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Bicycle Medical Bills - Who Pays What?

Posted by Chris Burns in Florida Bicycle Laws, on .

You are riding your bicycle. Suddenly a car, or a bus, or a trash truck, or maybe a motorcycle pulls directly into your path. You cannot elude the vehicle – you suffer a collision. You need to go to the hospital or be evaluated by a doctor. You live in Florida. How are the medical bills supposed to be paid?  What if you don’t have health insurance?

So many of my clients are confused by who pays!

If You are Hit by a Car on Your Bike

If hit by a car you are entitled to have your medical bills paid by your own auto insurance – even if the bike crash was not your fault. Your car insurance applies – even though your own car was not involved in the crash. This medical bill coverage under your auto insurance is called “Personal Injury Protection” or “PIP” or “No Fault Benefits”.  This coverage is “primary” for your medical bills, meaning your auto insurance is the first insurer who is supposed to pay the bills.

Many cyclists ask me if this is unfair. They often ask, “Why should MY insurance have to pay my medical bills, when I did nothing wrong?” They then add, “Will my auto insurance cancel me or raise my rates?”  It is fair!  You have paid money to your auto insurer called “premiums” for this exact type of insurance coverage under your policy. In Florida, it is mandatory that all auto insurance policies provide these “PIP” benefits. Believe it or not, the auto insurer for the vehicle driver does not have to pay these medical bills at first – nor does his/her auto insurance.

There is a saving grace to this – your auto insurance cannot cancel you or raise your rates because you were in an accident that was not your fault.

Are there limits on how much auto insurance will pay for bike crash-related medical bills?

Yes. In Florida, medical bills from your bike crash (when in a collision with a car) will not be 100% covered. Your auto insurance will generally pay 80% of all reasonable medical bills, unless you have purchased extraordinary (and not basic) coverage. The maximum payments for all medical bills for a single bike crash total $10,000. Once your auto insurance has paid $10,000 in PIP benefits (with basic coverage), the benefits are “exhausted”.

What happens after auto insurance pays 80% of a given medical bill, who pays the difference?  What if the auto insurance max of $10,000 in payments has been reached so that auto insurance doesn’t pay at all?

These bills should be submitted to your health insurance, such as BlueCross BlueShield, United Healthcare, Aetna, Tricare, etc.  In the beginning after your bike accident, your auto insurance is "primary" insurance and your health insurance is the “secondary” insurer.  On a given bill, auto insurance PIP benefits will pay 80% and then your health insurance can pay the balance due on the bill.  Once your PIP insurance has reached its limit of benefits, then the health insurance becomes the primary insurer.  Your attorney can still seek compensation from the at fault driver, vehicle owner, or their auto insurers for the medical expenses you have incurred.  

How can you make sure that all the insurers, auto and health, are bound to pay the bills submitted?

  1. It is critically important that your bike crash medical bills are submitted to the insurers as soon as possible.  Some auto and health insurance companies decline to pay medical bills if they are not submitted in a timely manner. When you go to the hospital or doctor, ask them to submit your medical bills to your auto insurance, and if you have it, your health insurance – on every claim – from the very beginning.
  2. Try to keep track of how your medical bills are being submitted and being considered by the insurers. Many auto insurer and health insurers give their customers on-line access to the claims submitted. By going on-line, you can check to make sure the insurer received the bills, and see how much was paid and why.

What if you don’t own a car, and don’t live with a family member or relative who owns a car?

Then you are still entitled to “PIP” or “No Fault” benefits under an auto insurance policy. You get these benefits to pay your medical bills from the owner of the car’s auto insurance. You are entitled to these PIP benefits whether the accident was your fault, the other driver’s fault, the fault of both of you, or nobody’s fault. You are entitled to have 80% of each reasonable medical bills paid up to $10,000 maximum benefits.

What if you are in a bike crash where you swerve to avoid being hit by the vehicle, and you crash without the vehicle actually touching you?

Florida Courts have not agreed on whether the bicycle rider is entitled to PIP benefits. The Florida law on PIP benefit says all auto insurance policies must “provide personal injury protection when the policy holder is “struck” by a motor vehicle and suffers injury. Thankfully, certain Florida Courts have interpreted this law to include PIP coverage where the cyclist crashed to AVOID being struck by the vehicle.  This is abundantly fair. It would be ludicrous for cyclists to be covered who were hit by cars, when other cyclists, who likely minimized their injuries by avoiding a collision, were not covered.

If you have payment related questions about bicycle crashes and medical bills please contact Christopher Burns directly at (904) 632-2424 or via email.

Christopher G. Burns is an attorney who has specialized in defending the rights of injured cyclists for 30 years. He is the Chairperson for the Jacksonville (Fla.) Bicycle Pedestrian Advisory Committee. Consultations are free of charge.