How Much Must Be Repaid?

The reimbursement amount depends on two key factors:

1. Policy Language
2. The Source of the Settlement or Judgment

Most policies state that the insurer is entitled to full reimbursement from the insured’s recovery—often before the insured or their attorney receives anything. However, when the recovery is from a tortfeasor (the at-fault party), Florida law may limit the insurer’s rights.

Florida Statute § 768.76(4): The Governing Rule

When recovery is made from a tortfeasor, Florida Statute § 768.76(4) controls, regardless of what the insurance policy says. This was confirmed in Ingenix v. Ham, 35 So. 3d 949 (Fla. 2d DCA 2010). In that case, United Healthcare sought full reimbursement after paying most of the decedent’s medical bills. However, the court limited reimbursement based on the statutory formula in § 768.76(4), stating:

“A provider of collateral sources…shall have a right of reimbursement…if such claimant has recovered…from a tortfeasor.”

A Different Outcome: When the Statute Doesn’t Apply

In contrast, Travelers v. Boyles, 679 So. 2d 1188 (Fla. 4th DCA 1996), involved a settlement with an uninsured motorist (UM) carrier—not a tortfeasor. The court held that § 768.76(4) did not apply and allowed the health insurer to pursue full reimbursement under its policy terms. The statute wasn’t triggered because a UM carrier is not considered a tortfeasor under the law.

Importantly, the Ingenix court emphasized that the Travelers decision does not mean policy language trumps the statute when § 768.76(4) does apply.

When Both Standards Apply

In certain cases—such as auto accidents involving inadequate bodily injury (BI) coverage and a payment from an underinsured motorist (UIM) policy—both Ingenix and Travelers may apply. Reimbursement rights may then be split between the statutory formula (for the tortfeasor’s share) and policy language (for the UIM portion).

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Contact us at 305-758-4900 or by email (kgale@jeffgalelaw.com and jgale@jeffgalelaw.com) to learn your legal rights.

Jeffrey P. Gale, P.A. is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.

While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.

DISCLAIMER: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.

The most common payment sources are PIP, MedPay, health insurance, Medicare, Medicaid, and bodily injury liability insurance.

With a few exceptions, every owner or registrant of a motor vehicle required to be registered and licensed in Florida must maintain PIP insurance. See Florida Statute 627.733. PIP, which applies without regard to fault, covers medical expenses and lost wages. Most Florida policies limit PIP coverage to $10,000 and apply deductibles.

One of the benefits of the ride share industry is that people can go without owning a vehicle. However, PIP is not automatically available to those PIP passengers who live in Florida and do not reside with a relative who maintains PIP insurance. Likewise, other medical insurance may not be available.

In some instances, ride share drivers have PIP coverage for passengers. The driver must inform his carrier of his ride share work and pay a premium for ride share coverage. If the driver fails to do this, the carrier will deny coverage. Uber is not required to maintain PIP in Florida, so it doesn’t.

Uber maintains bodily injury liability (BI) coverage and MedPay under its Florida insurance policies. Contrary to popular belief, it does not maintain UM/UIM coverage. Uber’s BI only applies if its driver is at-fault. It covers non-economic damages such as pain and suffering and economic damages such as income loss and medical expenses. Like PIP, MedPay applies without regard to fault. If PIP isn’t available or is exhausted, it will cover up to $5,000 in medical expenses. Unlike PIP, it must be reimbursed from BI payments (its own or from third-parties).

Health insurance, Medicare, and Medicaid may also cover medical expenses. Like MedPay, they must be reimbursed from BI money.

Medical expenses are costly. Steps can be taken to limit personal exposure to those expenses.

**************************************

Contact us at 305-758-4900 or by email (kgale@jeffgalelaw.com and jgale@jeffgalelaw.com) to learn your legal rights.

Jeffrey P. Gale, P.A. is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.

While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.

DISCLAIMER: This information provided by Jeffrey P. Gale, P.A. is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. It should not be considered legal advice or counseling. No such legal advice or counseling is either expressly or impliedly intended. This information is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney.