Wade Coye

It is a rare case that involves only one area of the law. If laws and the legal system were straightforward and easy to navigate, there would be significantly less demand for legal assistance, i.e. attorneys. People call lawyers to understand their options, work on their problems, and ultimately recover from them. Some attorneys serve clients by being well-versed in many practice areas and others do this by specializing in a limited range of cases. There are advantages to focusing on a few practice areas, but some attorneys lack the knowledge or initiative that complex issues require. For example, car accidents in other states are inherently complicated because each state has different laws governing the sources and process of claiming benefits. If you live in a different state from where the accident occurred, it is intimidating to say the least.

Every day, Americans travel from state to state by car with their families or friends. This form of travel can give people great freedoms in their vacations or visits, but it can also carry some risk. If you have ever been involved in a car accident in another state, you know it can be difficult to sort out even without serious injuries. Each state has different laws governing insurance and liability. The insurance and personal injury lawyers of the Coye Law Firm want to help you recover quickly from these overwhelming circumstances.

Unfortunately, some attorneys may say “you need to find an attorney in that state” or “I’m not experienced in insurance claims” when you call their offices. This sort of “tunnel vision” comes about when legal professionals only take on cases in a small number of practice areas. The attorneys at the Coye Law Firm know that this strategy doesn’t do the most to help clients. We want to help people solve the many problems that they need help with. Out of state car accidents, as mentioned above, are a prime example of the coordination, investigation, and communication that attorneys need to resolve a client’s complex problem.

Out of State Drivers in Florida

The first thing that tourists or other visitors from out of state need to know is that Florida is a no-fault state. This means that, regardless of who is at fault in an accident, a person’s injuries are paid for by their own insurance policy under most circumstances and up to the limits of their Personal Injury Protection. The system is designed to prevent law suits and pay benefits quicker, but it can also be confusing and limiting for people who don’t know what areas of liability exist in their accident. For example, you can use health insurance or workers’ compensation benefits in some circumstances to help cover extra medical bills or lost wages if necessary. These other forms of insurance can be repaid by any recovery you receive from the at-fault driver in court. As you can see, skillful coordination is needed in these accidents.

So what does this process mean for you and your accident? If you are an out of state driver and get into an accident in Florida, your own insurance may pay for your injuries if you are from a no-fault state and have a no-fault policy. Accident victims from non no-fault states may recover their full payment from the at-fault driver in some circumstances. Your ability to sue for more money may be limited in a no-fault state. In Florida, your injuries and other damages must surpass a certain threshold in an aspect of your policy in order to bring the case to court. Visitors from other no-fault states may have some familiarity with the system and can have a significant amount of coverage to protect themselves. People from non no-fault states, however, can feel overwhelmed and confused when seeking compensation for their injuries. A lawyer can help you understand insurance policies, laws, and areas of liability. A personal injury attorney from the Coye Law Firm can get you the benefits and peace of mind you need in the aftermath of an out of state car accident.

Florida Drivers in Other States

The Florida no-fault law requires that resident drivers have a minimum of $10,000 for Personal Injury Protection (PIP) and Property Damage liability. Just like the name implies, “no-fault” insurance pays for the policy holder’s injuries regardless of who caused the accident. Of course, your insurance policy may limit or deny claims that occur in other states based on the contract. For example, you might be required to be in the car listed on your policy. But if you are covered and in a car accident and break your arm, your own insurance pays for the hospital bills up to the amount you have insured. If your injuries go over the amount you have insured under the car insurance policy, then your health insurance can pick up the rest of the bill. You can choose to pursue benefits from the at-fault driver, but there is no guarantee that you can recover benefits this way. Property Damage Liability coverage pays for any damage you may cause in an accident up to the amount that you have insured. Both of these coverages also protect family members, as well as some unrelated passengers if they do not own a vehicle or have their own PIP coverage.

What happens if you get into an accident in another state? The short answer: it depends. Some other states (including Massachusetts, New York, Michigan, and Utah) have no-fault laws as well. Although the no-fault system is designed to limit the amount of law suits, the injured driver’s ability to sue for damages varies based on the way the state’s law is written. For example, drivers in Massachusetts can file a suit if their injuries surpass a certain quality, i.e. their injuries are classified as “disabling” or “severe.” In New York or Florida, a person can file suit if the damages exceed their covered amount in a certain area, such as coverage for medical bills. If the victim is disabled and can prove that they need costly long-term care, they can pursue damages as well. Additionally, no-fault benefits often only cover your injuries if you are in the vehicle listed on your policy.

