AUTO ACCIDENTS
Q: What is "PIP"?
A: "PIP" is an abbreviation for Personal Injury Protection. It is the PIP coverage of your automobile insurance that pays for your own medical bills, regardless of who was at fault for causing the car accident.
Q: What is liability coverage?
A: Liability coverage is the portion of your automobile insurance that protects you if another driver or a pedestrian makes a claim against you as a result of a car accident.
Q: What is the limitation on lawsuit threshold?
A: This feature restricts your right to sue for pain and suffering. If your policy has this threshold, in order to sue successfully for pain and suffering, your injury must fit within one of the categories of injury: (1) death; (2) dismemberment; (3) significant disfigurement or scarring; or (4) "Permanent Injury", which is defined to mean that the body organ or part has not healed to normal function and will not heal to normal function with further medical care. A certification by a doctor as to permanency is usually required.
Q: The adjuster for the other driver keeps calling me at home? What should I do?
A: Don’t talk to an adjuster until you speak to us. Keep in mind the adjuster works for the other driver’s insurance company. Their job is to pay you no money at all or as little as possible.
Q: "What do I do at the scene of an accident?"
A: You need to file an accident report. Florida state law requires you to file an accident report if an accident has resulted in personal injury, death or property damage exceeding $200. Filing a report can take place immediately or within 30 days of the accident depending upon the extent of the damage. You should always stay at the scene of the accident to report what happened.
Q: "I have auto insurance so why won't the insurance company take care
of all of the expenditures?"A: If you are a Florida resident, you should have PIP (Personal Injury Protection) or no-fault coverage. This insurance should cover expenditures whether or not the person seeking benefits is at fault. You may have a deductible associated with your PIP coverage, but after that, you can expect the insurance company to pay at least 80% of your accident related bills and 60% of your lost wages up to $10,000.
In the case of a catastrophic accident with a large amount of expenses, uninsured/underinsured motorist coverage is critical. Oftentimes, when purchasing insurance, consumers are not aware of the importance of this part of the coverage. If you are involved in an accident with an individual who does not have any or insufficient insurance coverage, the uninsured/underinsured coverage would step in to help make up the difference.
Q: "How much will I receive for my case?"
A: There are many factors in determining the worth of your case including: past medical bills, future medical bills, past lost wages, loss of earning capacity in the future, pain and suffering, emotional distress, loss of enjoyment of life, and others. This must all be considered against factors such as who was at fault and whether or not the doctors will testify your injuries suffered are specifically related to the accident versus a reoccurrence of an earlier injury. It is difficult to give an exact dollar figure to your case until all of the facts are reviewed and considered. However, an initial review could provide an estimate based on what you tell us about your case.
Q: "What will it cost me to pursue my case?"
A: If the case settles before filing a suit and receipt of an answer, our firm would receive a fee of 33 1/3%. If the case should proceed from pre-suit to suit and you recover, then our firm would receive a fee of 40%. If you are unable to recover any financial award, we do not collect a fee.
Q: "Why does a case go to trial?"
A: Insurance companies are very aggressive when it comes to protecting their assets. These companies are in business for a profit, and their responsibility is to their shareholders, not you. Therefore, they will make it more difficult for an individual to receive payouts by litigating the case. Litigation can result in going to court, although often, the insurer will wind up settling the case before getting to court. It is a method of dragging out the process and making things more difficult for the plaintiff.
Q: "What is maximum medical improvement (MMI) and a permanent
impairment rating?"
A: Maximum Medical Improvement is defined as the point in your treatment where the doctor determines that further recovery is not anticipated. Essentially, at that time your treatment shifts from rehabilitative treatment to palliative care. In the case where a permanent injury has occurred, the insurance company wants to know, after receiving maximum medical improvement, what is the permanent impairment rating as determined by your physician? When determining this rating, the physician is required to use guidelines established by the American Medical Association. Essentially, the impairment rating is a basis for evaluation by the insurance company.
