Category Archives:No Fault

La regla de los 14 días de Protección contra Lesiones Personales y la Condición Médica de Emergencia y cómo esto afecta su caso de lesión

La regla de los 14 días de Protección contra Lesiones Personales y la Condición Médica de Emergencia y cómo esto afecta su caso de lesión

Por: Abogado de Lesiones de Tampa, Martin J Hernandez

Como abogado de lesiones, he notado que aunque la regla de los 14 días ha sido la ley por 4 años, no todos entienden la regla de los 14 días de Florida y cómo los afecta. Hay dos puntos que a menudo encuentro que los clientes pierden: la regla de los 14 días y la regla de la Condición Médica de Emergencia.

Regla de 14 días de PIP

El estatuto de PIP de Florida rige el seguro de automóvil que todos los conductores (excepto motociclistas y taxis (pero se requiere que Uber y Lyft lleven)) deben llevarlo. La idea es conseguir que cada persona herida en una cobertura médica de accidente de auto sin tener que pelear sobre quién tiene la culpa (es decir, “no, él corrió la luz roja no a mí”). Esta es la razón por la que a veces se hace referencia a la cobertura como “seguro sin culpa de Florida”. Lea el lenguaje de § 627.736 aquí.

Una de las nuevas disposiciones tiene un gran impacto en miles de floridanos: la disposición de la regla de los 14 días.

Debido a Florida PIP, todos los conductores tienen cobertura de seguro que les da derecho a recibir el 80% de sus gastos médicos pagados y el 60% de los salarios perdidos pagados, pero estos montos no pueden ser más de $ 10,000 en total. El estatuto, sin embargo, establece que un automovilista tiene 14 días después de un accidente automovilístico para buscar tratamiento médico ya sea en un hospital, transporte de emergencia, médico, doctor en osteopatía, quiropráctico o dentista.

Si pierde ese período de 14 días, ¡perdió la cobertura de PIP por la que estuvo pagando todo el tiempo! Esto significa que si los síntomas no aparecen en las primeras dos semanas o si cree que puede tratar con ellos, esas lesiones no estarán cubiertas.

La nueva ley limita el monto que las compañías de seguros deben pagar por los reclamos presentados. Si, eso es correcto Las compañías de seguros encontraron una forma de no pagar las facturas médicas enviadas; esta es la forma en que lo quieren. El incumplimiento del requisito de 14 días significa que la parte perjudicada debe pagar las facturas médicas.

Debido a estas nuevas disposiciones, las compañías de seguros no tienen que cubrir a tantas personas, aumentando sus ganancias.

Debido a estas nuevas disposiciones, las compañías de seguros no tienen que cubrir a tantas personas, aumentando sus ganancias.

¿Por qué el cambio? De acuerdo con la Oficina de Regulación de Seguros de la Florida, la justificación para el cambio es disminuir el fraude PIP. De acuerdo con su estudio que justificó el cambio en la ley, el fraude de protección contra lesiones personales fue un problema de $ 600 millones en el estado de Florida. La intención era combatir el fraude PIP para que las primas bajaran. La idea era que aquellos que están realmente heridos buscarán atención médica de inmediato.

¿En cuanto a si este cambio causó que las primas bajaran? Realiza la llamada si su seguro de auto ha disminuido desde 2012.

Condición Médica de Emergencia PIP (EMC) El Estatuto PIP enmendado (Estatuto de Florida §§ 627.736 y 627.732) dejó a muchos médicos confundidos en cuanto a lo que verdaderamente constituye tal condición. La enmienda define expresamente una Condición Médica de Emergencia (CEM) como una afección médica: se manifiesta por síntomas agudos de suficiente gravedad, que pueden incluir dolor intenso, de modo que cabe esperar razonablemente que la ausencia de atención médica inmediata dé lugar a cualquiera de los síntomas agudos. siguiendo:

* Grave peligro para la salud del paciente,

* Deterioro grave de las funciones corporales

* Disfunción grave de cualquier órgano o parte del cuerpo.

Sin embargo, como puede ver, hay mucho espacio para la interpretación y la claridad no es una de las virtudes de la ley.

El Estatuto enmendado de “No-Fault” de Florida entró en vigencia el 1 de enero de 2014 y establece expresamente que se debe realizar una determinación de EMC para que el demandante (persona lesionada) tenga acceso a los $ 10,000 completos mencionados anteriormente.

Si un médico determina que las lesiones de un reclamante no alcanzan el nivel de un EMC, entonces solo tienen derecho a solo $ 2500 en beneficios PIP por su tratamiento médico.

Lo que hace que la disposición sea tan confusa es que el estatuto no deja en claro exactamente cómo se supone que un profesional médico debe decidir que una persona lesionada tiene un EMC.

