By David B. Pittman, Attorney At Law and Founder or Pittman Law Firm, P.L.
If you were in a crash on US-41 or I-75 and your doctor just informed you that you need surgery, do not sign a settlement offer from the insurance company. Once you sign a release of liability and accept a check, your case is permanently closed. If the surgery ends up costing more than you expect, or if your physical recovery keeps you out of work for six months, you cannot go back and ask the insurance company for more money.
For over thirty years, our office has handled personal injury claims across Southwest Florida. I frequently see insurance adjusters push early, lowball settlements right before a victim realizes they need a major medical procedure. They do this because surgery drastically changes the value of your claim.
If you are facing an operation after a collision, you are looking at facility fees, surgeon fees, anesthesia costs, and months of physical therapy. You need to know exactly how these bills will be paid before you even consider discussing a final number with an insurance adjuster.
Key Takeaways
- Do not sign a release if surgery is a possibility. Signing closes your claim forever, leaving you to pay for any future medical care out of your own pocket.
- Multiple insurance policies are usually required to cover the massive cost of an operation, including your PIP, your health insurance, and the at-fault driver’s bodily injury coverage.
- Prior medical conditions do not ruin your claim. Insurance companies will try to blame your current pain on an old injury, but Florida law allows you to recover damages if the crash worsened a prior condition.
- Having an experienced attorney forces the insurance company to factor in the true, lifetime cost of your medical care and lost wages before you settle.
Who Pays for the Surgery?
Surgery is expensive. A spinal fusion, a knee replacement, or a shoulder repair at a local facility like Lee Health or NCH can easily drain your savings if you do not line up the correct insurance coverage in the right order.
Figuring out who gets the bill is one of the most stressful parts of being injured. In Florida, paying for surgery is a layered process. It is rarely as simple as handing the hospital the at-fault driver’s insurance card. Here is how the billing actually works in our state.
Layer 1: Your Personal Injury Protection (PIP)
Florida is a no-fault state. This means your own auto insurance is the first line of coverage, regardless of who caused the crash. Under the Florida PIP 14-day rule, you must seek initial medical treatment within two weeks of the accident to activate this coverage.
Your PIP policy covers up to $10,000 of your medical bills. While that sounds like a lot of money, a single trip to the emergency room, an MRI, and a few follow-up visits can exhaust that $10,000 before you even schedule your surgery. PIP is just the starting point; it will not cover a major operation on its own.
Layer 2: Your Health Insurance
Once your PIP limits are reached, your personal health insurance steps in to cover the remaining medical bills. Whether you have Blue Cross, UnitedHealthcare, or Medicare, your health insurance will pay for the surgery, the hospital stay, and the post-operative care according to your normal plan benefits.
However, your health insurance company does not want to pay for injuries caused by a negligent driver. If your health insurer pays for your surgery, they will place a lien on your personal injury case. This means that when we win a settlement from the at-fault driver, your health insurance expects to be reimbursed for the money they spent on your operation. Part of our job is negotiating these liens down so you keep more of your settlement money.
Layer 3: The At-Fault Driver’s Liability Insurance
The ultimate goal is to make the driver who caused the crash pay for the damage. We go after the at-fault driver’s Bodily Injury (BI) liability policy to cover the full cost of your medical bills, your lost wages, and your pain and suffering.
Because surgery increases the total cost of your medical bills, we often have to demand the absolute maximum policy limits from the at-fault driver’s insurance company.
Layer 4: Uninsured/Underinsured Motorist Coverage (UM)
Many drivers in Lee and Collier counties carry state-minimum insurance, which does not include Bodily Injury coverage. If the person who hit you has no insurance, or very little insurance, their policy will not even make a dent in a $50,000 surgical bill.
This is where your Uninsured/Underinsured Motorist (UM) coverage comes in. If you have UM coverage on your own auto policy, we can file a claim against it to pay for your surgery and recovery when the at-fault driver lacks the funds to do so.
Coordinating these four layers of insurance takes aggressive work. Insurers will fight over who pays first and who pays what. Our firm steps in to manage the billing so your only job is showing up for your operation and healing.
What Happens if You Already Had a Bad Back or Joint?
Insurance companies train their adjusters to look for any excuse to deny a surgical claim. One of their favorite tactics is blaming your current pain on an old injury.