Q: "How do I pay for my treatments while awaiting any financial
recovery?"
A: In the event the insurance coverage is fully exhausted, a physician may accept a "letter of protection." Given the medical facility or treating physician accepts it, this allows you to continue receiving treatment until you receive a recovery for your case. Their bills will then be paid out of the amount you receive upon resolving your case.
Q: "How long will my case take?"
A: While every case is different, a typical auto accident case can take from four to eight months to resolve. A case may take longer where ongoing medical treatment is needed to determine the full extent of the client's injuries and needs for recovery. Obviously, it is important to know the full extent of the damages before a demand for damages is made. This process allows us to ensure an adequate demand for damages is made.
Workers' Compensation Frequently Asked Questions
Q: I was injured on the job and my employer and the insurance carrier have denied my claim for workers' compensation benefits. Do I need legal representation to get my benefits? What should I do?
A: You should get legal representation to file a claim. Mike Winer can help you. Call our Office at (813) 224-0000 and a Workers' Compensation Specialist can assist you in filing a Petition for Benefits.
Q: Do I have to pay any of my medical costs?
A: No. If you receive a bill from an authorized physician you should send it to your employer's insurance carrier. Your employer must furnish medically necessary remedial treatment, care, and attendance required by the injury. If you were injured on or after 01/01/1994, you must pay a $10 co-payment per visit for treatment after you reach overall maximum medical improvement as determined by your physician.
Q: If my injury causes me to lose time from work, will I be paid for the wages I lose?
A: Your employer's insurance carrier is not obligated to pay for the first 7 days of disability you lose from work unless your injury is severe enough that you lose more than 21 days from work. If the injury results in disability and time lost of more than 21 days, a portion of your lost wages (compensation) will be paid from the first day of the disability. You are entitled to compensation from your employer's insurance carrier for time lost from work for days eight through 20.
Q: How much will my benefit check be?
A: In most cases, your weekly benefit check will be 66-2/3 percent of your average weekly wage earned during the 91 day period immediately preceding the date of your injury, subject to a state maximum. If you worked less than 90% of the 91 day period immediately preceding your accident, the wages of a similar employee in the same employment who has worked substantially the whole 91 day period will be used in making the determination. Workers' compensation benefits are not taxable.
Q: When will I get my first check?
A: The earliest you can expect your check to be mailed is 14 days after your employer has knowledge of your accident and this can only happen if you report your injury to your employer immediately after the injury occurred. If your employer or your employer's insurance carrier initially deny your right to compensation, a Notice of Denial Form DWC-12 must be filed by your employer (or employer's insurance carrier) with the Division within 14 days after it has knowledge of the injury or death. A copy of the Notice of Denial will be sent to you within 14 days of your employer's knowledge of your accident if your claim is being denied.
Q: What can I do if I am not getting my benefit check?
A: Call your employer's insurance carrier first if your check is overdue by more than a week. If you have questions about your claim or do not understand why your benefits have stopped, call the Employee Assistance Office at 1-800-342-1741 and speak to a Workers' Compensation Specialist.
Q: What kinds of medical treatment can I get?
A: Medical treatment required as a result of your injury or illness must be provided by a health care provider approved by your employer or your employer's insurance carrier. Chiropractic visits may be limited. Surgery; hospital care; dental; prescription drugs; braces and crutches; and any other medical supplies ordered must be approved by your authorized treating physician.
Q: Can my employer fire me if I am unable to work because of an injury and receiving workers' compensation benefits?
A: By law, you cannot be fired for filing or attempting to file a workers' compensation claim. However, the law does not require your employer to hold your position for you until you are able to return to work. Call the Employee Assistance Office at 1-800-342-1741 for details.
Q: If I am unable to return to the type of work I did before I was injured, what can I do?
