PIP insurance

Many people have this question after an accident or injury, or in other situations where they may have an insurance claim. For most car accident injuries, the insurer is expected to pay or deny a claim “within a reasonable amount of time.”

Unfortunately, sometimes the insurer and the claimant have very different ideas about what constitutes a “reasonable amount of time.” Often we meet clients who have medical bills piling up. They may have a totaled car or other property damage. Due to their injuries, they may not be able to go to work, adding to their financial problems. In situations like these, any delay can feel unreasonable. Worse, if the insurer decides to deny the claim, and the injured person has to appeal, the whole process can drag on even longer.

Under Florida law 634.336, it is an unfair, deceptive trade practice for an insurance company to fail to accept or reject a claim within a reasonable period of time after a claimant submits proof of loss. When an insurance company denies a claim, they are required to give a reason for the denial. It’s also considered a deceptive trade practice for an insurer to misrepresent the facts, lie about the insurance coverage, or fail to communicate promptly during the claims process. Unfortunately, these things do sometimes happen, adding to the difficulties an injured person might face after an accident.

If the parties agree to a settlement, the insurance company is required to pay the claim within 20 days. In some situations, the injured party may be required to submit a release of these claims in exchange for payment. Under Florida law, if the insurance company doesn’t pay by the due date, they also have to pay the claimant 12 percent annual interest. Car accident settlements are often for large sums of money, so the 12 percent annual penalty can be substantial if the claim isn’t paid quickly.

What About Personal Injury Protection Claims?

Sometimes clients ask us about Personal Injury Protection (PIP) policies. The state of Florida has specific laws for this type of no-fault claim. In this case, the insurer has 30 days to pay or deny the claim.

The rules for PIP claims are more specific than the rules for other types of insurance claims in Florida. It’s important to know that you have a deadline— you have to seek medical treatment within 14 days if you want to submit a claim for PIP benefits. Sometimes people don’t have all of the information to submit their entire claim at one time—especially if they need continued treatment, like follow-up visits, additional surgery, physical therapy, etc. You may submit what you have within 14 days, and the insurer has 30 days to pay the claim after they receive each part of the claim.

For the purposes of paying PIP benefits within 30 days under Florida Statute 627.736(4)(b), the mailbox rule applies. This means the insurance company complies with the 30-day standard when they put the settlement check in the mail. It doesn’t count just to put the settlement check into their own intra-office mail system.

The good news is they can’t just decide to authorize payment on the day 30, and then wait around for the accounting department to print and mail a check. Instead, the insurance company has to put the check into the actual mail system (postmark it) by the 30th day. Once they’ve done that, if it takes a little while to reach the recipient, the insurance company is still in compliance with the law.

In the event that the insurer denies your claim, they have to give you an itemization of the denials. If the rejection is because of a clerical error by the claimant, the insurance company has to provide an explanation. If this happens to you, know that you have 15 days to submit a revised claim. Sometimes figuring out what needs to be fixed or how to do so can be frustrating and stressful. An injury attorney can help you sort out the details and determine what needs to be done.

PIP insurance claims have some benefits. Because they don’t require an inquiry into fault, the damages should be covered no matter who caused the accident. The insurance company’s investigation will be limited to whether coverage applies and the amount of your damages.

On the other hand, in a general insurance claim, fault can definitely be an issue. When fault might be a question in whether insurance coverage applies, the insurance company often takes more time to investigate the claim. “Reasonable amount of time” may depend on the circumstances of each particular case. Again, this is not always helpful for someone struggling with medical bills and lost wages.

Often people think the best thing to do is to talk to the insurance investigator as soon as they call. Unfortunately, this isn’t always the case. It may be hard to think clearly or remember all the details of your accident if you’re still in a lot of pain—or conversely, if you’re taking pain medication that leaves you groggy or otherwise impaired. Some clients have told us they don’t even remember conversations they had with an insurance company rep shortly after their accident. Keep in mind that it’s okay to tell the insurance company that now isn’t a good time, or let the call go to voice mail.

Sometimes insurance companies offer to settle for a small amount early on, in the hopes that will let them off the hook for further medical bills you may have later. It’s usually a good idea to speak with an injury attorney before agreeing to their first offer, especially if your injuries are severe. You should also consider whether you expect to have more treatment, or be out of work for a long time, before you accept a settlement offer.

We often meet people who don’t know what to do when their claim is denied, or if they simply haven’t heard back from the insurer. Sometimes the insurance company hasn’t followed the applicable laws for accepting or denying a claim within the required period of time, or within a “reasonable” period of time. If that happens to you, know that you may have a claim for bad faith. The insurance company may even have to pay extra because they didn’t meet requirements to fairly investigate and pay the claim. Clients are sometimes unsure if they are in this situation, and a Florida personal injury lawyer can help.

What If My Vehicle is a Total Loss?

Under Florida law, there are some guidelines for how the insurance company is allowed to value a vehicle when they determine a “fair value” for the total cost of your car. The insurer might look at recent sales for similar vehicles in the area. Additionally, they’re allowed to get quotes from reputable, licensed dealers in the area. Also, they may use a guide, usually the Kelley Blue Book, to choose a value for the damaged vehicle.

If you or a loved one were seriously injured, you do have rights and you need an advocate who is ready to protect those rights. Speak with an injury attorney today from the Law Offices of David M. Benenfeld, P.A.

We offer a free, no-obligation consultation. You can meet with an injury attorney now to discuss your case and see if you qualify for compensation. Call us now at 954-677-0155 or request more information online.