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Can My Insurance Company Deny Medical Care Claims After A Florida Auto Accident?


When you are injured in a car accident, your medical bills will quickly start piling up. Medical costs are extremely high in Southwest Florida and if an injury is severe, you will require a lot of care. Between diagnostic testing, treatments, and pharmaceuticals, you may suddenly find yourself in thousands of dollars of debt. In most cases after an accident, the auto insurance companies will cover the costs of medical care. Florida legally requires all drivers to carry personal injury protection (PIP). PIP covers medical costs regardless of who is at fault. However, there are some medical costs that will not be covered.

Reasonable And Necessary Medical Bills

There are some limits on what medical costs the insurance company will cover. These are defined as “reasonable and necessary.” In general this means that the medical care is reasonable in the sense that it is standard practice for the injury. Necessary means that the medical treatment was required for healing the injury as opposed to elective. There are some areas of grey within these definitions, but overall, the legal concept is that they should just pay for what is required to get you back on your feet from the accident.

Medical Treatments Considered Reasonable And Necessary

To better understand the concept of reasonable and necessary, here are some examples of the types of care that insurance companies are required to cover:

● Ambulance rides or other transportation to the hospital or medical facility
● Doctor’s visits including follow ups
● Diagnostic testing like x-ray, CT scans, and MRI
● Surgery
● Hospital stays
● Prescriptions and medical devices used in treatment

As you can see, this list is pretty standard for medical care. What will not be covered in some cases includes:

● Elective treatments
● Experimental treatments
● Treatments that are not approved by medical community as the standard of care
● Treatments that cost significantly more than market value
● Treatments from past injuries

You may still be able to have some of these treatments covered, but you will have to work with your licensed medical provider to prove they were reasonable and necessary.

What To Do If Your Medical Care Claim Was Denied?

Insurance companies are not in the business of paying claims. In fact, they are in the business of making money. So not every denial they issue is legitimate or even legal. If your medical care claim is denied, you can start a repeal. A skilled auto accident attorney can help. First, they will identify why your claim was denied. Then they will begin to put together the evidence needed to prove they are legally obligated to cover these costs. If the denial was because the insurance company did not consider your medical care reasonable and necessary, they will work with your care providers to prove that it is reasonable and necessary. Therefore, that treatment must be covered as part of your settlement.

Coverage For All Your Expenses

Beyond just making sure that the insurance company covers the costs of your medical care, your attorney will make sure they cover all associated healthcare costs. That includes things that are often skipped over. For example, if you’ve had to make modifications to your house because your injury requires the use of a wheelchair, that should be included in your claim. Another example that is often overlooked is the costs to transport you to and from medical visits. With the high price of gas and wear and tear on your vehicle, these costs can quickly add up. An auto accident attorney will look at all your expenses and make sure all the costs are covered.

If you’re having trouble getting the insurance companies to pay for your medical care, contact the team at Justice Pays Goldman, Fernandez, Babboni, and Walsh. The insurance companies in Florida (Sarasota/Bradenton area) know us by name and they know we fight for our clients.

Michael J. Babboni's wide-ranging legal career is based on the strong belief that everyone should be treated fairly and have access to effective legal help. Michael began putting his beliefs in action by helping the people of St. Petersburg Florida get what they are owed in civil trials fighting to protect families by making corporations pay, and honor their obligations.

Can My Insurance Company Deny Medical Care Claims After A Florida Auto Accident?

Goldman Babboni Fernandez
Murphy & Walsh




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