Amendments to Florida’s “No-Fault” Rules May Hurt Accident Victims’ Recovery

Florida is a “no-fault” state with respect to auto accidents. This means all drivers must carry auto insurance policies that provide “personal injury protection” in the event of an accident. You must carry at least $10,000 in personal injury protection, although you may certainly purchase a higher amount of coverage.

Unfortunately, simply carrying no-fault insurance is not a guarantee the insurer will pay benefits. In 2012, the Florida legislature, in an effort to address allegations of people abusing the no-fault system, amended the law to limit an insurer’s liability in certain cases. Specifically, the amended law said the $10,000 limit only applied if a physician or other medical provider “determined that the injured person had an emergency medical condition.” Conversely, if the medical provider determined an accident victim “did not have an emergency medical condition,” the insurer could limit no-fault benefits to just $2,500.

Court Limits Car Accident Victims’ Insurance Benefits Due to Confusing Law

But what about cases where a medical provider made no determination of an emergency condition one way or the other? A federal appeals court recently addressed a pair of Florida cases raising that exact question. Although most accident and insurance cases fall under state law, many insurance companies are based outside of Florida, which means federal courts may hear these disputes while still applying the substantive law of Florida.

Here, there were two cases involving completely different car accidents in Florida. In both cases, the victims sought no-fault benefits up to their respective policy’s $10,000 limit. Both insurance companies denied the claims because the victims never received a medical diagnosis, one way or the other, as to whether their injuries constituted an “emergency medical condition.”

In both cases, different judges concluded that neither victim could recover more than $2,500 in benefits under the terms of the amended Florida law. In the second case, the insurance company argued it should not be liable at all. Both victims appealed to the U.S. 11th Circuit Court of Appeals, which consolidated the two cases at the parties’ request.

On December 30, 2015, the 11th Circuit affirmed the two lower court decisions limiting the victims’ recovery to $2,500. The court acknowledged that the 2012 amendments were “in inescapable conflict,” as the language did not specifically address a situation, as presented in these two cases, where a medical provider simply failed to make any determination as to whether or not the victim’s injuries constituted an “emergency medical condition.” That said, the court looked to the “legislative history” of the amendments and, based on that, concluded the Florida legislature “sought to reduce fraudulent claims by making the full $10,000 amount of benefits available only to those insureds who suffered severe injuries, a restriction defined into the term ’emergency medical condition.’” Therefore, allowing the plaintiffs in these cases to “escape that restriction on the higher limit would defeat the legislative intent and policy behind the amendments, which we are bound to honor.”

Need Help from an Auto Accident Attorney?

Poorly drafted legislation often leads to bad law, which in turn can hurt innocent victims. The above decision illustrates the complexity of Florida law as it relates to accidents and insurance. If you have suffered serious injuries due to a car accident it is therefore essential you work with an experienced Clearwater personal injury lawyer. Contact the Law Office of Paul B. Genet, P.A., if you would like to speak with an attorney today.

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