Legislating in the Dark: How New NCCI Worker’s Compensation Legislation May Affect Your Premiums

In September of 2016, the National Council on Compensation Insurance (NCCI) requested that the Florida Office of Insurance Regulation (OIR) allow them to increase the cost of worker’s compensation coverage by 19.6%. Though the initial requested increase was denied for being too high, OIR still approved a rate increase of 14.5%.

No one likes to hear about insurance rate increases, but this one is particularly sinister. The increase, which was supposed to go into effect on December 1, 2016, was created under dubious circumstances, allegedly breaking Florida’s Sunshine Law. Because of this lawbreaking—and the outlandish rate increase—attorneys and groups in Florida are fighting this resolution.

concerned woman
 

Background

To understand this case, let us give you a little bit of background information on the two organizations involved in the ruling and what has been going on in Florida courts.

NCCI

The NCCI is a not for profit organization that collects and organizes data relating to insurance, with a particular emphasis on workers’ compensation. Owned by its member insurers, the NCCI advocates for insurance companies and their interests.

OIR

The OIR is responsible to regulate insurance companies and enforce Florida laws relating to insurance companies. It also collects and distributes data about insurance for consumers, insurance companies, and employers to use for their information.

Recent Florida Supreme Court Activity

The biggest influence on the NCCI rate hike were two recent Florida Supreme Court rulings: Castellanos v. Next Door Company and Westphal v. City of St. Petersburg.

In Castellanos v. Next Door Company, the court found Section 440.34, Florida Statutes, unconstitutional, because it set out mandatory attorney fees. Now, attorneys are not limited to the amount of money they can collect on a worker’s compensation case, which critics say will result in more cases going to court.

In Westphal v. City of St. Petersburg, the court found Section 440.15(2)(a), Florida Statues, unconstitutional as well. That statute, which went into effect in 1994, put a 104 week limitation on temporary total disability benefits in workers’ compensation cases. This limitation caused a gap in benefits for people injured on the job, which violated the injured person’s constitutional access to the courts. The limitation is now 260 weeks, which is what it was prior to the 1994 change.

Breaking the Law

The rate increase will put strain on business owners in Florida, who will be forced to pay higher premiums to cover their employees’ worker’s comp. Called a “money grab” by attorneys, the rate increase is essentially designed to protect insurance companies from having to cover their customers.

To make matters even worse, in order to pass the rate increase, the NCCI and OIR broke Florida’s Sunshine Law while they were negotiating the increase.

The Sunshine Law requires that all laws are passed in “sunshine,” that is to say, out in the open. Under this law, Florida has prohibited backroom dealings in lawmaking. Miami attorney for injured workers, James Fee, challenged the rate increase as soon as it was approved in September, saying that NCCI and OIR held, “multiple, non-public, secret meetings.”

Indeed, there was only one public meeting held with regard to this huge rate increase, and there is evidence of several internal meetings at NCCI—and even some illegal meetings between NCCI and OIR—for which no minutes were kept.

In November, Florida judge Karen Gievers agreed that there was evidence of these secret meetings, and put a hold on the increase.

Appealing the Hold

Within five days of Judge Gievers placing a hold on the rate increase, OIR filed an appeal. Both organizations insist that they were in compliance with the Sunshine Law, and both are “disappointed with [the court’s] ruling.” The case is now waiting to go to the Florida Supreme Court, where a final decision will be made.

Put simply, this rate increase is bad for workers and businesses, but good for insurance companies. The alleged violation of the Sunshine Law sheds a bad light on NCCI and OIR, who are letting insurance companies’ interests get in the way of what is best for Florida.

Check out our practice areas—Chuck Smith is an experienced and accomplished worker’s comp attorney, and he can advise you on all matters relating to worker’s compensation and how this court case may affect you.

Sources

  1. http://www.insurancejournal.com/news/southeast/2016/09/27/427642.htm
  2. http://www.orlandosentinel.com/business/brinkmann-on-business/os-workers-comp-jump-20160531-story.html
  3. http://www.insurancejournal.com/news/southeast/2016/11/27/433200.htm
  4. http://www.insurancejournal.com/news/southeast/2016/11/29/433411.htm
  5. http://www.politico.com/states/florida/story/2016/11/comp-ruling-sends-business-107604

Understanding Jones Act Claims: Answers to 5 Frequently Asked Questions

Many people are unaware that a specific set of rules apply to maritime employees when they suffer accidents with injuries on the job. Unlike state worker’s compensation claims, employee maritime injuries are covered in part under a federal law called the Jones Act.

The Jones Act helps protects workers injured at sea. Sailors and crew members who are injured or taken ill at sea can receive compensation, maintenance and cure benefits from their employers to cover lost wages, medical expenses, damages, and more. Read this blog to learn the answers to 5 of the most commonly asked questions about the Jones Act.

faq

How Do Jones Act Claims Differ from Typical Worker’s Compensation Claims?

Worker’s compensation is a standard benefit that most employers are required to have for their employees to provide compensation for medical care and lost wages resulting from workplace injuries. Under the Jones Act, maritime workers are also protected for injury or illness incurred, but the available damages available can be much greater.

