Why is PIP subrogation in Florida so complicated? How do you maximize recovery of commercial claims? The episode of On Subrogation: 3 Pitfalls for Florida PIP Reimbursement below is a follow-up to On Subrogation: Florida HB 837 PIP Commercial Right of Reimbursement, which provides an overview of the complexities of PIP subrogation in Florida.
In this article, we unpack Jason’s take on the three common situations subrogation lawyers encounter in the state that may limit or bar potential subrogation recovery:
1. Emergency Medical Condition Documentation is Required.
In order for the injured party to receive the full $10,000 in PIP reimbursement in Florida, there must be a finding of an emergency medical condition. Some subrogation lawyers and personal attorneys feel this rule is too strict and allows insurers to deny payments for legitimate injuries.
On the other hand, sometimes the entire PIP reimbursement is paid, but there is no documented medical emergency in the file. Claims specialists managing these subrogation claims must ensure the file includes documentation of an emergency medical condition so the opposing carrier cannot reduce the subrogation demand down to only $2500 under Florida law.
2. Your Insured is Also the Commercial Vehicle Owner.
The Florida commercial reimbursement statute allows a PIP carrier that pays PIP benefits to pursue the commercial vehicle owner or their carrier that owned the vehicle in which the injured party was damaged. But consider a small business; many times, a small business owner has dual auto insurance policies – one for their commercial vehicle(s) and one for their personal vehicle(s).
Say your insured is a plumber who is injured in an accident in their commercial vehicle. You pay the $10,000 PIP policy and now move to pursue the commercial vehicle owner. If they carry a commercial insurance policy, the subrogation process can proceed as normal. However, if they are self-insured without a specific policy covering the vehicle, you now must pursue the commercial vehicle owner – your insured.
This is a difficult situation, and you may have already incurred costs in the initial stages of the subrogation claim; had you known more, maybe you would not have pursued the claim in the first place. Situations like these are why subrogation law firms are such valuable partners to insurance carriers – a timely investigation by a knowledgeable legal team can collect these facts at the outset of a claim to better analyze the utility of subrogation.
3. Your Insured Signed a Waiver of Subrogation Rights.
An insured technically cannot waive an insurer’s PIP subrogation rights because they are statutory and belong to the carrier once the PIP benefits are paid. The insurer retains the right to pursue subrogation recovery from the owner or their carrier, regardless of a subrogation waiver.
However, complications arise when the insured settles a bodily injury claim with the at-fault party, which is something Florida subrogation lawyers often encounter in pedestrian vs. commercial vehicle cases. A BI settlement release may use broad language that requires the insured to indemnify the settling carrier for all subrogation liens, including PIP. If your insured signs such a release, it can indirectly complicate subrogation recovery even if the insurer’s statutory right to PIP subrogation is technically intact.
Insurers should provide early notice of their reimbursement rights via a subrogation lien letter at the outset of this type of claim so insureds and their attorneys avoid signing releases that may undermine, complicate, or thwart recovery pursuit. Having subrogation counsel on hand is a major asset in Florida PIP cases – the required labor and legal complexity can increase carrier losses, while an adept team of lawyers can maximize recovery potential.
Want More Information on Florida PIP Subrogation?
For more on Florida PIP subrogation, check out the links provided at the top of this article and visit:
- Florida HB 837 & Rolling With the PIP Subrogation Changes: a comprehensive look at Florida HB 837, including links to the accompanying three-part On Subrogation video series.
- Exceptions to the Rule: Successfully Subrogating a PIP Claim in Florida: a guide to the basics of PIP subrogation in Florida.
- State Subrogation Laws: How Does PIP Coverage Work in Florida?: a look at how emergency medical condition requirements affect Florida PIP subrogation.
Rathbone Group provides free educational resources for subrogation lawyers, adjusters, and professionals across the insurance industry. Find coverage on more important topics in subrogation at our YouTube channel, Subrogation Blog, or On Subrogation podcast. You can suggest new topics and ask questions by messaging blog@rathbonegroup.com. And for more information on Rathbone Group’s subrogation services, reach out at info@rathbonegroup.com.