Compounded Laws: Interstate Accidents

What happens when a driver from New Jersey gets into a car accident with a driver from Florida while they are both traveling on I-95 in South Carolina? Road trips can be a great way to see the country, but each state has its own set of laws that govern who is at fault, who pays for damages, and how the legal system protects those involved in an accident. It is important to know that wherever your accident occurs, that is where the case or claim will be filed, and the laws of the state dictate the process of delivering benefits. This area in which the accident occurs is referred to as the “jurisdiction.” So, in this example, the case will be filed in South Carolina and the recoverable benefits are governed by their laws. The cases can be moved in rare circumstances, but victims should be prepared to communicate with attorneys in many areas of the country in these situations. Again, the benefits you are entitled to and the process of getting them is governed by the state in which the accident occurred. The Coye Law Firm can communicate with other attorneys and multiple insurance carriers in order to speed up your recovery.

The Coye Law Firm helps injured victims in many ways. Our lawyers are experienced in many practice areas, thorough in their research, and able to practice in many parts of the country. Additionally, our firm maintains professional relationships with other firms around the United States. These connections help Florida residents or visitors work from their home states and recover the benefits they are seeking. If you have been in a car accident in Florida or anywhere else in the country, contact the Coye Law Firm to recover quickly, both physically and financially.

The information contained in this post is not intended to be or replace legal advice. Consult an attorney at the Coye Law Firm to receive legal advice tailored to your situation.

Wade Coye, Attorney

The fight to provide more health care coverage for Americans has sparked debate in all parts of the country. The issue is complex and goes beyond tax payer costs or quality of care. Nationalized health care raises many legal issues as well.

How Can a Benefit Be a Burden?

It can be an exciting thing to get a new job, especially in our country’s current economy. When a person finds out that their new job provides health insurance benefits under an employer-sponsored plan, they think that concerns over health care costs have been lifted from their shoulders. But what happens if the plan precludes coverage for certain areas or the language is confusing? While it may save employees money in some circumstances, employer-sponsored health care plans can create expensive, federal-level legal disputes that can end up costing you more money than you’re saving.

Employers are not obligated to offer group health insurance plans. If they do, the plans are regulated under federal law, specifically the Employee Retirement Income Security Act or ERISA. ERISA excludes employees of state or local government entities, religious groups, and some unions. Some states have laws governing employer health care as well.

Self-funded vs. Insured Health Care

The health care plans offered by employers may be self-funded or insured. If employers do not purchase insurance for their employees, but instead pay for health care costs themselves, then the plan offered to employees is said to be “self-funded.” This is a risky practice, particularly when the employer faces financial trouble. Insured health care plans are offered when employers buy an insurance policy for their group of employees. Which one do you think is more likely to create disputes? If an employee has a problem with the benefits they are receiving–or they are receiving none at all–they have certain options when it comes to fighting the decisions.

If your coverage, even routine care such as prescriptions or preventative doctors exams, is disputed and your plan is insured, your right to appeal the decision to the insurance company’s review board is governed by ERISA. ERISA dictates the process of internal appeals in self-funded plans as well, but that is where the government’s assistance ends. If your appeal is denied, you have the option to file a lawsuit in federal district court. Our firm sees these cases often and we know the heart-wrenching circumstances that come with the frustration of benefit denial. This is when you need a lawyer. This is when your small insurance dispute can become a state or federal case. Call the Coye Law Firm to speak with a compassionate, experienced attorney who can address your specific questions regarding employer-sponsored health insurance benefits.

If your claim reaches court, a judge often just reviews the terms of your employer-sponsored health care plan and decides whether or not the decision to deny benefits fits into the rules outlined. They cannot take over a decision on your health care benefits, but instead only decide on whether or not the decision matches the terms of your plan. Even if he or she rules in your favor, there is no obligation for the employer or insurance carrier to pay your attorney’s fees. You may end up paying more to win your case than the cost of the original benefits that you need to collect.

A Federal Case out of Health Care

The discussion about nationalized health care is different for many people. Consumers tend to focus on the costs and delivery of health care, while legal professionals are considering what the new system would mean for the appeals process and number of law suits. Consumers will have to spend more money to defend their right to insurance coverage and attorneys will have to fight to get their fees covered. Courts rule in favor of employers often, which can prevent employees from receiving care they need. If health care is nationalized, then more disputes will be turned into “federal cases,” creating a financial and time-consuming headache for many employees who are being denied health care coverage.

The Bottom Line…

Any insurance plan needs to be thoroughly reviewed before you know you’ll need to use it. If an employee suffers a broken leg on vacation, and finds out too late that their health insurance plan will do nothing to protect them because of some small clause or loop-hole, he or she does not want to find this out while lying in a very expensive hospital bed. No one wants to get tangled up in legal disputes, especially when they’re recovering from an injury or illness. If you’re in the middle of a battle with your health insurer, call our firm today.