Because of the Jones Act—and the related Admiralty Laws—maritime employers have greater liability to their employees for causing injuries and their resulting damages. In addition to maintenance and cure, employers or ship owners can be held liable for pain and suffering and other damages if the injury was caused by unseaworthiness or risky/carless behavior by the employer, captain, or coworker, or if the conditions of the vessel are found to be unsafe. This makes it easier to prove general negligence on the part of the employer.

What Qualifications Must I Meet?

One limitation of the Jones Act benefits is that only seamen (also referred to as crew members) qualify for all of these benefits. Based upon years of litigation by maritime attorneys over the years, the Courts have come up with these criteria to define seamen:

  • Someone who is assigned to a vessel or fleet of vessels that works in waters that can be used in interstate or foreign commerce
  • Someone whose work is relevant for the ship’s purpose (i.e. not a passenger but can include all types of employment)
  • Someone who spends 30% of work time on the ship (this is a rule of thumb, but it not completely binding)

Qualifying as a seaman is essential to file a Jones Act claim, and an experienced maritime attorney will be able to tell you if you qualify. For example, the 30% rule is not so much a rule as a guideline, and an attorney who is experienced in Maritime Law and Jones Act worker’s compensation can tell you if you have a case.

How Do Negligence Lawsuits Fit In?

Because of the Jones Act, maritime workers can sue their employers for negligence. Seamen injured on the job can receive more compensation by proving negligence, which holds employers more fully accountable for their employees. In comparison, most State and Federal worker’s compensation statutes do not allow employees to receive damages for pain and suffering and for many other types or damages, future damages, and impairments which often occur.

Establishing negligence allows the injured seaman to request both economic and non-economic compensation. It included both lost daily living expenses and medical expenses (which you often hear referred to as maintenance and cure), the past and future impairment of your ability to earn wages after the injury, as well as pain and suffering caused by the injury. Non-economic damages can also act to punish employers for, particularly severe negligence.

What Is the Unseaworthiness Doctrine?

In some maritime worker’s compensation claims, the accident or injury occurred because the vessel was not in a condition to be at sea. When the poor condition of the ship is to blame, the “unseaworthiness doctrine” applies. This doctrine states that the owner of the vessel is legally obligated to keep it in good and safe working order, including the proper equipment and a qualified crew. If any of these things are missing and a crew member gets injured, the owner of the vessel is responsible and the victim may be able to receive the same damages as a negligence lawsuit. This is similar to a negligence inquiry, but there are important distinctions which a qualified attorney can help explain to you.

How long do I have to file a lawsuit?

A statute of limitations limits the period of time during which you can begin or file a lawsuit. After the running of a statute of limitations (often abbreviated SOL for two reasons), you can be barred as a matter of law from bringing claims for damages from your accident. In more simple terms, if you are more than three years from your date of accident and you have not filed a lawsuit, you may be SOL.

The normal statute of limitations under the Jones Act is three years from the date of the incident or accident. If you are more than three years from the date of your incident and have not filed suit in Court, your claims for Jones Act damages will likely to be barred as a matter of law. There are some exceptions to this general rule (and the SOL is shorter for individuals injured on a U.S. government-owned vessel), but it is always a good idea to speak to a qualified attorney well in advance of the three year anniversary of your accident. You should note that unlike many State workers’ compensation statutes, the payment by your employer of maintenance and cure (living expenses and medical expenses through maximum medical improvement) do not toll or extend the statute of limitations time period.

Maritime law and the Jones Act claims are complicated legal matters that are best left up to attorneys who have studied and practiced in those areas of law. If you have a Jones Act claim, you should speak to an attorney experienced in maritime law to help you navigate your claim.

Contact C.W. Smith P.A. for help with your Jones Act Claim. Mr. Smith can help you determine if you should file a negligence lawsuit, and help you along every step of the process.

When Should You Hire an Insurance Attorney? Learn from These 3 Tips

When you file an insurance claim, you trust that your insurance company will take care of your damages and needs. After all, that is the contract you entered into with them: that you would pay your premiums and they would help you when a catastrophe occurred. Unfortunately, it doesn’t always happen this way. Insurance companies are in the business of making money and generally want to pay out the least amount of money possible, which means sometimes you have to fight for the payout to which you are entitled.

If your insurance company is denying your claim, and you feel they are wrong in doing so, you should always get advice from someone who knows and can advise you of your rights. When insurance companies delay, deny or “low ball” legitimate insurance claims, attorneys need to get involved in setting things right.

In situations like these, the best course of action is to hire an insurance attorney. An attorney who has experience working on and, if needed, litigating insurance claims and who can help you get the benefits you need. Check out our three tips for hiring an insurance attorney in claims being made against your own insurance company (this advice does not apply to claims made against others for which they held insurance).

insurance attorney

#1 Try to Make Progress Before Formally Hiring an Attorney

Initially, you can communicate with your insurance company before formally hiring an attorney, including completing a written proof of claim and making sure all forms required have been signed and returned. The types of forms, proofs of claims and releases which insurance companies require vary depending upon the insurance company involved, the type of claim involved and the extent of coverage that you purchased. You should note that some insurance companies require written “proof of claims” to be submitted as required in their policies, but will not request one from you or even advise you of that requirement.

