What Is a Set Off in a Florida UM Claim?

When you file a personal injury claim under Uninsured Motorist/Underinsured Motorist (UM) insurance, it is important to know about “set offs.” Read on to understand what constitutes a set off in a Florida car accident claim, and how set-offs affect the overall settlement amounts in an injury claim involving UM benefits.

If you are injured in a Florida car collision in which the at-fault driver carries little or no liability insurance, you may file a claim under your UM policy. UM protects you in the event the person who causes an accident and injures you is not insured, or is insufficiently insured, or a hit-and-run driver injures you.

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In a case involving serious or permanent bodily injury, UM coverage will help you recover money damages for:

  • Wage loss
  • Medical bills
  • Future economic loss such as loss of income, long-term disability or future hospitalization or surgeries
  • Pain and suffering
  • Mental anguish
  • Loss of consortium

What is a Set Off?

In any automobile accident involving injuries, various forms of insurance often come into play. Multiple insurers may pay benefits on a single claim.

For example, when you go to the ER or the doctor’s office for medical treatment for injuries, you would give each care provider all of your insurance coverage information. This may include PIP, Medpay, Worker’s Compensation, Medicare and other health insurance.

When this happens, coverage sometimes overlaps. It is possible for an insured to get double recovery in certain cases.

UM providers are entitled to set off—deduct from the claimant’s damages—an amount of money paid to an injured party from some other coverages or other transactions. Otherwise, a claimant would stand to collect twice on an award of benefits.

Set-offs are Governed by Florida Statute

Fla. Stat. § 627.727 says that UM benefits are intended to be over and above, but not duplicating the benefits available to you and your insureds under various forms of insurance or other coverage. It is up to the UM provider to show duplication of benefits.

What Set-Offs Can You Expect in a Florida UM Claim?

Personal Injury Protection (PIP) and Medical Payment Coverage (MedPay):

PIP and MedPay are allowed to be set off against an award of UM benefits. An exception to the rule is, in cases where PIP or MedPay benefits are pending award and are still available, the UM provider cannot set off for anticipated or “likely” coverage.

Workers’ Compensation:

Workers’ Compensation benefits that have been paid, or are due and payable, may be set off against UM coverage.

However, the UM provider cannot set off for “likely” coverage. As portrayed in USAA Cas. Ins. Co. v. McDermott, the Florida Court of Appeals held that a UM insurance provider is not entitled to a setoff for workers’ compensation benefits that were likely to be available or payable to the employee in the future.

UM Awards May Also be Set Off Against:

  • Disability benefits or similar compensation under similar law;
  • Bodily injury limits of the uninsured, at-fault motorist’s automobile liability policy.

Medicare Benefits Are Not Set Off

Medicare benefits will not be offset from a UM award. Medicare is a Federal health insurance program targeting a specific set of people for their general welfare: individuals over age 65, those under age 65 with certain disabilities, and people with permanent kidney failure needing dialysis or a kidney transplant.

Therefore, Medicare cannot be compared to UM insurance coverage, which compensates an insured for injuries triggered by an automobile accident caused by an uninsured vehicle.

Know Your Legal Rights

If you were recently injured in an Orlando car accident, you need precise, insightful answers to questions about insurance coverage and many other details you have never before faced.

We urge you to call Kramer Law for straightforward, practical advice based on the facts of your case. It costs nothing to have your case reviewed by our injury lawyers.

A full service law firm, Kramer Law is here to protect you, your family, your home, and your business with any legal issue, one firm for life.

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