A: Florida Workers' Compensation provides, at no cost to the injured worker, reemployment services to help injured workers return to work. Services include vocational counseling, transferable skills analysis, job seeking skills, job placement, on-the-job training, and formal retraining. To find out more about this program, please contact the Department of Education, Division of Vocational Rehabilitation, Bureau of Rehabilitation and Reemployment Services at (850) 488-3431.
Q: If I am unable to return to work until my doctor releases me, does my employer have to hold my job for me?
A: If your employer has more than 50 employees, the law states that your employer is obligated to make available to you, within a 100 mile radius of your residence, work appropriate to your physical limitations within 30 days after the carrier notifies the employer of maximum medical improvement and the employee's physical limitations, or face a penalty. If holding a job open for an injured worker creates a hardship, the employer may either hire a temporary person or hire someone else. The employer may want to contact his legal representative to ensure that he is not in violation of other applicable law, i.e. Family and Medical Leave Act (FMLA), Americans with Disabilities Act (ADA), etc. Employers with 50 or fewer employees are not obligated to rehire injured workers.
Q: Can I choose my own doctor?
A: If your Employer participated in a managed care agreement, you may choose a physician from a list provided by your employer's insurance carrier or managed care arrangement. If you go to a doctor not authorized by your employer or the insurance carrier, you may be responsible for payment of your medical bills.
Q: When should a claim be reported to the insurance carrier?
A: In the event of a medical only or lost time case (where the injured worker loses more than 7 days of work), the employer has 7 calendar days from his knowledge of the injury to submit the First Report of Injury or Illness Form DWC-1 to the insurance carrier. The carrier must submit the First Report of Injury or Illness to the Division on lost time cases within 14 days of the carrier's receipt.
Q: My employer will not report my injury. What can I do?
A: Within 7 calendar days after the employer's actual knowledge of the injury, the employer must file the First Report of Injury or Illness Form DWC-1 to the carrier. If the employer refuses to complete the DWC-1, the injured worker should contact the Bureau of Compliance at (850)488-2333 to obtain information about the employer's insurance carrier and then telephone the insurance carrier to report the injury over the telephone. Another option for you would be to call the Employee Assistance Office at 1-800-342-1741. Personnel at this toll-free number will intervene on your behalf.
Q: How long after an accident do I have to report it to my employer?
A: An employee who suffers an injury arising out of and in the course of employment shall advise his employer of the injury within 30 days after the date of or initial manifestation of the injury. Failure to so advise the employer shall bar a petition under the workers' compensation law, unless certain circumstances apply.
Q: What is the time limit for filing a Petition for Benefits?
A: Except in certain situations, all injured worker Petitions for Benefits must be filed within two years of the date of injury or death. For dates of accident on or after 01/01/1994, if there is payment of any indemnity benefit or furnishing of remedial treatment, the limitation period to file the Petition for Benefits is one year from such payment or treatment.
Q: How long can I receive temporary total/partial disability benefits?
A: In cases where the injured worker can do no work whatsoever for a temporary time period, 66-2/3 percent of his average weekly wage will be paid for a period not to exceed 104 weeks for dates of accident occurring on or after 01/01/1994.
Q: Can I receive social security benefits and workers' compensation benefits at the same time?
A: If you were injured before 01/01/1994 and you are receiving wage loss benefits and regular social security retirement benefits, your social security retirement benefits are primary. The total amount of your wage loss benefits and the social security benefits cannot exceed the amount of wage loss benefits which would otherwise be payable. Combined benefits cannot exceed 66-2/3 percent of the employee's average weekly wage.
Q: Can I receive unemployment compensation and workers' compensation benefits at the same time?
A: Workers' compensation benefits will not be payable for temporary total disability for any week in which the injured worker has received unemployment compensation. You must be medically unable to work to receive temporary total disability benefits. To receive unemployment compensation, you must be available and able to work. If the injured worker is entitled to temporary partial benefits, unemployment compensation could be due and would serve as the primary compensation. Additionally, the sum of the two benefits may not exceed the amount of the temporary partial benefits for which the injured worker is entitled.
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