To make sure you have properly completed all required forms in order to prevent your claim from being denied, it is a good idea to speak initially with an insurance attorney to discuss your required actions under your policy, which are often called “conditions precedent” to coverage. That way, you do not run the risk of voiding or losing coverage for failing to cooperate with your insurance company. In many cases, your insurance company is trying to give you a fair payout while still maintaining its own financial interests. If you are communicating with your insurance company respectfully but assertively, you are making progress, and you have made sure that you have taken all actions to protect your rights (including having a free consultation with an insurance attorney), then there may be no need to formally hire an attorney.

That being said, if your polite but firm communications are being ignored, if your insurance company is being unprofessional and obstinate, or if they have denied or “low balled” an offer to you, you will likely need to formally involve an attorney. In addition, if the process is taking too long or you are becoming too frustrated to deal with it on your own, an experienced attorney can take over for you.

#2 Start by Getting Advice

Attorney fees can be expensive when you are paying them, and not all attorneys provide free consultations or contingent representation, so be sure to confirm that your initial consultation with your attorney will be free of charge. Most insurance attorneys, including Chuck Smith, will speak with you initially regarding your insurance claims under Florida law to discuss your claim in general, your responsibilities and what you will need to do to “perfect the claim” in an initial free consultation.

Mr. Smith represents most clients in Florida insurance claims on a contingency basis, with no attorney fees being paid up front or paid at all unless a recovery or judgment is obtained. He can let you know if such representation would be possible on your claim after the initial free consultation and can further discuss your options. Additionally, meeting with an attorney to go over your claim and to learn your rights may be enough to get your situation resolved. An insurance attorney can give you advice on how to proceed without ever communicating with your insurer directly.

It is especially useful to get advice from an experienced attorney if you are trying to avoid litigation. Certainly not every insurance case needs to be resolved in court, and you can expedite your resolution by taking a knowledgeable attorney’s advice. In cases in which you do need to sue your insurance company, you will still often need the assistance of a professional and experienced attorney to plead your case. You should also know that under Florida law if a suit is filed then you can get your own attorney fees paid directly by your insurance company if you are successful in securing additional benefits or rights in your claim. This is under Florida Statute Section 627.428.

#3 Choose Carefully

If you reach the point in your claim where you conclude that you are going to have to sue your insurance company to get the payout you deserve, choose your attorney carefully. Make sure that you research insurance attorneys in your area, get referrals from friends and loved ones when possible, and find the right professional to help you. Make sure that you understand your fee arrangements upfront with your attorney and that you are comfortable with the same.

Taking your insurance company to court can be a stressful and time-consuming experience, so do your research to find an attorney with experience in insurance claims. Indeed, make sure to read reviews and look at your prospective attorney’s record with cases like yours.

If you are looking for an experienced and compassionate insurance attorney in Orlando or anywhere in Central Florida, enlist the help of C.W. Smith, P.A. Working with our firm will mean that you work one-on-one with Mr. Smith himself, benefiting from his years of experience with difficult insurance cases like yours.

Please contact us to get started!

Workers’ Compensation Part 2: What You Need to Know About Lost Wages and Indemnity

Workers’ comp is an extensive subject with many rules, guidelines, and best practices. Because there is so much involved, we have decided to do a two-part series about the two main categories: medical benefits and lost wages or indemnity benefits. This is second first part of the series, covering lost wages and indemnity. You can find the first part of the series, covering medical benefits, here.

As we mentioned in part one, workers’ compensation is a form of insurance that employers with more than four employees must have. Workers’ compensation, or workers’ comp, replaces wages and provides medical benefits to employees who are injured at work. If you have been injured at work, you may be eligible for workers’ compensation. Keep reading to learn what you need to know about lost wages and indemnity.

Workers Compensation claims

How Are Benefits Determined?

To determine how much you qualify for, your employer will look at your average weekly wage, or AWW, for the last thirteen weeks before your injury. The AWW usually includes the wages from your employer and from any concurrent jobs that you hold that you will not be able to work during your recovery period. Lost wages are paid through temporary disability or permanent disability.

Temporary Disability

Temporary disability falls under three categories under the law: temporary total disability (TTD), temporary partial disability (TPD), and retraining temporary total disability benefits.

Regardless of which category of temporary disability you fall under, you are only eligible to be paid for the first seven days that you are out of work if you miss working for more than twenty-one days. Otherwise, you will not be paid temporary disability for the first seven days of work that you missed.

Disability is only paid if your doctor orders that you reduce or limit your work. In order to receive disability payments, you must provide proof of your doctor’s restrictions to your employer. Also, note that TTD and TPD are payable for 104 weeks or if you have reached MMI—maximum medical improvement. There is currently a case in the Florida Supreme Court that may extend partial disability past 104 weeks, depending on the verdict.

  • Temporary Total Disability (TTD)

If your injuries are severe enough that your doctor orders you not to work at all, then you will be eligible to receive TTD. TTD benefits are paid at 66 2/3% of your average weekly wage. You may not work and receive TTD benefits, as that is criminal workers’ compensation fraud.

