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Why is my insurance company refusing to cover the full cost of my medical bills after a car accident in Miami?

This legal question related to medical malpractice attorneys in MiamiFlorida has been answered.

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Location: Miami  |  Law type: medical malpractice attorneys
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I was involved in a car accident in Miami, Florida, last month. Another driver ran a red light and hit my car, causing me to suffer a broken leg (tibial plateau fracture) and whiplash. The medical bills for my injuries are estimated to be around $50,000. The other driver was found to be at fault, and their insurance company has agreed to pay $25,000. However, my own insurance company is refusing to cover the remaining $25,000.

What does my insurance policy say?

My auto insurance policy has a limit of $50,000 for medical expenses. It also includes uninsured/underinsured motorist coverage, which should cover the remaining costs if the at-fault driver’s insurance is not enough.

Have I taken any steps yet?

  • I have contacted my insurance company multiple times to understand why they are not covering the remaining cost.
  • I have reviewed my insurance policy to ensure that I understand the coverage.
  • I have consulted with a lawyer to understand my legal options.

What are my options?

1. File a complaint with the Florida Department of Financial Services. - This could result in an investigation into the insurance company’s practices. 2. Take the insurance company to court. - This would be time-consuming and could be expensive, but it may be necessary to recover the remaining costs. 3. Seek an alternative dispute resolution. - This could be a less adversarial way to resolve the issue.

Can you please advise on the following?

1. What are the specific laws in Florida regarding insurance claims after a car accident? 2. What are my rights as a policyholder? 3. What is the process for filing a complaint with the Florida Department of Financial Services? 4. What should I expect if I take the insurance company to court? 5. Are there any other steps I should take before proceeding with legal action?

Commonly posted questions...

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Legal Solution

The response provided below is specific to medical malpractice attorneys in the jurisdiction of Miami. If the response is inadequate, please submit a detailed inquiry.

Florida Car Accident Insurance Claims

Understanding Florida's Insurance Requirements Florida is a "no-fault" state when it comes to auto accidents, which means that in most car accidents, an injured person's own insurance policy (usually their personal injury protection or PIP coverage) will pay for some, if not all, of their medical expenses, regardless of who was at fault for the accident. However, this doesn't eliminate the possibility of pursuing a claim against the at-fault driver's insurance, especially when medical costs exceed the PIP limit.

Relevant Florida Statutes

  • Florida Statute 627.736 – Personal Injury Protection Benefits
  • Florida Statute 627.727 – Uninsured/Underinsured Motorist Coverage

For detailed provisions of these laws, it would be best to visit the official Florida State Legislature website.

Possible Solutions to Your Issue

  1. Direct Negotiation with Your Insurance: Before opting for legal recourse, consider scheduling a meeting with your insurance adjuster. With the evidence and your policy details, there's a possibility of a resolution.

  2. Alternative Dispute Resolution: This involves mediation or arbitration where a neutral third party aids in reaching a mutually agreeable solution. The advantage is that it's often faster and less expensive than litigation. You can find the right lawyer specializing in arbitration and mediation attorneys.

  3. Legal Action: If other avenues fail, taking your insurance company to court might be the next logical step. If you decide to go this route, ensure you compare lawyers in your area to find a skilled auto accident attorney.

  4. Filing a Complaint: The Florida Department of Financial Services is responsible for overseeing insurance disputes. They can initiate an inquiry if they find the insurer's actions questionable.

Estimated Legal Costs in Miami

Service Average Cost in Miami % Difference from National Average
Consultation with Personal Injury Attorney $250 +15%
Mediation with Insurance Company $1,500 +10%
Taking an Insurance Claim to Court $5,000 +20%
Expert Witness Fees $2,000 +18%

Note: Legal fees in Miami tend to be higher due to the city's high living standards and competitive legal market.

Complexity of Insurance Claims

Car insurance claims, especially in no-fault states like Florida, can be intricate due to the multiple layers of policies and legal stipulations.

Case Study 1: A person was injured in an auto accident but had previously existing medical conditions. The insurance company disputed the claims, suggesting the injuries were pre-existing. It required extensive medical examinations and expert testimonies to resolve.

Case Study 2: A driver with only the minimum required insurance got into an accident with a driver with no insurance at all. The costs exceeded both their limits, leading to complicated legal battles.

Case Study 3: A person was hit by an underinsured driver while walking. The pedestrian's own auto insurance, strangely enough, came into play due to Florida's PIP laws.

Questions for Further Clarification

  • Extent of Policy Coverage: Are there any specific exclusions or clauses in your insurance policy that could be affecting the coverage?

  • Communication Record: Do you have a record of all communications with the insurance company? This can be vital for legal proceedings.

  • Additional Policies: Do you have any additional health or accident insurance policies that might cover the excess medical expenses?

Frequently Asked Questions

Q1: Can I sue the at-fault driver for pain and suffering?

In Florida, if you've suffered a significant and permanent injury, you may be able to step outside the no-fault system and bring a traditional liability claim against the at-fault driver.

Q2: How long do I have to file a lawsuit after the accident?

Florida's statute of limitations for car accident injuries is typically four years from the date of the accident.

Q3: Can I still claim if I was partly at fault for the accident?

Florida follows a "pure comparative negligence" rule, meaning you can recover damages reduced by your percentage of fault.

Q4: Does my PIP coverage pay for lost wages?

Yes, Florida's PIP coverage will cover 60% of lost wages due to the inability to work after the accident.

Q5: What if the other driver's insurance company contacts me?

It's generally advised not to give any statements or sign any documents without consulting with a personal injury lawyer first. They may be trying to minimize their payout.

Disclaimer

This content is for informational purposes only and does not establish an attorney-client relationship. It's always recommended to consult with a local attorney about your specific situation.

Written, answered, changed

Legal question "Why is my insurance company refusing to cover the full cost of my medical bills after a car accident in Miami?" has been changed 1 year 6 months ago. Demonstrate your legal skills and willingness to help and answer right now! Issue is related to the location of Miami & area of law: medical malpractice attorneys.
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Photo of a serious and professional-looking legal advisor standing in front of a court room, holding a document about a car accident insurance claim. The advisor is a middle-aged white man with grey hair, wearing a suit and glasses. In the background, there is a judge and a court reporter.
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