Póngase en contacto con un abogado con experiencia en PIP de Florida En Fernández y Hernández, contamos con un equipo de abogados con experiencia que lucha contra las compañías de seguros diariamente. Debido a los cambios realizados en 2012, ahora es más difícil que nunca recibir un reembolso por daños como resultado de un accidente automovilístico. Se suponía que el seguro sin fallas de Florida facilitaría las cosas. En cambio, las compañías de seguros se han aprovechado de los recientes cambios en la disputa y niegan cada vez más reclamos.

Póngase en contacto con un abogado de lesiones personales para analizar los detalles de su caso y decidir si necesita representación legal. Un abogado de lesiones personales podría significar la diferencia entre obtener un acuerdo que apenas cubre sus gastos o un acuerdo o veredicto que paga todas sus facturas y le permite volver a vivir su vida.

En Fernández & Hernández, entendemos que estar herido de gravedad o sufrir la pérdida repentina de un ser querido es un evento traumático y que cambia la vida. Si usted o un ser querido ha sido herido de gravedad por un conductor distraído en el área de Tampa Bay, contacte a un abogado de lesiones personales en Fernandez & Hernandez para programar una consulta gratuita.

Llame al Abogado de Lesiones Personales de Tampa, Martin J. Hernandez de Fernandez & Hernandez al 813-229-5353 o lea más en: SuAbogadoLatino.com

Personal Injury Protection’s 14 Day rule and Emergency Medical Condition and how this affects your injury case

Personal Injury Protection’s 14 Day rule and Emergency Medical Condition and how this affects your injury case

By: Tampa Injury Attorney, Martin J Hernandez

Although this has been the law for 4 years, not everyone understands the 14 day rule and how it affects them. There are two points that I often find clients lost on: the14-day rule and the Emergency Medical Condition rule.

 PIP 14-Day Rule

Florida’s PIP statute governs the auto insurance that all drivers (except motorcyclists and cabs (but Uber and Lyft are required to carry)) are required to carry. The idea is to get every injured person in an auto accident medical coverage without having to fight over who is at fault (i.e., “no he ran the red light not me”).  This why the coverage is sometimes referred to as ‘Florida No-Fault Insurance’.  Read the language of § 627.736 here.

One of the new provisions has a major impact on thousands of Floridians: the 14-day rule or provision.

Because of Florida PIP, all drivers have insurance coverage which entitles them to have 80% of their medical expenses paid and 60% of lost wages paid, but these amounts cannot be more than $10,000 total.  The statute, however, states that a motorist has 14 days after an automobile accident to seek medical treatment from either a hospital facility, emergency transport, medical doctor, doctor of osteopathy, chiropractor, or a dentist.

If you miss that 14-day window, you forfeited the PIP coverage that you have been paying for all along!  This means that if the symptoms do not surface within the first two week period or you think you can deal with it, those injuries will not be covered.

The new law limits the amount insurance companies must pay for the claims submitted.  Yes, that’s right.  Insurance companies found a way not to pay for medical bills submitted; this is just the way they want it.  Failure to meet the 14 day requirement means that the injured party must pay for the medical bills.

Because of these new provisions, insurance companies don’t have to cover as many people, increasing their profits.

Why the change? According to the Florida Office of Insurance Regulation, the justification for the change is to decrease PIP fraud. According to their study that justified the change in the law, personal injury protection fraud was a $600 million problem in the state of Florida.  The intent was to combat PIP fraud so that premiums would go down.  The idea was that those who are really injured will seek medical attention right away.

As to whether this change caused premiums to go down?  You make the call if your auto insurance has gone down since 2012.

PIP Emergency Medical Condition (EMC)

The amended PIP Statute (Florida Statute §§ 627.736 and 627.732), left many physicians confused as to what truly constitutes such a condition. The amendment does expressly define an Emergency Medical Condition (EMC) 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 could reasonably be expected to result in any of the following:

  • Serious jeopardy to patient health,
  • Serious impairment to bodily functions,
  • Serious dysfunction of any bodily organ or part.

However, as you can tell, there is plenty of room for interpretation and clarity is not one of the law’s virtues.

The amended Florida “No-Fault” Statute went into effect on January 1, 2014, and expressly states that a finding of an EMC must take place in order for the claimant (injured person) to have access to the full $10,000 mentioned earlier.

If a physician determines that a claimant’s injuries do not meet the level of an EMC, then they are only entitled to just $2500 in PIP benefits for their medical treatment.

What makes the provision so confusing is that the statute does not make clear exactly how a medical professional is supposed to decide that an injured person has an EMC.