  • Temporary Partial Disability (TPD)

Injuries that result in TPD are generally less severe than those that result in TTD. In order to qualify for TPD, your physician must have given you physical restrictions that prevent you from doing some of your work, and therefore keep you from earning 80% or more of your average weekly wage.

Because you can still perform some work, just not work that can exacerbate your injury, your employer may offer you lighter work. If you turn down replacement work, you may not receive TPD benefits. If you are offered light work, speak with an attorney to understand your options.

TPD is paid at 64% of your AWW if you are not working. If you are working and earning some wages, but less than the required 80% of your AWW, then your TPD benefits will be figured by taking your gross earnings from 80% of your AWW, then multiplying that number by 80%.

Once you are placed at MMI by your doctors and given permanent restrictions, you may qualify for retraining through the Division of Workers’ Compensation. If you qualify for such retraining, then you are supposed to be paid TTD wages while going to school/retraining, but that program is underfunded and many deserving individuals do not qualify. The retraining TTD benefits are also currently subject to the 104-week cap on temporary benefits.

  • Retraining TTD

Once you have reached MMI or exceeded the 104 weeks of disability benefits and you still cannot work your previous job, you may be able to receive retraining from the Division of Workers’ Compensation. In cases in which you qualify for retraining, you will be paid TTD benefits—remember, this is 80% of your AWW—for the duration of your training or up to 104 weeks.

Retraining is a poorly funded program, so it is difficult to qualify for this benefit. As always, speak with an attorney to discuss filing for retraining TDD.

Permanent Disability

If retraining is not an option, and you have reached MMI and received benefits for the maximum 104 weeks of temporary disability, you may qualify for permanent disability. There are two kinds of permanent disability—impairment benefits and permanent total disability benefits—and depending on your situation, you may qualify for one of them.

  • Impairment Benefits

If your injury or accident has left you with a permanent impairment, you may be entitled to impairment benefits. This is a highly variable benefit which requires your physician to give you a permanent impairment rating. Your rating will determine how much you get paid (once again based on your AWW), and for how many weeks you receive payment.

Once you qualify for impairment benefits, you will receive them regardless of whether you are working. If you are employed and making as much or more than you made before, impairment benefits are paid at 33 1/3% of your AWW. If you are making less than you did before your injury, your benefits can be paid at 50% of your AWW.

Permanent Total Disability (PTD) Benefits

If the work restrictions given by your doctor are particularly severe when you have reached MMI, you may be eligible for permanent total disability (PTD) benefits. In order to qualify for these benefits, you must prove that you cannot work within 50 miles of your home under the restrictions set forth by your doctor.

In order to prove this, generally, you have to show a long and unsuccessful job search. You must be unable to find work, even part-time sedentary work, after a search of at least six months.

Workers’ compensation is a huge and complex issue that is difficult for many to grasp. There are so many facets of this coverage that many people do not know where to begin. If you think you should receive workers’ compensation, or that you are eligible for disability benefits, then contact C.W. Smith, Public Attorney, to find out what you are entitled to.

Workers’ Compensation Part 1: What You Need to Know about Medical Benefits

Workers’ compensation, or workers’ comp, is a form of insurance that all employers with four or more employees or that work in construction must have. Workers’ compensation provides wage replacement and medical benefits to employees who are injured at work or because of work. If you are injured at work—or sustain certain repetitive injuries because of your work—you are likely entitled to workers’ compensation.

Workers’ comp is an extensive subject with many rules, guidelines, and best practices. Because there is so much involved, we have decided to do a two-part series about the two main aspects of workers’ comp: medical benefits and lost wages or indemnity benefits. This is the first part of the series, covering medical benefits.

As the name suggests, medical benefits cover doctor’s care, prescriptions, surgeries, and other medical procedures. Before you start seeing a doctor, make sure to follow the right steps or your care might not be covered. In fact, in order to ensure that you are covered under workers’ comp, make sure to follow these five guidelines.

workers' compensation
 

Go to an Authorized Doctor

Once you have requested medical care—which you must do within thirty days or your claim may be denied because of untimely reporting—your employer must authorize a doctor or medical care provider for you. It is imperative that you go to a doctor who is within your employer’s network or your care will not be covered.

Under the law, employers are not required to pay for medical care—except in cases of emergency care—that was not authorized by them ahead of time. Going to a doctor that was not approved by your employer will mean that you do not receive coverage, and testimony from an unauthorized doctor will not hold up in court.

Avoid “Doctor Shopping”

In some cases, an insurance agent or employer who is unhappy with your doctor’s opinion will try to coerce you into seeking other opinions, or “doctor shopping.” This is not allowed in most cases and you are within your rights to refuse.

In fact, you should not see another doctor or medical caregiver without clearing it with an attorney first. The exception to this would be if your doctor refers you to another doctor—for example if a general practitioner refers you to a surgeon or specialist.

There may be cases in which you may go to another doctor or physician but only do this after discussing it with your attorney. Doing so may cause you to lose your coverage and waive your claim, so make sure to speak to an attorney about it before you do so.

