We are here to help you. Under Florida Law, you will be compensated quickly and fairly. The laws of the State of Florida take a very dim view to responsible parties who do not quickly and properly compensate the victim of an accident. An insurance carrier once presented with a claim has a very quick time period to evaluate the merits of the claim, determine who is at fault and to determine the nature and the extent of the damages. The law is clear. The insured must be treated as a fiduciary. This requires the insurance carrier to make sure that claims are quickly and effectively handled. It has been said that in Florida, an insurance company that wants to fight a case does so at its own peril.
Why do we say this? Let’s suppose you are rear-ended on I-95 and suffer neck and back injuries. The person that hits you has a $10,000 insurance policy. What happens when you present that claim to the insurance carrier of the person who hit you? The insurance carrier must acknowledge the claim and decide to either pay it quickly or fight it. What happens when the insurance carrier fights this claim and a jury rules in your favor? You are often times entitled to what the jury awards despite the limits on the other person’s insurance policy. This is called bad faith and causes cases to settle quickly and fairly.
Florida follows the common law approach to determining liability on a trip and fall case. We first look to see the relationship of the victim to the establishment. Most often times, this will be what is called a business invitee. A business invitee is owed the greatest duty of care. The establishment must go out of its way to make sure the location is free of debris, dirt, and other open and obvious perils on the property. Upon injuring oneself on a peril, liability will often attach to the premises owner. This occurs under the common law premises liability and often times the mode of operation doctrine. Please note that as of 2010, the transitory substances act (Florida Statute Section 768.0755) made it more difficult in a premises liability case to attach liability in a slip and fall based on foreign substances. That said, an establishment that knows or should know of a substance that causes harm will be liable.
One of the most challenging and consistently changing areas of law in Florida is the No-Fault law. Florida is one of a few PIP states that remain in the United States of America. Passenger vehicles and commercial vehicles must provide PIP. Taxis, Uber type vehicles while engaged in a ride, pickup, panel, van, camper or motor home types ordinarily used for business, mass transit vehicles do not provide PIP. PIP offers a statutory benefit in the sum of $10,000. But a few rules have to be noted. The motor vehicle accident must be reported within fourteen (14) days and all billing must be submitted within thirty-fine (35) days subject to certain exceptions. The Law gives the insurance carrier 30-days to pay or deny. An insurance carrier will get a 60-day extension to pay or deny of the carrier believes that fraud is in issue.
The fee schedule that is adopted is the 80% of 200% of Medicare Part B. Should a code or service not be listed in Medicare Part B, then it is 100% of Workers Compensation. Any payment limitations would be when the service is rendered. However, payment limitations for services under Medicare apply in the service year of the treatment. The “service year” is from March 1 through February 28 (or February 29 in a leap year).
Once a claim is denied in whole, in part or not denied at all, the question is what do you do? Well, the next step is to send a demand letter, certified maul, return receipt request. This safe-haven letters gives the insurance carrier thirty (30) days to pay the amount due, along with interest and a 10% penalty of the principle remaining amount, up to $250.00
Should an amount be due and owing after the expiration of the safe haven provision, the provider has the right to bring a court action. Remember, the Florida Constitution has held that arbitration clauses are illegal.
Once a Court action is begun, it remains the medical providers’ burden to prove standing, medical necessity and relatedness to the accident and reasonableness of the charges. Motion practice will normally endure, depositions are common and a jury trial looms if the case is not resolved through summary judgment or settlement.
Are you confused yet? We are here to help you!
