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Can an Insurance Company Exclude Certain Medical Expenses From Claims?

Major accidents impact everyone in different ways. There’s more to it than physical damage to a vehicle or your person. It can also be the root of life-long injuries and mental and emotional trauma at times. Often, many also worry about and question the system in place. One of the most common concerns is whether insurance companies exclude certain medical expenses.

While this may seem like a trivial issue to some, it can be life-altering to others. There are times when those in this situation find that they have less-than-ideal answers. This is why it’s crucial that you understand your rights and what you’re entitled to. Knowing where you stand and what your leverage is, is necessary.

Get the most out of a vehicle or a car accident claim now. Know which medical expenses insurance companies are likely to exclude or dispute.

Getting Coverage

In the US, there are 12 states that require a No-fault or Personal Injury Protection (PIP). Florida is one of them; in context, all vehicles with at least four wheels need this type of insurance. Note that in these 12 states, it’s illegal to have an automobile and drive without PIP.

Through it, both parties who get into accidents get treated fairly. Regardless of who’s at fault, you won’t have to worry about the possibility of compensation. Even if one of the parties is completely in the wrong, there won’t be any issues with payouts.

This is vital, especially when you need to recover and get back on your feet after the accident. What’s even better is that it can also serve as a buffer, and most of the time, prevents full-fledged court cases. Not only do you get to be free of burdens, but you also save time and money.

It also protects people from predatory insurance companies. In turn, this reduces the likelihood of unfair and low-ball offers. But, while No-Fault or PIP is generally beneficial, it also has its caveats.

This is why not all states have it as a compulsory policy. Not a lot of insurance companies want to spend their money and time on you. There are also set limits on the compensation those involved can receive.

For the most part, it covers basic and common medical expenses but sometimes, it’s not enough to cover everything.

Dealing With Insurance Issues

The gist of things: PIP is not a full ride, and it’s not always as simple as it seems. There will always be legal jargon involved when trying to file a claim, more so if it’s a difficult one. One of the terms you need to know is proof of injury causation.

In layman’s terms, it only means the cause and effect of a person’s injuries. When filing a claim for injuries, the responsibility of proving they were a direct result of the accident falls on you. This can get tumultuous, as you’ll need evidence after evidence.

Any pre-existing conditions will undergo heavy scrutiny. This is especially true if the part in question has had previous medical attention. Your complete medical records have to be available for questioning most of the time.

Any medical evidence needs to have the backing of a reputable doctor or specialist. However, it’s worth mentioning that only a few of those in the medical field like involving themselves in such matters. This is one of the reasons why you need to know the basics of filing an auto accident lawsuit.

Trying to get these requirements alone isn’t something you can do with ease. More so, after a severe accident – you should be focusing on your health and immediate needs. Additionally, most premiums can only cover so much.

Your needs after an accident remain debatable to any insurance company. Most minor and general medical expenses are almost always covered, but not all.

Why Exclude Certain Medical Expenses?

Trying to define what is minor and general or unnecessary when it comes to an injury can be vague and unfair. Delving deeper, PIP covers an acceptable list of medical issues and injuries. Some of the most common ones are expenses related to:

  • Medical bills
  • Rehabilitation programs
  • Compensation for replacement services
  • Wages lost
  • Funerals

Also, considering Florida’s PIP minimum, you might be only entitled to up to $10,000. Anything above that means you’re out of pocket. More expensive medical services and expenses are almost always overlooked.

You’re unlikely to receive compensation for the more severe (and most likely permanent) problems. These can range anywhere from surgeries, amputation, or disfigurement. After-accident PTSD or other mental health services are sometimes non-existent too.

Worse, brain and spinal damage and paralysis are not often compensated. When this happens, it’s time to lawyer up. A car accident lawyer can help you deal with these through a personal injury claim.

Legal Advice Matters

When it comes to your health and well-being, dismissing your medical needs as “unreasonable” is unreasonable. Having the law and jurisdiction back you up is your best bet in getting what you’re entitled to. Especially when states with the No-Fault policy, like Florida, make it harder for you to do so.

There should be no cap or limit to the compensation you receive. Nor should they ‌‌exclude certain medical expenses or deny you access to any. More so if they’re valid and legitimate.

After all, it is your life, well-being, and future at stake. The trauma and stress of getting into an accident aren’t something money can erase.

Knowing What Medical Expenses Insurance Can Exclude

No one likes being in an accident. Stressing about whether your insurance will cover your medical bills is even worse. By looking into what your state or jurisdiction requires of insurance companies, you can rest easy.

If all else fails and you need to know your rights after an accident, it helps to have good lawyers. At RHINO Lawyers, we have the experience to help you get what you’re entitled to. Contact us today and get the help you need and deserve.


In short, after a car accident, you may not know your rights. Above all, don’t struggle through the process alone. Actually, our personal injury team is here to help you with any legal needs you might have regarding your accident.

Lastly, let RHINO Lawyers answer your questions and review the facts of your case with a Free Consultation. So, get started by completing the “Free Instant Case Evaluation” or by calling us any time, day or night, at 844.RHINO.77.