Why Won't My Doctor Treat Me After I Got Injured in a Car Accident?

The first step toward a successful insurance claim after being injured in a car accident in Florida is to see a doctor for treatment. That allows your injury to be documented. Unfortunately, some primary care physicians turn away car accident victims, declining to provide care to them once they are told about the car accident. Often, the issue is Florida’s reliance on Personal Injury Protection (PIP) insurance.

PIP insurance coverage pays the policyholder’s medical bills and other costs after a car accident up to the limits of the policy, regardless of fault. But many doctors’ offices aren’t set up to bill auto insurers. They want to deal with health insurers, and the added work and/or potential difference in reimbursement rates from a PIP policy is enough for them to refuse treatment.

Chiumento Law, PLLC can refer you to physicians who will treat you if your doctor won’t work within your Personal Injury Protection coverage to address you for injuries suffered in a car accident. For more than 40 years, we have helped accident victims in Flagler and Volusia counties – including Palm Coast, Ormond Beach, and Daytona Beach – recover compensation for their injuries and the devastation caused by automobile accidents. Our car accident attorneys can help you obtain compensation from every insurance company and policy that is legally obligated to you.

What Is Florida’s PIP Auto Insurance Coverage?

Florida is one of 10 states that rely on a type of no-fault auto insurance known as Personal Injury Protection (PIP) coverage. All owners of motor vehicles in Florida must buy and maintain PIP coverage to register their vehicles.

PIP coverage makes the individual responsible for his or her own injuries in an accident, regardless of fault. The system is meant to provide injured drivers up to $10,000 in immediate medical coverage in lieu of having to go through the courts to establish fault for a car accident. The goal was to reduce payment delay for injured drivers and to limit utilization of the court system for smaller injury claims.

PIP coverage typically pays 80% of medical treatment costs, 60% of lost wages, and in a fatal car accident, $5,000 in death benefits. PIP may or may not have a deductible, depending on the coverage purchased.

Some of the medical expenses PIP typically covers include:

• Doctor bills
• Surgery costs
• Hospitalization
• Medication
• Medical testing
• Rehabilitation / physical therapy.

A closer look at the Florida no-fault auto insurance program indicates that Personal Injury Protection coverage is meant to pay for immediate, emergency medical care after a car accident. After all, PIP only provides up to $10,000 in medical coverage, which is about what a single night in the hospital costs.

Further, a 2012 amendment to Florida’s no-fault auto insurance statutes requires that the policyholder’s treating physician certify the existence of an Emergency Medical Condition (EMC) for full PIP benefits to be available.

An emergency condition is defined under Florida Statute 627.732(16) as one involving acute symptoms of sufficient severity, include severe pain, such that the absence of immediate medical attention could be expected to cause any of the following:

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

If a physician determines the car accident victim has not suffered an emergency condition, then they are only eligible for $2,500 in PIP benefits for their medical costs. That’s a 75 percent loss of benefits.

Generally, the initial claim for benefits following a car accident is against a PIP policy. Once those benefits are exhausted, the accident victim’s medical provider would bill other health insurance coverage the patient holds.

If someone else’s negligence caused the car accident – speeding, distracted driving, drunk driving, etc. – and your medical bills total more than $10,000, Florida law allows you to sue the at-fault driver and seek additional compensation through a personal injury lawsuit.

A car accident injury lawsuit may be settled through negotiations or in court and provide compensation to the accident victim from the at-fault driver’s insurance coverage.

The 2012 amendment to Florida’s PIP law also says that if you do not obtain medical treatment for car accident injuries within 14 days of the accident, your PIP coverage pays you nothing. This might become a problem if your primary care doctor refuses to treat you.

Finding a Healthcare Provider Who Will File Your PIP Coverage

In a serious car accident, you may summon emergency medical care (an ambulance and/or EMTs) and be taken directly to a hospital emergency room, where you can count on being treated. We do not hear about Florida hospitals taking issue with filing for reimbursements under PIP coverage.

In other cases, a car accident victim may not go directly to the emergency room. However, it is imperative that anyone injured in a car accident see a doctor, preferably within 24 hours of the crash.

Many symptoms that may not appear until a day or so after an accident are potentially signs of serious injury, such as:

• Headache, sluggishness, or fatigue, which may be caused by head injury, such as a concussion, or more serious traumatic brain injury (TBI), or a blood clot.
• Neck and/or shoulder pain, which may be due to cervical spine injury, such as whiplash, or a pinched nerve.
• Back pain, possibly caused by a ruptured disk, fractured vertebrae, whiplash, or muscle sprain/strain.
• Abdominal pain, possibly indicating organ damage and/or internal bleeding.
• Numbness due to herniated disk or pinched nerve.
• Emotional distress or agitation, which may be symptoms of concussion or more serious TBI, or post-traumatic stress disorder (PTSD).

You should inform the doctor who treats you that you have been in a car accident and are suffering symptoms such as those above. However, it is becoming increasingly common for family doctors and primary care providers to not treat car accident victims.

If you are denied treatment, we suggest you:

• Ask for a referral. In some cases, a primary care physician won’t treat you because you should be seen by a specialist. They may refer you right away. But you can be proactive. Anytime a doctor declines to assist you, ask to be referred to a qualified medical professional who will help you.
• Contact an attorney. A personal injury attorney who believes you have a viable claim can prepare a letter of protection on your behalf. Such a letter explains that your attorney is pursuing a claim in your name and that the healthcare provider will be paid out of an anticipated settlement or jury award. This should persuade your physician that he or she will be paid for treating you, particularly if it comes from a firm with a long-standing local reputation, like Chiumento Law, PLLC.
• Go to an emergency room or “urgent care” center. Go to a hospital emergency room if you are at risk of not obtaining a diagnosis within 14 days of your accident as required for PIP benefits. We do not advocate adding to crowded ERs or urgent care centers if you have a primary care physician who will treat you or refer you to another doctor. But, it is important to see a doctor within two weeks of a car accident and get a diagnosis on the record if you have been injured.

Contact Our Experienced Palm Coast Car Accident Lawyers

Florida’s approach to auto insurance and car accidents is unique and favors insurers over accident victims. Many people who are badly injured and need the insurance they purchased in good faith find that their coverage actually offers little protection. You need a legal advocate on your side.

A car accident lawyer from Chiumento Law, PLLC can help you seek compensation if you have been seriously injured in a car accident caused by another driver in Flagler County or Volusia County. We will work promptly to file for coverage you are eligible for under your personal injury protection (PIP) policy and help you seek compensation from the at-fault driver’s insurance company if your injuries are more serious and your medical bills exceed the PIP limits. We will investigate your car accident to identify all liable parties and every potential source of insurance compensation so that we may maximize your financial recovery.

Chiumento Law, PLLC was established in 1973, and our lawyers are known and respected in Flagler and Volusia counties. We can put our years of experience and network of contacts behind you to make sure your medical and legal needs are met, and that your creditors know that you have legal representation and your claims will be addressed.

If you have been injured in a car accident in Palm Coast or anywhere in Flagler or Volusia counties, contact the attorneys at Chiumento Law, PLLC today by telephone at (386) 445-8900 or by using our online form. Our law firm is dedicated to protecting your rights and aggressively pursuing the maximum compensation you are entitled to receive. Call us now.