualify but rather each case is assessed on an individual and unique basis.
Florida PIP Statute §395.002 defines an “emergency medical condition” is defined as a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention would reasonably be expected to result in any of the following:
01 Serious jeopardy to patient health
02 Serious impairment of bodily function
03 Serious dysfunction of any bodily organ or part
Not every medical provider is qualified to diagnose an Emergency Medical Condition (EMC). Only a qualified physician, osteopathic physician, dentist, physician’s assistant, or advanced registered nurse practitioner. Florida Statute §627.736 provides: