If you live in Florida and are ever involved in a car accident, being in a no-fault state might give you some peace of mind that you will have fair coverage from your insurance provider. Personal injury protection, also known as PIP coverage or no-fault insurance, covers medical expenses, regardless of who is at fault. It can often cover lost wages as well. Let’s see what to do if your Florida PIP claim is denied.
Naturally, if you are in an accident and you have dutifully paid your insurance premiums, you would expect the insurance company to pay your PIP claim fairly.
Unfortunately, many people are surprised to discover that their PIP claim does not cover all of their medical bills or lost wages. Worst yet, some people involved in Florida car accidents can receive a denial of claim letter from their insurance companies.
What do you do if your Florida PIP claim is denied? It can be shocking to have your PIP claim denied in Florida because the insurance should provide you coverage regardless of who was at fault in the accident.
Unfortunately, insurance companies treat all claims the same way: They try to find ways to undervalue the claims or outright deny them to save money. After all, that is how insurance companies preserve their profits.
Fortunately, you have options that you can pursue if your Florida PIP claim is denied. Here is what you need to know about appealing a PIP insurance claim denial in Florida so that you can seek adequate compensation for the losses you have incurred.
Table of Contents
What Are No-Fault Insurance Requirements In Florida?
Drivers in Florida must purchase PIP coverage that offers at least $10,000 in coverage. A PIP insurance plan pays benefits to the insured after a car accident, even if they caused the car accident.
Drivers who are injured in car accidents file insurance claims with their insurance provider after an accident. Their PIP covers 80% of all reasonable and necessary medical expenses for injuries incurred due to the accident. The PIP coverage should also compensate them for up to 60% of their lost wages due to the accident.
Suppose you sustained severe injuries due to the accident. In that case, you can pursue a claim against the at-fault driver to recover compensation for damages that the PIP insurance does not cover. Filing a claim against the at-fault driver may result in you receiving fair compensation for all your medical bills and lost wages. You may also be eligible to seek compensation for pain and suffering damages due to the accident. These damages can include:
- Emotional distress
- Physical pain and suffering
- Psychological damages
- Mental trauma and anguish
- Out-of-pocket expenses
- Loss of enjoyment of life
- Disabilities and permanent injuries
If your injuries are not considered as severe under Florida’s personal injury law, you will be limited to receiving PIP coverage.
Why Was Your Florida PIP Claim Denied?
When you submit an insurance claim to your provider, the company assigns a claims adjuster to your case. The insurance claims adjuster will review your claim to determine whether the claim is legitimate and how much your claim should be worth. The adjuster can deny your Florida car accident claim if they find any problems in your claim.
Insurance claims adjusters are very good at what they do. Unfortunately, it means that they will be very quick to find anything that they can use to deny your PIP claim. Some reasons that your insurance company could give for denying your claim can include:
- Receiving treatment from someone other than a licensed medical facility or physician.
- Not seeking medical care for the injuries you incurred within two weeks of the date of the accident, as required by your PIP policy.
- The car accident did not cause your injuries.
- Not receiving reasonable or necessary medical treatment for your injuries.
- Intentionally causing the accident or driving under the influence.
- Your injuries do not constitute an emergency medical condition that is eligible for compensation up to your policy limits.
- You were committing a felony at the time of the accident, or the vehicle was stolen.
- The PIP policy does not cover the accident or injuries.
If you filed a claim for your injuries and received a denial letter from your insurance company, you need to review the letter carefully. You will have to file an appeal for your insurance denial. Remember that there’s a deadline for you to file this appeal.
What To Do If Your Florida PIP Claim Is Denied?
You have to appeal the denial of your PIP insurance claim. The denial letter should outline the instructions for filing a request for an internal review. The deadline will also be clearly highlighted in the denial letter.
You have to request the demand for an internal review according to the instructions defined in the letter.
The denial letter should also give you a clear explanation for why the company denied your Florida PIP claim. You might be able to provide additional documentation or other information that could help clear up the issue.
The internal review process will involve another insurance adjuster who will review the claim and process it again. Once the second adjuster reviews the claim, the insurance company will send you another letter that explains the decision. Unfortunately, the company can deny your PIP insurance claim a second time.
If the company denies your claim after the review, you should immediately contact a Florida personal injury lawyer. The insurance company may be engaging in bad faith practices by denying your claim. Even if the company is not acting in bad faith, it is possible that both of the insurance adjusters made a mistake by denying your claim.
Involving a personal injury lawyer and filing a lawsuit for an insurance denial is the most well-advised way to proceed if you want to seek the fair compensation you should have received for your Florida PIP insurance claim. Filing a lawsuit could also result in obtaining compensation for any losses caused by the insurance provider for wrongfully denying your PIP insurance claim, if your claim merits it.
Are You Looking For A Florida Personal Injury Lawyer?
Working with a personal injury lawyer in Florida may be the wisest thing to do when you are seeking fair compensation for the losses you incurred due to an accident. If your insurance provider denies your PIP claim and the internal review ends with the same results, having an experienced attorney on your side can make the legal process go smoothly while you focus on healing.
Frankl Kominsky Injury Lawyers specialize in helping their clients deal with personal injury cases. This includes dealing with insurance companies who deny PIP insurance claims for their clients. Working with a qualified and experienced firm to file a lawsuit for insurance denial can help you better understand the details of your case. The firm can determine the best course of action and fight the claim on your behalf to help you seek the compensation you deserve.
Based in the Palm Beach area, the lawyers from Frankl Kominsky Injury Lawyers have several years of experience helping their clients recover damages for injuries they have suffered in accidents, whether it involves the at-fault driver’s insurance company or yours. If you’re looking for a West Palm Beach injury lawyer, working with Frankl Kominsky Injury Lawyers can help you build a strong case and have the best possible outcome for your insurance denial lawsuit in Florida (by appointment).