Wade Coye

No question about it, as the the debate on national health insurance continues, we are beginning to see that tort reform as envisioned by business interests will occur and that it will be part of a package on universal care. It does not seem to matter whether people are politically tuned to the right or the left everyone has their own sacred cow in the fight. The left wants universal coverage and doesn’t really want to look at the cost nor even consider that the Massachusetts attempt was far more expensive than anyone really imagined. The right thinks that the free market will correct all problems and doesn’t want to consider that there is no real effective competition in the health insurance market.

For a deal to emerge in the Congress on a matter that the President views as critical, some old fashioned horse trading will occur. On the left, they will concede on tort reform to pickup some votes on the right. The tort reform will likely consist of some protections for doctors and hospitals who stand to receive less payment for providing care. This will likely satisfy some on the right and will be the basis for the votes necessary to ensure passage of the bill.

In the end who will really benefit? First, there is no question in the short term those who currently do not have health insurance will have an ability to obtain it easier than ever in history. This will be touted as a great achievement in human affairs and will make great campaign rally speeches. Doctors and hospitals will receive less for the care they give and should receive substantial reductions in medical malpractice premiums since with additional protections they will either no longer need the types of coverage or insurance companies will charge substantially less for their premiums.

Unfortunately it will not work. The cost savings touted from medical malpractice reform essentially occurs in two areas. First the lower premiums for insurance. That seems a bit unrealistic to think that an insurance company which makes substantial profits on professional liability insurance is going to suddenly give away a product. Nevertheless there will be some savings. But since it is estimated that medical malpractice insurance and claims is less than 2-3% of total healthcare spending, then likely this will not amount to much if any savings. Still a savings nevertheless.

The second area of savings from medical malpractice tort reform is supposed to come from a reduction in the amount of unnecessary testing. The discussion goes something like this: doctors have patients who will sue them over poor outcomes. So the doctor, in an effort to protect themselves and the hospital, orders unnecessary tests for these patients. The idea being that this is an enormous cost and we will have an incredible savings if you no longer have to give these unnecessary tests. It sounds great, except no one really has any decent numbers about what savings will actually occur. More to the point: is this unnecessary testing? Again, I am not so sure. First, to whom is the testing unnecessary? The doctor or the patient, or perhaps the insurance company? If you go to the doctor and there are a number of tests that can be run on a given condition, who is willing to take the chance? Understanding the logic of the doctor, you would have to think that there was some medical necessity. I cannot imagine any doctor indicating that they were ordering unnecessary tests in any one particular case. In fact, in my professional practice I have never even seen an insurance doctor go so far as to state under oath that another doctor was ordering tests that were medically unnecessary. (That would be insurance fraud.)

Most people will not decline a test especially if they don’t have to pay for it out of their bank account. So then who makes the decisions? The doctor? Probably not going to happen. How about the hospital? Again, probably not going to happen. How about the insurance company, or better yet the government? Now you get the idea. The fact is you only get cheaper care when someone either gives the care to you cheaper than they were before or if you get less care than you would have normally. Doctors get paid less, hospitals get paid less, and the quality of the care goes down.

So the reality is that while more people will receive more primary care and more people will receive emergency type procedures that will get paid for, it is far more likely that some will not obtain care that they would have otherwise received (those tests that were “unnecessary.”) Sometimes that is not necessarily bad, especially when you consider some of the shocking examples of people receiving outrageously expensive procedures that have little prospect of succeeding. Except and unless you were the one that wanted to have a chance. Sometimes people having choices even when they are not great choices serve everyone better. That is the system we have and I think the system we should keep.

Wade Coye, Attorney

Any discussion of universal healthcare necessarily requires inquiry into the types of insurance that already provide some level of care for a person’s health. For instance, many people access healthcare through health insurance that is paid for by tax dollars already: federal, state, and local employees, medicaid, medicare, federal workers compensation, and military benefits such as veterans benefits. In the private sector people receive health care from individual and employer sponsored group health benefits, workers compensation policies, auto no-fault policies and other accidental and health policies. Some of these policies pay based upon specific conditions and some pay for health care no matter the situation.

All of the above pay for much of the care that is obtained in this country and is necessarily something which bears significant consideration in a discussion of so-called universal healthcare.  Each of the above has overlapping and duplicate coverages for some, and for others is the sole financial resource to obtain healthcare.  The funding for the different types of coverages are paid for by a combination of state and federal regulatory frameworks, compensation plans, and tort liability. No discussion in the national media has completely reviewed these issues or the likely effect that universal healthcare will have on the existing means of obtaining medical treatment.