Receive “Reasonably Medically Necessary Care”

Once you have found a doctor, workers’ comp entitles you to coverage for “reasonably medically necessary” care. This means that any medical treatment, service, or supplies that will treat or cure your injury are covered. If you were sick, injured, or had a condition before your workplace accident, you will need to prove that the accident was the major contributing cause (MCC) of the condition and NOT your pre-existing condition.

Workers’ comp will also pay to test for what is known as a “differential diagnosis.” This testing is designed to ensure that the symptoms you are having are not related to your injury, but rather the symptoms are a result of a different condition that may not be work-related.

Understand Maximum Medical Improvement (MMI)

When you are entitled to workers’ comp, your employer will pay for all emergency treatment and authorized medical care necessary to treat your compensable injuries. This includes the following:

  • Doctors
  • Medical facilities
  • Surgery
  • Testing
  • Therapy facilities
  • Prescriptions
  • Orthopedic braces and devices
  • Anything that is medically necessary

It is important to understand that workers’ comp only covers you so far. Maximum Medical Improvement, or MMI, is a medical term that refers to the time in your treatment that further care will aid in your recovery. With some injuries, there comes a point in treatment where the doctors can no longer make improvements to your condition, at which point your employer is no longer required to pay for your care.

Once you reach MMI, you may still visit the doctor or medical professional, but you will have a copay of $10 per visit in order to receive your care.

Forward Medical Bills

If at any point in your treatment you start to receive medical bills, forward them to your attorney immediately. Do not ignore the bills or assume that they are getting paid by your employer’s insurance.

As you can see, workers’ compensation is complex. It is important to follow the rules set forth by the law and your employer in order to receive your benefits.

If you need legal advice on your workers’ compensation claim, contact C.W. Smith, Public Attorney.

Do You Have the Right Automobile Insurance Coverage?

Living in Florida, it is extremely important to have the right automobile insurance coverage to protect you, your loved ones and your property. Florida is in the top five states nationally for uninsured drivers with a recent study showing over 23% of Florida drivers to be uninsured. The percentage of drivers in Florida who do not carry Bodily Injury or “BI” coverage may, however, be much higher as Florida law does not require drivers to carry BI coverage. The minimum coverage required by Florida law to license a vehicle is $10,000.00 in Property Damage coverage and $10,000.00 in Personal Injury Protection or PIP coverage. Some people mistakenly think this is “full coverage”, but this is just the bare bones minimum of auto coverage required. This means that being involved in a motor vehicle collision in Florida, it is highly likely that the at-fault driver will not be carrying enough insurance to cover you and your family for your injuries and damages.

Automobile Insurance Coverage
 

Do You Have the Types of Coverage That You Need?

Now is always a good time to check your insurance coverage on your motor vehicle as changes in coverage do not apply retroactively to prior accidents which have already occurred. You will need the coverage in place before an accident occurs for it to cover an accident. There are many different types of automobile insurance coverage available in Florida and you should be aware of what each of those insurance coverages provides when purchasing or changing your coverage:

  • Minimum Coverage in Florida – The minimum automobile insurance coverage required in Florida is $10,000 in Property Damage (to cover other vehicles and property damaged by your negligent operation of your vehicle) and $10,000 in Personal Injury Protection or PIP coverage. THIS IS NOT FULL COVERAGE but is bare bones coverage which you should only have if you simply cannot afford anything else (and even then is not recommended).
  • Collision Coverage – Collision coverage is the coverage that insures your own vehicle from damage caused by your own fault or by an uninsured or underinsured driver. If you have a loan on your vehicle, this will likely be required by your bank or credit union to make sure that the vehicle you are paying off can be fixed after an accident. Unless your vehicle is worth less than your insurance premium, and you can afford to replace your vehicle, you should be carrying collision coverage for your vehicle. You should not carry a deductible larger than you could afford to pay on short notice to have your vehicle repaired, although raising your deductible will lower your premiums.
  • Comprehensive Coverage – Comprehensive coverage insures your own vehicle for losses other than a motor vehicle collision, such as theft, vandalism, fire, or flood. If you carry comprehensive coverage, windshield damage and replacement without a deductible are included under Florida policies. Unless your vehicle is worth less than your insurance premium, and you can afford to replace your vehicle, you should be carrying comprehensive coverage for your vehicle.
  • Property Damage Coverage usually applies whether you are driving your vehicle or another vehicle and you negligently cause damage to another vehicle or property (not your own vehicle). A minimum of $10,000 is required on Florida policies, but it is recommended that you carry coverage of at least $50,000 per vehicle or $100,000 per accident. With that coverage, you would have up to $50,000 in property damage coverage per vehicle and up to $100,000 per accident (if there were 2 or more other vehicles or buildings involved). More insurance is a good idea if you can afford it – this is just a minimum recommended. Although you should make sure that you have enough insurance coverage, going with only minimal property damage coverage is a bad idea as your license and vehicle title will likely be suspended and other insurance companies will likely take a judgment against you for any additional property damage caused by you for which you did not carry sufficient coverage.
  • GAP Insurance Coverage – GAP coverage is just that; it covers the gap in between the value of your vehicle at the time of a collision and what you still owe on it. Given the significant drop in the value of many vehicles driving them off the car lot, GAP coverage is often a good idea if you are not putting much down on a loan or are “upside-down” or “underwater” on a loan (owing more than the vehicle’s value). Replacement coverage is also often available which would provide enough coverage to buy an equal or better vehicle if your vehicle is totaled, but it is not the same as GAP coverage and can still leave you upside down on a loan.
  • Personal Injury Protection or “PIP” Coverage – Although required by law, there are changes which can be made to the general PIP coverage which you can purchase. The general PIP coverage is for up to $10,000 in related lost wages and reasonable and related medical expenses when an emergency medical condition or EMC exists. This is a combined total of $10,000 and not $10,000 for each and PIP pays at 80% of medical expenses and 60% of lost wages up to that $10,000 total. Many policies now define reasonable as 200% of Medicare rates for medical expenses, but that will depend on the insurance company with whom you shop and their policy language. If no authorized medical doctor has declared an emergency medical condition or EMC from the accident, then PIP can be capped at $2,500 of medical expenses paid by the insurance company but some companies ignore this restriction.
  • 14 Day Treatment Requirement – Please note that if you fail to treat within 14 days of your accident, your insurance company will likely deny PIP payment of your medical bills related to your accident as the statute requires medical treatment within 14 days of the accident.
  • PIP Deductibles – It is still possible to get a $500 to $2,500 deductible on your PIP coverage (meaning that losses must exceed that number before PIP pays anything), but it does not save you much money and is generally a bad idea because it will leave you responsible for those bills up front and can affect your ability to obtain a doctor.
  • Waiver of PIP Wage Loss – You can waive PIP wage loss benefits as part of the coverage, which if you carry short term and long term disability insurance or do not work can reduce the cost of your insurance, but it is otherwise not recommended.
  • Medical Payments or MedPay Coverage – MedPay pays in a supplement to PIP medical payments and if you do not have health insurance it is a good idea to carry $5,000 to $10,000 in MedPay, but be sure to read the fine print on MedPay coverage as it varies from company to company. It is not statutorily required so there can be many limitations placed within the policy on MedPay coverage, including a requirement of an EMC to obtain it. The restrictions placed on MedPay coverage by a few insurance companies make it not worth the expense.
  • Bodily Injury or BI Coverage – BI coverage covers physical injury caused by you or someone driving your vehicle to other people and is actually not required in the State of Florida, except for some drivers who have been convicted of a DUI. As the at-fault driver’s insurance, and to a limited extent the owner of the vehicle’s insurance if different, pays for the damages caused to other individuals due to negligence, it is important to carry sufficient coverage to protect you and your family. Although more coverage is recommended, a minimal amount of BI that should be carried is $50,000 per person and $100,000 per accident. Please note that not carrying any BI coverage is a bad idea because you are likely to face a lawsuit and judgment either from the other driver or their insurance company (if they paid MedPay or UM benefits to their insured and you were at fault for the collision). If you carry BI coverage, you should also be provided with a legal defense to any such lawsuits against you to help protect you, but you will be on your own to hire your own attorney out of pocket if you did not carry BI coverage.
  • Uninsured Motorist or UM / Under-Insured Motorist or UIM Coverage – Although often waived by insured, this is probably the most important (and comparatively cheap) insurance coverages you can purchase as it protects you and your loved ones for injuries and damages caused by uninsured and under-insured motorists. Do not ever waive UM/ UIM coverage! Although more coverage is recommended, a minimal amount of UM/ UIM coverage which should be carried is $100,000 per person and $300,000 per accident.
  • Stacked vs. Unstacked Uninsured/ Under-Insured Motorist Coverage – If you own more than one vehicle insured on the same policy you should request that the coverage is “stacked” which essentially multiplies your coverage available based on the number of vehicles insured.
  • Umbrella Policies – If you have substantial assets or are an individual against whom an attorney might consider taking a judgment against, it is a good idea to carry an umbrella policy as this will help cover you against a potential excess judgment above your BI limits. Umbrella policies are comparatively very cheap and can be purchased to provide excess coverage for potential judgments against you.
  • Accidental Death & Dismemberment Benefits – Is self-explanatory and should be included in your coverage if you can afford it.
  • Towing & Rental Vehicle Coverage – If you are a member of AAA and have extra vehicles at home this might not be an important coverage, but towing and rental costs can add up quickly at a time when you are already potentially out of work and incurring medical expenses. It is recommended.
  • Coverage for Vehicle Owner – Note that if you have a minor or family member driving your vehicle, or loan your vehicle to another to use, then you can be liable for any accidents and damages they cause. Although the limits of the damages you can be responsible for are capped by statute in some circumstances, you should be sure to carry no less than $10,000 in PIP, $50,000/ $100,000 in Property Damages and $100,000/ $300,000 in BI coverage on any such vehicle to better protect yourself.
  • BE SURE to disclose all family members and individuals living in your home or residence to your insurance company and to update them with that information in writing whenever it changes. Some insurance companies look for failures to disclose changes in residents at your residence as a basis to frequently deny claims.