Contact an Experienced Florida PIP Attorney

At Fernandez and Hernandez, we have an experienced team of attorneys who battle insurance companies on a daily basis. Because of the changes made in 2012, it is now more difficult than ever to be reimbursed for damages as a result of an auto accident. Florida’s No-Fault insurance was supposed to make things easier. Instead, insurance companies have taken advantage of the recent changes to dispute and deny more and more claims.

Contact a personal injury attorney to discuss the specifics of your case and decide whether you need legal representation.  A personal injury attorney could mean the difference between getting a settlement that barely covers your expenses or a settlement or verdict that pays all of your bills and allows you to get back to living your life.

At Fernandez & Hernandez, we understand that being seriously injured or suffering the sudden loss of a loved one is a traumatic and life changing event.  If you or a loved one has been seriously injured by a distracted driver in the Tampa Bay area contact a personal injury lawyer at Fernandez & Hernandez to schedule a free consultation.

Call Tampa Personal Injury Attorney, Martin J. Hernandez of Fernandez & Hernandez at 813-229-5353 or read more at: InjuryLawyersOfTampa.com

What is Florida "No Fault" or "PIP" Insurance?

What is Florida “No Fault” or “PIP” Insurance?

By your Tampa Auto Accident Attorney – Martin Hernandez

When it comes to auto insurance, Florida is a “No-Fault” insurance state.  This is an often misunderstood topic and what other people tell you it is, like most legal concepts, is usually wrong.

Florida PIP Laws - Know the law and Florida PIPDrivers who are injured in a car accident in Florida and sometimes wonder why they are filing a “No-Fault” Claim under their own insurance policy when they are not at-fault.  Those drivers incorrectly believe that because the other party is at-fault they should be paying all of the injured party’s medical bills.  However, that is not the case.  Why?  Let’s change the facts around.  What if both parties are blaming each other for the accident?  For example, they both say that they had the green light.  Yet, the injured party went to the hospital and incurred $5,000 in hospital bills (cheap for a Tampa hospital after a car accident).  What if they missed two weeks of work ($2,000 in lost wages)?  That means that the injured party is in the hole $7,000 for an accident that may not be their fault.  The hospital is going to ask for payment from you because you are the patient and you are responsible for payment.

Hence, Florida No-Fault.  You pay yours.  I’ll pay mine.  We’ll figure out later on who is responsible.

Now, under Florida law, every motorist is required to carry a minimum of $10,000 in Personal Injury Protection (PIP) coverage.  A driver’s PIP coverage, as this type of insurance is most often known, is to cover medical bills and lost wages the driver may suffer in an accident, no matter who caused the accident. When a crash occurs, each person involved in the crash turns to his or her own insurance company to pay the costs of medical care and other losses.

Car Accidents under Florida’s No Fault Insurance Scheme What many drivers do not realize is that, under Florida’s no fault statute, their PIP coverage by law only covers 80% of the medical bills which they may incur in an accident as well as only 60% of lost wages or income they may suffer in a car accident.  For example on how this works, assume you have a $10,000 PIP policy with a $1,000 deductible, the absolute minimum required under Florida law.  You are hit by another driver in an accident in which the other driver is clearly at fault.  Assume you go to the emergency room and your medical bills are $5,000 plus you are out of work for two weeks and lose out on $2,000 in income.  Your car insurance will pay $4,000 to the hospital (leaving you a $1,000 co-pay) and pay you $1,200 of your lost wages.  This way your bills are getting paid and you are not being sent to collections for the entire hospital bill.

But I shouldn’t pay the rest! Shouldn’t they pay for everything else?

Yes, they should and that’s how we can help.  There are exceptions to Florida’s “No- Fault” law that permit a motorist to directly sue another motorist who caused the accident.  The first exception to Florida’s no fault statute is if a person suffers a permanent injury as a result of the accident, Florida  statute (627.737(2)) defines a permanent injury as: (i) significant and permanent loss of an important bodily function; (ii) permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement; (iii) significant and permanent scarring or disfigurement; or (iv) death.  Accordingly, if a driver suffers a “permanent injury” as defined above, then he is not subject to the “No-Fault” limitation against the at fault driver and may be able to bring a claim not only for medical bills and lost wages but also to recover for pain and suffering and other “intangible” damages suffered as a result of the accident. Another exception would be if the injuries suffered  are not permanent, but the medical bills (or lost wages) total more than the $10,000 in PIP coverage.  In that instance, a claim can be brought to recover the medical bills (or lost wages) not covered by the PIP insurance.

Obviously, even though Florida is a “No-Fault” state, the application of the law is limited since it only applies to those accidents in which the medical bills and/or lost wages or lost income do not exceed $10,000 and where someone has not suffered a permanent injury.

