Who pays the medical bills after a crash?
Your own personal injury protection pays first, regardless of who caused the crash, up to $10,000 and only 80 percent of each bill. Everything after that has an order to it — and some of what gets paid along the way has to be paid back out of any recovery.
The question people actually have is not which policy is technically primary. It is: who is going to send me to collections, and what will I owe at the end. So this answers in that order: what pays now, what fills the gap, and what comes back out at the end.
Reviewed by Paul R. Shalhoub, who handles these claims himself.
The order coverage pays in
Each row is the answer to a different letter arriving in the mail.
| 1. Your PIP, first and regardless of fault | Section 627.736(1) requires a complying policy to provide personal injury protection “to a limit of $10,000 in medical and disability benefits and $5,000 in death benefits.” Paragraph (1)(a) pays 80 percent of reasonable, medically necessary expenses, if initial services and care are received within 14 days of the crash |
| 2. But often only $2,500 of it | Subparagraph (1)(a)3 opens the full $10,000 where a listed provider has determined the injured person had an emergency medical condition. Subparagraph 4 limits reimbursement to $2,500 where a provider determined they did not. Which of those happened is the single biggest variable in whether PIP covers anything meaningful |
| 3. Your health insurance, for the rest | Including the 20 percent PIP does not pay. Health plans normally have a right to be reimbursed out of any recovery, which is why the plan documents get read rather than assumed |
| 4. Medicare or Medicaid, if you are covered | Both pay and both come back for it, by different mechanisms and on different deadlines |
| 5. A letter of protection, for treatment nobody else will cover | A written agreement under which a provider treats now and is paid from the settlement. It is a real debt, not a favor, and the amount is negotiated at the end |
| 6. The at-fault driver’s liability coverage | Which pays once, at the end, in a lump sum, after fault and damages are resolved. It does not pay bills as they arrive, which is the single most common misunderstanding about how this works |
| 7. Your uninsured motorist coverage | Where the at-fault driver had nothing or not enough. Also paid at the end. Uninsured motorist claims → |
What PIP actually covers, and who it covers
Wider than people expect in one direction, narrower in another.
Section 627.736(1) extends personal injury protection to the named insured, relatives residing in the same household, persons operating the insured vehicle, passengers in it, and “other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle.” That last clause is how a pedestrian or a cyclist is covered by a policy they never bought — and how a person with no car of their own can still have PIP available through a household relative’s policy.
On the narrower side: medical benefits are 80 percent of reasonable charges, not 100 percent. Disability benefits under paragraph (1)(b) are “sixty percent of any loss of gross income and loss of earning capacity,” and must be paid at least every two weeks. And subparagraph (1)(a)5 excludes massage therapy and acupuncture from medical benefits entirely, whoever provides them.
PIP also has a deadline running the other way. Under section 627.736(4)(b), benefits “are overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of same,” and where an insurer pays part of a claim or rejects it, it must give “an itemized specification of each item that the insurer had reduced, omitted, or declined to pay.” If your bills are being denied, that itemization is the document that tells you why.
One more provision worth knowing if the at-fault driver was uninsured: section 627.733(4) provides that an owner required to carry security who did not have it at the time of an accident “shall have no immunity from tort liability, but shall be personally liable for the payment of benefits under s. 627.736.”
What comes back out of the settlement
The part nobody explains until the end, when it is too late to plan around.
A settlement is not what you keep. Several of the people who paid for your care have a right to be repaid from it, and the arithmetic decides whether an offer is worth taking.
Medicaid. Florida sets a formula. Section 409.910(11)(f) provides that after attorney’s fees and taxable costs, “one-half of the remaining recovery shall be paid to the agency up to the total amount of medical assistance provided by Medicaid,” and that for the purpose of that calculation the attorney’s fee “shall be calculated at 25 percent of the judgment, award, or settlement.”
Then the deadline almost nobody writes about. Under section 409.910(17)(a), a person who receives settlement proceeds must, within 60 days, pay the agency or place the full amount of the third-party benefits in an interest-bearing trust account pending a determination. And under (17)(b), where federal law limits the agency to recovery from the medical expense portion, the recipient may contest the amount by filing a petition with the Division of Administrative Hearings within 21 days of the payment or escrow — proving by “clear and convincing evidence” that a lesser portion of the recovery represents medical expenses. The statute calls that “the exclusive method for challenging the amount of third-party benefits payable to the agency.” Twenty-one days, one route, and it closes.
Medicare. Medicare pays conditionally and then recovers. Under 42 C.F.R. 411.24, where a conditional payment has been made, CMS “may initiate recovery as soon as it learns that payment has been made or could be made” under liability insurance, and a primary payer must reimburse Medicare even if it has already paid the beneficiary. Where procurement costs are involved, the reduction rule in 42 C.F.R. 411.37 applies.
Health insurance and letters of protection. Both are contractual. What a health plan may recover depends on the plan document, and what a provider holding a letter of protection is paid is negotiated — frequently down, and that negotiation is part of the work rather than an afterthought.
A claimed hospital lien. Whether a hospital actually has lien rights, and on what authority, is checked rather than assumed. A letter asserting a lien is a claim, not proof of one.
An illustration, not a prediction
A composite of how these files actually move. Every case is different and nothing here predicts a result.
A woman is taken by ambulance from a crash on Okeechobee Boulevard, admitted overnight, and discharged with a shoulder injury. Her bills: $14,000 hospital, $1,900 ambulance, then $7,000 of orthopedic care and physical therapy over four months.