If your pre-surgical MRI shows degenerative disc disease, arthritis, or an old sports injury, the adjuster will immediately argue that the Bonita Springs crash did not cause your need for surgery. They will claim your back or shoulder was already in bad shape, and they should not have to pay to fix it.
This is a common tactic, but it is not the end of the story. You can still recover damages even if you had a prior condition.
Florida law clearly recognizes the aggravation of a pre-existing condition. Let’s say you had a mild ache in your lower back that flared up occasionally after yard work. Then, a distracted driver rear-ends you on Bonita Beach Road. Suddenly, that mild ache turns into radiating pain down your leg, and an orthopedic surgeon tells you that you need a spinal fusion.
The insurance company is responsible for the difference. They are responsible for taking a manageable, pre-existing condition and making it so severe that surgery became the only option. We gather the medical evidence, working closely with your treating physicians, to show exactly how the crash worsened your condition to the point that an operation became necessary.
Why You Need a Lawyer Before You Settle
The moment the insurance company finds out surgery is a possibility, their strategy changes. They will likely try to rush a check to your door or send you a digital release form to sign on your phone.
They do this because they want to buy out your claim for pennies before you understand the full financial impact of your injury. Handling this alone puts you at a severe disadvantage. Here is what an attorney does to protect you.
Calculating the True Cost of Your Care
Surgery is never just the procedure itself. We calculate the lifetime cost of your injury. A fair settlement must include the cost of the surgical room, the anesthesiologist, the hardware implanted in your body, the weeks of physical therapy, and any future operations you might need years down the road if the hardware fails.
Recovering Lost Wages
If you have back or neck surgery, you are going to miss work. Whether you are a construction worker in Cape Coral or an office manager in Naples, losing months of income while you recover can ruin you financially. We calculate your lost past wages and your lost future earning capacity to ensure the settlement covers your missing paychecks.
Protecting You from Immediate Financial Ruin
If you do not have health insurance, or if your deductibles are too high, you might think you cannot afford the surgery you desperately need. We can often help clients obtain medical care through a Letter of Protection (LOP). This is an agreement with your surgeon and the medical facility that allows you to get the surgery now, with the promise that the medical providers will be paid directly out of your final personal injury settlement.
A Real Example from Bonita Springs
A Bonita Springs driver was T-boned at an intersection on Bonita Beach Road and suffered severe shoulder damage. The victim’s doctor stated that surgery was the only way to restore their range of motion.
The at-fault driver’s insurance company initially tried to blame the joint pain on an old sports injury from years prior. They offered a tiny fraction of what the surgery would actually cost, hoping the victim would take the quick cash. Our firm stepped in, proved that the crash directly aggravated the shoulder to the point of needing surgical repair, and recovered $250,000 for the client.
Talk to Us Before You Sign Anything
If a doctor has recommended surgery following a car crash, the stakes of your case have just increased significantly. Do not let an insurance adjuster tell you what your claim is worth.
Let our family team review your case before you speak to the insurance company again. We will sit down with you, look at the police report, review your insurance policies, and tell you exactly what your options are. Call our office today at 239-992-8259 for a free consultation.
FAQs
Will my health insurance cover my auto accident surgery? Yes. Your health insurance can and should pay for your surgery after your $10,000 PIP limits are reached. Your health insurer will then likely place a lien on your personal injury settlement, meaning they expect to be paid back out of the money we recover from the at-fault driver.
How long do I have to file a lawsuit in Florida? Under current Florida statutes, you have two years from the date of the car accident to file a personal injury lawsuit. If you miss this deadline, you permanently lose your right to seek compensation, regardless of how badly you need surgery.
What if I already signed a settlement agreement? If you signed a final release of liability with the insurance company, your claim is almost always closed permanently. This is exactly why you should have an experienced attorney review any offer before you sign your name to a document.
About the Author David B. Pittman, Esq. is the founder of Pittman Law Firm, P.L. A Citadel graduate and alumnus of the USC School of Law, David brings over 30 years of personal injury practice to Southwest Florida. He is Martindale-Hubbell AV-Preeminent rated, a member of the Multi-Million Dollar Advocates Forum, and a 25-year licensed Florida Real Estate Broker. He concentrates on helping injured victims across Lee and Collier counties hold negligent parties accountable.
Legal Disclaimer The information provided on this website does not, and is not intended to, constitute legal advice. All information, content, and materials are for general informational purposes only. Prior results do not guarantee a similar outcome.