If you have been injured in a Tampa Car Accident and need a Tampa Injury Attorney, Get Lawyered Up Now and call Tampa Injury Attorney Martin Hernandez of Fernandez and Hernandez, LLC for a free consultation at 813-229-5353 or read more at: InjuryLawyersOfTampa.com

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ARTICLE FROM YOUR TAMPA INJURY ATTORNEY: INJURED IN A TAMPA CAR OR AUTO ACCIDENT?

ARTICLE FROM YOUR TAMPA INJURY ATTORNEY:
INJURED IN A TAMPA CAR OR AUTO ACCIDENT?

I don’t think I am hurt…but I don’t feel the same.

Have you been injured in a car accident?

After A Car Accident: You may be injured and not know it. Ask yourself this: are you the same today physically as you were the day before the accident? Do you feel pain or just out of whack?

Injuries such as whiplash or “soft tissue” may not show any symptoms for hours, days, or even weeks later but the majority of medical professionals agree that the first 72 hours after an auto accident are the most critical and the time period during which treatment can be the most effective.

Believe it or not, the majority of auto accident injuries occur at speeds of 6 – 12 mph. This results in your car not showing much damage but your body might!

Often, a soft-tissue injury such as whiplash is permanent. Scar tissue can form in your muscles leaving them less flexible and prone to re-injury if you don’t receive proper treatment. If you are injured, your injuries typically will not heal on their own.

After an accident, get prompt medical attention. If you don’t get medical attention within the first 14-days, your benefits could be denied or limited, and your level of pain will likely increase. In most cases, treatment can cost you nothing out of pocket, even if the accident was your fault.

Don’t wait. Get help immediately.

If you do not have a doctor that can treat you after your car accident, we can recommend a doctor near your work or home or elsewhere that will work with you and get you feeling better.

Call Tampa Injury Attorney Martin Hernandez of Fernandez & Hernandez to discuss your Tampa Car Accident legal matters. Call your Tampa Injury Attorney at 813-229-5353 or read more: InjuryLawyersOfTampa.com

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IS FLORIDA NO FAULT GOING AWAY?  IS PIP DEAD?

IS FLORIDA NO FAULT GOING AWAY?  IS PIP DEAD?

By your Tampa Auto Accident Attorney – Martin Hernandez

Florida No Fault / PIP - Know your laws.There is a movement in the Florida Legislature to repeal the state’s no-fault car insurance system after 47 years in place.

Florida is only one of 6 states that is still on the No-Fault system and, according to many, it is riddled with fraud and overbilling by doctors.  The No-Fault or Personal Injury Protection (PIP) system cover injuries from car accidents, regardless of who is at-fault, up to $10,000.  However, this number has not changed since 1971 and let’s face it, in 1971, you could buy a house for $10,000 and today, it is not even a down payment.  Several attempts to fix the PIP system have yielded nothing except increased premiums and a silly 14-day rule that only increased the number of claims for emergency care.  Yet, premiums have risen 25% from 2015 to 2017.

Other states repealed their No-Fault system and their premiums have gone down.  For example, Colorado dropped their No-Fault system and their premiums went down by 35%.  Florida drivers pay among the highest premiums in the nation for some of the lowest required coverage amounts.

Florida Legislature is now proposing going to an “at-fault” system and making bodily injury coverage mandatory which would make the “at-fault” driver’s insurance primary over the claims.

Read more about the proposed Florida Legislatures bills

If you have been injured in a Tampa Car Accident and need a Tampa Injury Attorney, Get Lawyered Up Now and call Tampa Injury Attorney Martin Hernandez of Fernandez and Hernandez, LLC for a free consultation at 813-229-5353 or read more at: www.InjuryLawyersOfTampa.com

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Tampa Car Accident Lawyer

A car accident can turn your entire life upside down. Injuries can require hospitalization, surgery, and rehab.  A crash can make you miss time from work or incur medical expenses.  All for something that was not even your fault.  When this happens, you need and deserve an experienced attorney who can represent you and get the justice you deserve.  This isn’t your fault!

In Florida, vehicle owners are required to purchase protection which, in the event of an auto accident, will 80% of the first $10,000 of medical bills you incur.  This law was put in place more than 40 years ago and has not changed since then.  Well, 40 years ago you could buy a house for $10,000.  Now, that is not even a down payment.

Unfortunately, PIP (Personal Injury Protection) may also limit your ability to take legal action, so it’s important to contact an experienced personal injury attorney immediately following an accident, especially if you have suffered a severe or disabling injury.

At Fernandez & Hernandez, LLC, our Tampa attorneys have decades of experience handling car accident claims and can evaluate your claim for the best course of action.  Our lawyers will evaluate the difficulties you may face in recovering compensation.

Were you or a loved one severely injured in a car accident? If so, call Tampa Injury Attorney Martin Hernandez at 813-229-5353 or InjuryLawyerOfTampa.com

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