Insurance Coverage and the Ever-Present Risk vs. Reward Formula

So, the main question at hand; Is the reward of not having the proper coverage / any coverage worth the risk?

A case came into the office that was a real eye opener for me and the patient. I learned something that day and I would like to use this situation and the suffering it produced to be used as, dare I say, a teachable moment. Ms. Jones walked into the clinic stating that she was involved in an automobile accident and sustained injuries. She also let us know that the primary holder of the insurance policy canceled her as a driver on the policy 3 days prior to the accident without her knowledge. She called her insurance company and they said that there is nothing they could do for her being she was not covered under the policy at the time of the accident. Ms. Jones then retained legal counsel and wanted to move forward with medical care related to the injuries sustained in the accident. Unfortunately, this is not an uncommon scenario and we will revisit the different paths this could take depending on driver fault.

Ok, Ms. Jones has had a few visits to the clinic by now and we received a call from her attorney’s office who brought us up-to-speed concerning the recent plaintiff-harming case law developments that pertain directly to her situation. In a nutshell if you are a driver in the State of Florida, as of this writing (2017), you are required to have $10,000 personal injury protection (PIP) coverage as part of the policy. If you are a driver without insurance and therefore without the PIP coverage, attempt to receive medical treatment along with an insurance settlement, the first $10,000 of the settlement will be withheld (set off) due to the PIP requirement not being adhered to. In other words, as an uninsured driver in the State of Florida that requires, by law, each driver to have coverage will be penalized if their situation becomes a medico legal case with settlement. For example, Ms. Jones files a demand with the insurance company and has a favorable settlement of $15,000. Due to her not having a valid policy at the time of injury there will be a $10,000 penalty assessed and her settlement amount is now $5,000. Big difference here people…

Here are a few excerpts from case law that is used as the standard which opinions are based:

“We will pay benefits under this coverage only over and above any personal injury protection benefits that are paid or payable for the bodily injury under this or any policy, or would be payable except for a deductible.”

“An owner of a motor vehicle with respect to which security is required by this section who fails to have such security in effect at the time of an accident .. shall be personally liable for the payment of PIP benefits under section 627.736. With respect to such benefits, such an owner shall have all the rights and obligations of an insurer in sections 627.730-627.741.”

I’m not an attorney but this is not favorable to the uninsured individual!

The basic math that results from not wanting to pay the monthly insurance premium for most uninsured drivers will never add up. Of course, there are outlying situations, as in Ms. Jones’s case. But by and large these drivers are breaking the law and now this is a way for the courts, and insurance companies to penalize the injured parties when in the past this was never the case. An uninsured driver that was hit by another person and therefore was not at fault was not penalized in anyway. Those days are over for the most part. The savings of not paying the monthly premium does not add up favorably in Ms. Jones’s case as there are numerous plans available that are under $100 / month. Premium cost of $100/month and a penalty of $10,000 equates to 8.33 years of premiums… This makes zero sense from a basic financial standpoint, forget about the legal and general responsibility issues that accompany such behavior.

What can we learn from the suffering of Ms. Jones?

That this can happen to anyone and it is preferable to arrange with the insurance company that you are looked at as a primary driver and absolutely no modifications to the policy can be made without your express notice and/or blessing.

If you are an uninsured driver you are a ticking financial time bomb as this behavior is not worth it in the long run. Please call an independent insurance agent now and get the proper coverages.

Now, let’s flip the script so to speak.

Ms. Jones is now the at fault party and she was injured by the motor vehicle accident. She has no recourse for affordable medical treatment being she does not have the necessary pip coverage. She may have a commercially available insurance policy (Aetna, Blue Cross and Blue Shield, United Healthcare, Humana, Cigna etc…) but her deductible, co-payments, co-insurance and any potential treatment limitations / caps will apply. This makes the average medically-necessary rehabilitation treatment protocol prohibitively unaffordable for most people. Also in this scenario with Ms. Jones being the at-fault party, what if the occupants of the vehicle she impacted sustained injury and they retained legal counsel? Her personal assets are now in-play. This can be even more costly than her mounting medical bills by a large margin. Never mind the sense of guilt that will inevitably be felt by injuring others in a negligent way and then not being able to offer payment for the mess you have caused. This is wrong on numerous levels.

As you can see it’s not just your civic duty to operate a motor vehicle in a legal way but it’s just the responsible, right-thing-to-do.

I hope this helps inform you of the potential pit falls of being an uninsured motorist and the pitfalls of being injured by an uninsured motorist. They are out there, unfortunately.

This article is purely for educational purposes and should be treated as such. If you have questions concerning insurance policies, you need to call a Florida Licensed insurance agent or go to The Office of Insurance Regulation at http://www.floir.com/ for the proper advice as they will have the final word as it relates to insurance matters.

Thank you

Dr. Adam Zeccardi DC, FIAMA