Her PIP pays 80 percent of covered charges up to its limit, and because a hospital physician documented an emergency medical condition the full $10,000 was available rather than $2,500. Her health plan picks up most of the rest, subject to reimbursement. The orthopedist agrees to treat on a letter of protection for the balance her plan will not cover.
The at-fault driver has $50,000 in liability coverage and it is tendered. What she keeps depends entirely on the end-stage arithmetic: the health plan’s reimbursement claim, the letter of protection balance, and fees and costs. The letter of protection was negotiated down, and the plan was asked to document its right to reimbursement from the plan language rather than from a form letter.
Nothing in that paragraph is about liability. It is about why two $50,000 settlements can leave two people with very different amounts.
What to gather
A bills case is a paperwork case, and the paperwork is scattered across six places.
| Every bill and every explanation of benefits | From each provider and each plan, including the ones marked as denied |
| Your PIP log | What your own carrier has paid, to whom, and what remains of the limit. Ask for it in writing; you are entitled to know where your $10,000 went |
| The emergency medical condition determination | Or the absence of one. It is the difference between $10,000 and $2,500 |
| Your health plan’s summary and plan document | Not the member card. The reimbursement rights are in the document |
| Any letter of protection you signed | These get forgotten and then surface at settlement as a debt nobody budgeted for |
| Anything from Medicare, Medicaid or AHCA | Including conditional payment letters and any lien notice, with the date it arrived — because the deadlines run from dates |
| Collection letters, with envelopes | A bill in collections while a claim is open is usually a coordination failure rather than a debt you owe, and it is fixable |
Do you need a lawyer about the bills?
An honest answer, including when it is no.
Where you probably do not. One emergency department visit, PIP paid it, your health plan covered the balance, and nothing is in dispute. There is no claim to bring and no lien to negotiate.
Where you probably do. Your PIP was exhausted or capped at $2,500. Bills are going to collections while the claim is open. You have no health insurance and providers want payment up front. A provider is asking you to sign a letter of protection. Medicare, Medicaid or a health plan has asserted a right to repayment. A hospital has filed something it calls a lien. Or you are being offered a settlement and nobody has told you what has to come out of it.
The consultation is free, so finding out which one you are in costs a phone call.
Common questions
Who pays my medical bills after a car accident in Florida?
Your own personal injury protection pays first regardless of fault, 80 percent of reasonable charges up to the $10,000 limit in section 627.736(1), if you were seen within 14 days. Health insurance, Medicare or Medicaid, and letters of protection cover what PIP does not. The at-fault driver’s insurer pays once at the end, not as bills arrive.
Why did my PIP only pay $2,500?
Because no provider determined you had an emergency medical condition. Section 627.736(1)(a)3 opens the full $10,000 where a listed provider makes that determination, and subparagraph 4 caps reimbursement at $2,500 where one determined you did not. Whether the determination was ever made is worth checking.
Why is PIP only paying 80 percent?
Because that is what the statute provides: paragraph (1)(a) pays “eighty percent of all reasonable expenses for medically necessary” care. The remaining 20 percent normally goes to health insurance, or into the claim against the at-fault driver.
I have no health insurance. Can I still get treated?
Often yes. PIP applies regardless of insurance status, and beyond it some providers treat on a letter of protection, paid from a recovery. It is a real obligation rather than charity, and the amount is negotiated at the end of the case.
Does the at-fault driver’s insurance pay my bills as they come in?
No, and this is the most common misunderstanding about the process. Liability coverage pays once, at the end, after fault and damages are resolved. Nothing obliges it to pay a provider in the meantime.
Do I have to pay Medicaid back out of my settlement?
Yes, on a formula. Section 409.910(11)(f) directs that after attorney’s fees and taxable costs, half the remaining recovery goes to the agency up to the total Medicaid paid, with the fee computed at 25 percent for that calculation. Under (17)(a) you must pay or escrow within 60 days of receiving proceeds.
Can the Medicaid amount be reduced?
It can be contested, but on a short fuse. Section 409.910(17)(b) allows a petition to the Division of Administrative Hearings within 21 days of the payment or escrow, requires clear and convincing evidence that a lesser portion of the recovery represents medical expenses, and states that this is the exclusive method of challenging the amount.
What about Medicare?
Medicare pays conditionally and then recovers. Under 42 C.F.R. 411.24, CMS may begin recovery as soon as it learns a payment has been or could be made under liability insurance, and a primary payer must reimburse Medicare even if it has already paid the beneficiary. The reduction for procurement costs is governed by 42 C.F.R. 411.37.
A bill went to collections while my claim is open. What now?
Usually a coordination problem rather than a debt properly owed by you: a provider billed the wrong carrier, PIP was exhausted without anyone telling them, or a letter of protection was never filed with the account. It is normally fixable, and it is worth fixing before it reaches your credit.
The driver who hit me had no insurance at all. Who pays?
Your own PIP still pays first, and your uninsured motorist coverage carries the rest of the claim. Separately, section 627.733(4) makes an owner who was required to carry security and did not personally liable for section 627.736 benefits, and strips the tort immunity that security would have given them.
Where this fits
The claim types this answer touches, and how the firm runs them.
Talk to Paul, not a case manager
If bills are arriving faster than anyone is explaining them, that is a conversation worth having early rather than at settlement. Paul R. Shalhoub will go through them with you himself. Consultations are free and confidential. We advance case costs, and you owe no attorney’s fees or reimbursement of those costs unless we recover compensation for you.
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Shalhoub Law Injury & Accident, 1011 N Olive Ave, West Palm Beach, FL 33401. This describes Florida and federal law as of 27 October 2026 and applies to claims in Florida. It is general information, not legal advice, and reading it does not create an attorney-client relationship. Past results do not guarantee or predict a similar outcome.