After a pedestrian accident in Florida, your medical expenses are initially covered by your own Personal Injury Protection (PIP) auto insurance, regardless of who was at fault for the crash. While this might seem surprising, it is the first phase of a multi-layered process designed to get you the care you need.
If your medical expenses exceed your PIP coverage, you may be able to seek compensation from the at-fault driver’s insurance and potentially other sources. Knowing your options can make a significant difference in your physical and financial recovery.
Key Takeaways about Who Covers Medical Expenses in a Pedestrian Accident
- Under Florida’s no-fault system, an injured pedestrian’s own Personal Injury Protection (PIP) auto insurance is the primary source for covering initial medical expenses, regardless of who was at fault.
- PIP coverage is limited, typically to $10,000, which can be quickly used up by costs from a serious pedestrian accident.
- When medical expenses and other losses exceed what PIP covers, an injured person can file a claim against the at-fault driver’s Bodily Injury Liability (BIL) insurance.
- Proving the driver’s negligence is essential for a successful personal injury claim to recover costs for medical treatment, lost income, and pain and suffering.
- Florida's comparative fault rule allows an injured pedestrian to recover compensation even if they were partially at fault for the accident, though their award may be reduced.
- Strict deadlines, known as statutes of limitation, apply to filing personal injury lawsuits in Florida, making it important to understand the timeline for taking legal action.
The First Line of Defense: Your Own Personal Injury Protection (PIP)
Many people are surprised to learn that after being hit by a car as a pedestrian, the first place to turn for medical coverage is usually their own auto insurance policy. This is because Florida operates under what is called a "no-fault" insurance system. This system was designed to ensure that people injured in traffic accidents have access to quick medical payments, no matter who caused the crash.
The specific part of your insurance that handles this is Personal Injury Protection, or PIP. As required by Florida law, every owner of a motor vehicle in Florida must carry a minimum of $10,000 in PIP coverage. This coverage applies to you not only when you are driving but also when you are a passenger, a bicyclist, or a pedestrian injured in a crash involving a motor vehicle.
PIP coverage helps pay for a percentage of your initial medical costs and lost wages. Typically, it covers:
- 80% of your initial medical bills, including ambulance rides, hospital stays, doctor visits, and rehabilitation.
- 60% of your lost wages if your injuries prevent you from returning to work.
- A $5,000 death benefit.
It is crucial to know that to use your PIP benefits, you must seek medical treatment within 14 days of the accident. Waiting longer than two weeks could result in your insurance company denying your claim. This makes getting a medical evaluation right away a top priority, even if you don't feel seriously hurt at first.
What Happens When PIP Isn't Enough?
While PIP is a helpful starting point, the $10,000 limit is often not enough to cover the full costs of a serious pedestrian accident. A single trip to the emergency room, combined with surgery and follow-up care, can easily exceed this amount. When your medical expenses go beyond your PIP limit, you can then step outside the no-fault system and pursue a claim against the driver who was responsible for the accident.
To do this, you must show that your injuries meet a certain "seriousness threshold" as defined by Florida law. This usually means the injury consists of a significant and permanent loss of a bodily function, permanent injury, significant and permanent scarring or disfigurement, or death. If your injuries qualify, there are several other potential sources for covering your medical expenses and other losses.
You may be able to seek compensation from:
- The At-Fault Driver's Bodily Injury Liability (BIL) Insurance: Unlike PIP, BIL coverage is not mandatory for all drivers in Florida, but many carry it. This insurance is designed to pay for the injuries the driver causes to others.
- Your Own Health Insurance: Your personal health insurance can be used to pay for medical bills after your PIP coverage is exhausted. However, your health insurer will likely seek reimbursement from any settlement you later receive from the at-fault party.
- Your Uninsured/Underinsured Motorist (UM/UIM) Coverage: This is optional coverage you can add to your own auto insurance policy. It protects you if the at-fault driver has no BIL insurance or not enough to cover all of your damages.
Securing payment from these sources requires proving that the other driver was legally at fault, or negligent, in causing your injuries.
Pursuing a Claim Against the At-Fault Driver in South Florida
To successfully get compensation from the at-fault driver, you and your legal team must demonstrate that their negligence caused the accident. Negligence is a legal term that means someone failed to act with reasonable care, and this failure resulted in harm to another person. Imagine a driver looking at their phone instead of the road as they approach a crosswalk on Atlantic Avenue in Pompano Beach—that's a clear example of failing to act with reasonable care.
To build a strong case for negligence, it's necessary to gather evidence that tells the story of what happened. This evidence helps prove the four key elements of a negligence claim:
- Duty: The driver had a legal duty to operate their vehicle safely and watch out for pedestrians.
- Breach: The driver breached, or violated, that duty through a careless action (like speeding, texting, or running a red light).
- Causation: The driver's breach directly caused your injuries.
- Damages: You suffered measurable losses, such as medical bills, lost income, and pain.
Collecting strong evidence is fundamental to holding the responsible driver accountable. Key pieces of evidence in a South Florida pedestrian accident often include police reports, photos of the accident scene, and statements from anyone who saw the crash happen.
Understanding Florida's Comparative Fault Rule
When you file a claim, the at-fault driver's insurance company may try to argue that you were partially to blame for the accident. They might claim you were looking at your phone while crossing the street or that you weren't in a designated crosswalk. While this can be a frustrating tactic, it doesn't automatically prevent you from receiving compensation in Florida.
This is because the state follows a rule known as modified comparative fault. This law states that you can still recover damages even if you were partially at fault, as long as your percentage of fault is not more than 50%. Your final compensation award will simply be reduced by your percentage of fault. For example, if you are awarded $100,000 in damages but are found to be 20% at fault, you would receive $80,000.
Some common reasons a pedestrian might be found partially at fault include:
- Crossing the street outside of a marked crosswalk (jaywalking).
- Walking against a "Don't Walk" signal.
- Darting out into the street unexpectedly.
- Walking along highways or other areas where pedestrian access is prohibited.
Even if you believe you might share some responsibility, it is still worthwhile to explore your options for seeking compensation for your injuries.
The Role of Health Insurance and Medical Liens
If your medical bills exceed your $10,000 PIP limit, your personal health insurance may begin to cover the costs of your treatment. This can be a huge relief, ensuring that you continue to get the care you need without paying completely out of pocket. However, it's important to understand that your health insurance company isn't just giving you free money.
When a health insurer pays for bills related to an accident caused by someone else, they usually have the right to be paid back. This is called "subrogation," and it often involves placing a medical lien on your personal injury case.
Here’s a simple breakdown of how it works:
- You are treated for your pedestrian accident injuries.
- After your PIP is used up, your health insurance company pays the remaining hospital and doctor bills.
- Your personal injury lawyer successfully negotiates a settlement with the at-fault driver’s insurance company.
- Before you receive your money, a portion of the settlement is used to reimburse your health insurance company for the bills it paid.
An experienced personal injury attorney can often negotiate with the health insurance company to reduce the amount of the lien. This means you get to keep a larger portion of your settlement to help with your recovery and other life needs.
What if the Driver Has No Insurance or Fled the Scene?
One of the most distressing scenarios is being injured by a driver who is uninsured or who leaves the scene of the accident (a hit-and-run). In these situations, you may feel like you have no options for covering your extensive medical bills. This is where Uninsured/Underinsured Motorist (UM/UIM) coverage becomes incredibly valuable.
UM/UIM is an optional form of insurance you can purchase for your own auto policy. It is designed specifically to protect you if you are injured by:
- A driver who has no Bodily Injury Liability (BIL) insurance.
- A driver who has BIL insurance, but their policy limits are too low to cover all of your damages.
- A hit-and-run driver who is never identified.
Having UM/UIM coverage acts as a safety net, allowing you to file a claim with your own insurance company to cover the medical costs and other losses that the at-fault driver should have paid for.
If you find yourself in this situation, it is important to act quickly. Report the hit-and-run to the police immediately and notify your insurance company about the accident to begin the UM/UIM claim process.
Types of Compensation Available in a Pedestrian Accident Claim
When you pursue a personal injury claim, the goal is to obtain compensation that covers all of your losses—not just the medical bills that have already piled up. A serious injury can affect your ability to work, your emotional well-being, and your enjoyment of daily activities. The compensation, legally referred to as "damages," is intended to help make you whole again.
Damages in a pedestrian accident case are typically broken down into two main categories:
- Economic Damages: These are the tangible financial losses that can be calculated and proven with receipts, bills, and pay stubs. They include things like all past and future medical expenses, lost wages from being unable to work, and any reduction in your future earning capacity if you are left with a long-term disability.
- Non-Economic Damages: These are the intangible losses related to the impact the injury has had on your life. While they don't have a specific price tag, they are very real and significant. They include compensation for your physical pain and suffering, emotional distress and mental anguish, and loss of enjoyment of life.
A thorough legal claim will account for all of these damages to reflect the full impact the accident has had on you and your family. An experienced Coral Gables pedestrian accident attorney can help calculate these losses, including projecting future medical needs and the long-term effects on your career and quality of life.
Medical Expenses from a Pedestrian Accident FAQs
We understand you likely have many more questions about your situation. Here are answers to some common concerns people have after being injured as a pedestrian.
What if I was hit by a car but don't own a vehicle, so I don't have PIP insurance?
If you don't have your own auto insurance policy, you may still be covered by PIP. Florida's system allows you to seek PIP benefits from the insurance policy of a relative you live with. If that's not an option, you can file a claim for PIP benefits through the at-fault driver’s insurance policy.
How long do I have to file a lawsuit for a pedestrian accident in Florida?
Florida has a strict deadline, known as the statute of limitations, for filing personal injury lawsuits. For most negligence cases, including car and pedestrian accidents, a lawsuit must be filed within two years from the date of the accident. If you miss this deadline, you will likely lose your right to seek compensation in court.
Does it matter if the accident happened in a parking lot instead of on a public road?
No, the same general rules of negligence and insurance coverage apply whether you were hit in a crosswalk on a busy Port St. Lucie boulevard or in a shopping center parking lot. Drivers have a duty to operate their vehicles safely and watch for pedestrians in all locations.
Should I give a recorded statement to the at-fault driver's insurance adjuster?
It is generally not advisable to give a recorded statement to the other driver's insurance company without first consulting with an attorney. Insurance adjusters are trained to ask questions in a way that may get you to say something that could be used to minimize your claim or shift blame to you. A lawyer can handle communications with the insurance company on your behalf.
What if I was hit by a government vehicle, like a city bus or a police car?
Claims against government entities in Florida are more complex and have different rules and shorter deadlines. You must provide formal written notice of your claim to the correct government agency within a specific time frame. Due to these complexities, it is highly recommended to seek legal guidance immediately if you were injured by a government vehicle.
We Can Help You Seek the Compensation You Deserve
Dealing with insurance companies and the legal system can be frustrating. At Frankl Kominsky Injury Lawyers, our attorneys are committed to providing diligent legal representation and personalized client service. We have a record of accomplishment helping people across South Florida pursue the compensation they need to move forward after a serious accident.
Wondering if you really need a pedestrian accident attorney? This quick read explains when legal help matters most.
Our experienced trial advocates can protect your rights, gather the necessary evidence, and build a strong case on your behalf. We serve clients in Boynton Beach, Pompano Beach, Port St. Lucie, and throughout the region. We are ready to handle negotiations with insurance companies and, if needed, take your case to court. For a free, no-obligation consultation to discuss your case, contact us today.
