After being injured in a car accident, a Florida woman’s Personal Injury Protection (PIP) claim was denied because her medical services provider failed to submit a completed claim form to her insurance provider. On the submitted form, they omitted the doctor’s professional license number. The omission was repeated on subsequent form submissions, resulting in the insurance company’s continued denial of the claim. However, the insurance company did not refer to this omission as cause for the claim’s denial.

More than two years after the initial claim, the medical provider eventually provided completed claim forms which included the physician’s professional license number. The insurance company then denied the claims as untimely, according to Florida Law.

The medical provider sued the insurance company seeking payment of claims and additional  financial compensation. The county court granted final summary judgement to the insurance company, citing the omitted professional license number as inadequately notifying the insurance company of the claim within 35 days as required by § 627.736(5)(c)(1), (d). The medical provider appealed to the circuit court.

The circuit court reversed the summary judgement, finding that the medical provider had adequately notified the insurance company of the claim by submitting forms that were “substantially complete,” followingThird District precedent in United Automobile Insurance Co. v. Professional Medical Group, Inc.

The insurance company appealed to the Second District, but the appeal was denied.

This result affirms that although an insurance company’s denial of your claim may seem ironclad and based on Florida law, you may still have rights that only an experienced attorney can identify and defend.

St. Johns County circuit court cases are appealed to the 5thDCA. But this theory of law applies through out the State of Florida. This case involves a car accident where, arguably, the emergency personnel contributed to the death of the driver.

The fifth district court of appeal stated that the supreme court set out the standards for granting a new trial based on juror nondisclosure during voir dire. In determining whether a juror’s nondisclosure of information requires a new trial, courts use a three-prong test.  First, the party requesting a new trial must show that the undisclosed information “is relevant and material to jury service in the case.”  Second, the complaining party must prove that the juror concealed the information. And third, the party must show that the “failure to disclose the information was not attributable to the complaining party’s lack of diligence.”  As to the first prong, the supreme court would later explain that materiality is shown only “where the ‘omission of the information prevented counsel from making an informed judgment — which would in all likelihood have resulted in a peremptory challenge.

The fifth district found that the test was met and granted a new trial.

Ramirez v. United Automobile Insurance Company is a recent automobile accident case out of the 3rd DCA where the injured party appealed PIP denial and won. In PIP cases the insured is entitled to attorneys fees if they prevail. In this case, the insurance company lost but appealed to Circuit Court and lost again. Then the Circuit Court,acting as an appellate court, ruled that the injured party was not entitled to appellate attorneys fees. The 3rd DCA reversed the Circuit Court finding that it “was a miscarriage of justice for circuit court to deny an award of appellate attorney’s fees to insured”. 

If you are hurt in an accident Florida law requires you to turn to your own insurance company for medical care and lost wages. If you are unlawfully denied coverage contact  St. Augustine’s personal injury lawyers at Canan Law. We specialize in St. Johns County in car accident litigation.

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Petitioner, v. GILDA MENENDEZ, et al., Respondents. Supreme Court of Florida. . August 25, 2011. The Third District Court of Appeal determined that the household exclusion in State Farm’s policy issued to Gilda Menendez is ambiguous and therefore could not be enforced to eliminate coverage for bodily injuries suffered by members of the household of a permissive-driver insured. The Third District thus applied the rule that ambiguous policy provisions must be interpreted in favor of the insured. The Florida Supreme Court concluded otherwise holding that the household exclusion provision in the policy issued to Menendez unambiguously applies to claims by members of the household of a permissive-driver insured.

There is a big lesson to learn here. Even though this man gifted the car to his ex-wife, he still got sued. Hence, it is important to make sure your name is removed from the title when selling or gifting an automobile. The jury did return a special verdict finding that the ex-husband was not the owner of the car.

It is important to note that the 5th District Court of Appeal serves St. Augustine and St. Johns County.

First, you should know a little bit about the law. Florida is a “no-fault” state which means that auto insurance will cover certain risks regardless of fault. It is called personal injury protection (PIP) insurance and is required by law for all vehicle owners in the state of Florida. Everyone who lives in Florida, or who operates a motor vehicle here for over 90 days a year, must have PIP insurance. The insurance company providing your PIP coverage will pay 80% of all reasonable expenses for necessary medical care and treatment. Your PIP insurance will potentially reimburse expenses up to at least $10,000.00. Your insurance company may also pay 60% of any loss of gross income or loss of earning capacity.

On top of your required PIP, you can also purchase insurance to cover auto liability, medical payments and uninsured motorist coverage. Auto liability insurance may be very important to you because it protects those who are “insureds” from legal liability for bodily injury or property damage to others resulting from an accident. Uninsured motorist protection (UM) is insurance coverage for those situations in which the at-fault driver is uninsured or insufficiently insured. Uninsured motorist protection should seriously be considered and may be one of the best bargains in auto insurance. Check your coverage carefully and review your policy with legal counsel if you have questions.

If you and another driver are involved in an accident, Florida law requires both drivers to stop right away. You should stop at the scene or close to the scene without obstructing traffic more than absolutely necessary. If possible, the cars should be left where they came to rest unless they are blocking traffic. While it is important to protect the accident scene, obstructing traffic can delay the arrival of police or emergency vehicles or even cause another accident.

Your first responsibility in the even of an accident is to find out if anyone is hurt. If someone is seriously injured, get an ambulance, rescue squad, or doctor immediately. Although not all accidents require police notification, accidents involving injuries, damage in excess of $500.00, or the death of any person, require police notification. If any of these occur, you must immediately notify the police of the accident.

If you are involved in an accident, you are required by law to provide certain information to the other driver. You must provide your name, address, vehicle registration number, and allow the other driver see your driver’s license. You are entitled to receive the same information from the other driver. Also, remember to get the names and addresses of all the witnesses you can. Attempt to have the witnesses write down or tell to you what they know while still at the scene.

With the exception of your exchange of information, you should not comment on the accident. Do not admit you were wrong or careless. Finally, don’t allow anyone to rush you into a settlement. You may be entitled to significantly more, or conversely, you may not be obligated to pay as much. You can safeguard your rights by consulting a lawyer following an accident.