Contact Us

Figuring out the proper motor vehicle insurance coverage for you can be complicated and time-consuming, but it will become a lot more complicated after an accident if you did not get good coverage in the first place. If you are not sure whether your coverage is sufficient, you should ask your agent or insurer for further information. But if you have already been in an accident or become entangled in a legal matter or a dispute with your insurance company, please contact us for the experienced insurance attorney that you need to ensure your rights are protected. Initial phone consultations for Florida personal injury cases and insurance claims are free and most cases can be handled on a contingency.

Uninsured Motorist Provisions, the Forgotten Coverage

Even though car insurance is required by law in every state, that does not mean that every driver is covered equally. In Florida, the minimum insurance coverage required by law does not protect victims injured in accidents.

In fact, Florida law only requires motorists to have personal injury protection and property damage liability insurance. There is no requirement for bodily injury insurance, which covers the people who are not at fault in an accident; although, the state requires that drivers sign a waiver if they do not want uninsured motorist protection.

This means that if you are struck and injured by another driver with the minimum coverage required by law, and you do not have uninsured motorist coverage, you will not have any coverage for your medical expenses except your own health insurance. It is almost as if that person is not insured at all.

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A Cautionary Tale

A few months ago, Chuck met with two high-level professionals—one of whom was a bank executive—who had been injured in an accident. Driving their BMW, they were sideswiped by a young man and collided with a median. The man who hit them immediately drove away, leaving each of these men with extensive back and neck injuries, which caused them to miss work to recover.

These two friends assured Chuck that they had full coverage, and they wanted his help getting what was due to them from their insurance companies. They each had tremendous coverage for everything: $1 million in property damage, $1 million in bodily injury, you name it. But after a quick investigation, Chuck discovered that neither of the men had Uninsured Motorist Coverage because they had waived it.

There was nothing he could do for them.

Uninsured Motorist Insurance—Why You Need It

We call UM insurance the “forgotten coverage” because it so few people has it. It is easy to assume that if you are in a car accident, your medical expenses will be covered by your auto insurance or that of the other driver. This is not always the case because so many Florida motorists are not insured or under-insured.

High Percentage of Uninsured Drivers

According to national data, approximately 13% of drivers were uninsured across the nation in 2012. During that same year, nearly 24% of Florida drivers did not have any car insurance. Florida is second in the country for uninsured, losing out on the first place spot by just two percent.

Because Florida drivers are twice as likely to be uninsured, it is critical to have uninsured motorist coverage. If you are in an accident by a driver who does not have any insurance at all, you will be left without coverage for damages.

Uninsured Motorist or Under-Insured Motorist

In an accident in which the at-fault driver is uninsured, the other driver can be left in the dust. Uninsured motorist (UM) or underinsured Motorist (UIM) coverage solves this problem by covering medical expenses, lost wages, and other costs that the at-fault driver would normally cover.

Bad Drivers Are Rampant

A study found that Florida’s drivers are the sixth worst in the nation. Florida ranked in the bottom half in nearly all the categories in the study, proving how abysmal the drivers are.

Here is where Florida ranked:

  • 51st for careless driving (behind every state AND Washington D.C.)
  • 48th for tickets
  • 38th for failure to obey
  • 33rd for fatalities per 100 million vehicles traveled
  • 18th for drunk driving

These disheartening statistics show that driving in Florida can be a dangerous feat, so truly comprehensive coverage is critical.

When the unthinkable happens, being prepared is the most comforting thing. Uninsured and underinsured motorist insurance protects you. You cannot afford not to have it.

Looking for Coverage? Find the Insurance That You Need

Do You Have the Types of Coverage That You Need?

Different homeowners insurance policies from different insurance companies can be similar but are almost never identical. Although most will provide coverage for general damages to your home and theft of your property, different policies often exclude different types of claims so it is important to know all of the exceptions to coverage so that you can purchase additional coverage for relevant contingencies. Otherwise, you run the risk that even getting an insurance attorney will do you little good if you were underinsured.

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At a Loss? Below Are the Explanations of Available Coverages

The following are some explanations of the coverages available and some suggestions we have come up with as to making sure that you have the coverage you will need:

  • Coverage for your home, often referred to as Coverage A, is what covers your home from accidental damages and storms. You should be sure that the amount of coverage you carry is sufficient for your home’s appraised value especially if you have had any upgrades or improvements made recently and make sure that your deductible and hurricane deductible are not so high that you would be unable to repair your home in the event of a loss.
  • Coverage for unattached structures, such as sheds and some garages, is often referred to as Coverage B and should be added to your coverage if your property has any unattached buildings or structures. Otherwise, any damage or theft to such structures will likely be excluded from any claims you could make.
  • Coverage for your personal property, or the stuff in your house, is often referred to as Coverage C. You should be sure that you purchase enough coverage to replace everything in your home which would need to be replaced if your home was completely destroyed by fire or storm. People often underestimate the value of their belongings, and we suggest erring on the side of caution if you can afford the extra coverage. There are often special riders required for expensive jewelry, electronics and firearms, so be sure to ask what is covered and what is not if you have any expensive items in your home.
  • Loss of use coverage, which covers the cost of an apartment or other accommodations while your home is being repaired after an extensive loss, is often referred to as Coverage D. Be sure to include this coverage if you can afford it, and remember that friendships and even family relations can be strained if the repairs to your home end up taking six months to a year.
  • Personal liability coverage sometimes referred to as Coverage E, is the coverage that can provide coverage for a lawsuit for negligence or your child’s negligence at your home resulting in injuries or damages to another. Although you should always add this coverage if you can afford it, this is especially important if you own a dog or have large groups of neighborhood children frequenting your home.
  • Medical Payments or MedPay coverage sometimes referred to as Coverage F, is good to have at least in small amounts to cover medical expenses of anyone being injured at your home regardless of fault. So if your neighbor or niece trips on their own feet and breaks their arm, this coverage can help pay their emergency room bill when they have no health insurance.
  • Flood insurance is a coverage which should be added to every policy in Florida but is usually provided through the Federal government’s National Flood Insurance Program. Keep in mind that if even a small hurricane stalls over Florida, even areas not normally subject to flooding can have extensive flood damage. That actually happened in 2008 in Central Florida, and thousand suffered serious flood damage to their homes with no coverage to pay for their damages.
  • Sinkhole and ground shifting coverage is a must in some areas of the State, such as Hillsborough County where sinkholes are more common, but no part of the Florida is completely safe from shifting soil or sinkholes. Many people are surprised to find that damage to their home from ground shifting or a sinkhole is not covered under a policy, so be sure you know now whether you are covered and how much that extra coverage would cost. Get it if you can afford it.
  • Additional coverages for claims often excluded from most homeowner policies include fungi and dry rot, yeast and bacteria damages, debris removal, damage to trees and plants, forgery, long-term water seepage, civil unrest and riots, and damages for changes in laws or ordinances which result in your needing to modernize or upgrade your property.
  • Appraisal provisions – be sure to know your policies’ provisions as to required or optional appraisal of claims. Although appraisal may be right for you on certain claims, required appraisal that can be invoked by your insurance company is not desirable and may result in your having to pay for an appraiser and an umpire to resolve disputes in a number of your damages.
  • Finally, you should consider your personal risk tolerance when it comes to the extent of your coverage and your deductibles. Never hesitate to consult your insurance attorney or other insurance experts for the information you need to make the right decision.

Contact Us

Figuring out the proper homeowner’s insurance coverage can be more complicated and time-consuming than most people expect, but will become even more complicated after a claim is made if your coverage is denied. If you are not sure whether your coverage is sufficient, you should ask your agent or insurer for further information. But if you have already become entangled in a legal matter or a dispute with your insurance company, please contact us for the experienced insurance attorney that you need to ensure your rights are protected.

Initial phone consultations for Florida insurance claims are free and most cases can be handled on a contingency. If a suit is required, your lawyer’s fees will usually be paid by the insurance company if benefits are secured on your behalf.

Do You have Proper Coverage for Your Homeowners’ Insurance?

Living in Florida, it is important to know your homeowners’ insurance coverage and the extent of your coverage and deductibles. There is a myriad of different problems you can encounter as a homeowner and it is important to make sure that you are fully insuring what may be your largest asset. Simply carrying any policy of homeowners’ coverage alone does not usually protect you from all of the potential perils you can face in Florida, so now is always a good time to review the extent of your coverage and deductibles with your agent or insurance company. Keep in mind that changes in coverage may not apply to damages from an already looming hurricane, so it is best to make these changes before you need them.

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Why Do You Need Proper Coverage?

Carrying full and proper coverage ensures that you will have the funds you need to cover potential damages, repairs and losses, which will allow you to focus on returning your life back to normal rather than worrying about the devastating financial issues which can come from major damage or losses incurred in your home. Although more coverage usually results in higher premiums, you will need to balance the competing priorities of keeping your insurance costs affordable while still making sure that you are capable of covering your losses and repairing your home if the worst happens.

Remember that in pricing out coverage, you will need to pay close attention to the actual coverage options being provided under each policy, as the cheaper policy may simply give you too little coverage or have too many excluded claims.

Do You Have the Right Homeowners Insurance Company?

There are fewer options now in Florida for insurance companies (especially on the coasts), but you should still research the different companies you are choosing from prior to selecting a company and coverage. Remember that if you cannot locate a company who will write coverage for you, you should still qualify for coverage through Citizens Property Insurance Corporation, which is a quasi-governmental company.

Also remember that if you have a loan on your home, your bank may obtain “forced coverage” for your home if you fail to obtain coverage or let your coverage lapse and then charge you back for the premium. Those forced coverage policies are often more expensive and can carry much less coverage for you individually.

Although a catastrophic hurricane could potentially bankruptcy many companies, you should make sure that the company you go with is financially strong and we would suggest having at least an A- rating. You can also compare the number of consumer complaints made between individual companies through the Florida Division of Consumer Services. That will at least provide you with some basic information to use in comparing different companies’ policies.

Want to learn more about obtaining the proper coverage for you and your family? Then contact C.W. Smith Law today to find out more!