Florida Health Insurer Reimbursement: What Section 768.76 Says and Does Not Say

By the FigureMyTax Editorial Team · How we calculate

A Florida health insurer or other collateral source with a subrogation or reimbursement right must assert it within 30 days of your notice or waive it, and is limited to the benefits you actually recovered from the at-fault party minus its pro rata share of your costs and attorney fees.

The statute

Fla. Stat. 768.76 addresses collateral sources, including health, sickness and disability insurance, automobile accident insurance that provides health benefits, and contracts to pay for hospital and medical care. Medicare, Medicaid and other programs with a federal lien or reimbursement right are not collateral sources under it. Where a provider has a subrogation or reimbursement right, subsections (4) to (9) set the rules for reimbursement.

The reduction

The provider's right is limited to the actual amount of collateral sources you recovered from the tortfeasor, minus its pro rata share of costs and attorney fees you incurred to recover them. Its share is found by deducting the percentage of the judgment or settlement that is for costs and fees. On a $100,000 settlement with $33,333 in fees and $3,000 in costs, a $9,000 claim is reduced by about 36.3% to roughly $5,730. A court decides disputes and may consider your comparative negligence, limited liability coverage and other mitigating factors (768.76(4) and (5)).

The 30-day waiver

You must send the provider, by certified or registered mail, notice of your intent to claim damages, with a statement that it will waive its right unless it asserts payment and its right within 30 days. If it does not, it waives subrogation and reimbursement for those benefits (768.76(6) and (7)). Keep proof of the mailing.

What we could not confirm

We did not read Florida case law on the made-whole doctrine, so the calculator applies the statute's reduction and does not assume that an insurer is barred until you are fully compensated. The statute's phrase "actually recovered" and the court's power to consider limited coverage point the same way, but ask an attorney whether a made-whole argument applies to your plan. A self-funded federal plan may not be bound by the statute, so ask for the plan document.

PIP is different

A PIP insurer has no lien on any tort recovery (627.736(3)). See how hospital liens and PIP differ and how Medicaid and Medicare recover. Run your own numbers in the Florida medical lien calculator.

This is general information, not legal advice, and the state comparisons above are illustrative, not an exhaustive survey. Confirm how Florida's rules apply to your specific case with a licensed Florida attorney.