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Have questions about Florida PIP law? Our personal injury lawyers are experts in this area, and we have the answers to all of your questions. Like every state, Florida has requirements for auto insurance that drivers have to abide by, and insurance companies will typically sell only policies that meet the requirements. In Florida, one of the requirements is Personal Injury Protection (PIP), also called No-Fault Coverage.
PIP is generally required for Florida vehicles with four or more wheels and provides no-fault benefits for medical expenses and lost income after a covered motor vehicle accident, regardless of who caused the crash. Florida’s required PIP coverage provides up to $10,000 in combined medical and disability benefits, subject to the terms and limitations of the law and policy.
PIP is generally required in No-Fault states, including Florida. The purpose of PIP is to reduce the number of lawsuits. Personal injury protection is thus designed to ensure that your medical bills are covered without the need to sue the other driver over small amounts.
Florida PIP is no-fault coverage, meaning benefits may be available for covered injuries without regard to who caused the accident. PIP benefits are primary for covered losses, subject to the requirements and limitations in Florida law.
After a traffic accident, regardless of who was responsible, PIP may cover your qualifying medical expenses up to the applicable limit. In Florida, it is considered the primary payer; that is to say, it is the first source turned to by medical providers to cover your expenses. This can help keep your health insurance from being impacted by an accident.
PIP covers the named insured and certain relatives residing in the same household, people operating the insured vehicle, passengers in the vehicle, and certain people injured by the vehicle while not occupying another self-propelled vehicle.
PIP can also apply in situations involving:
PIP covers the driver and will also cover you if you were riding in somebody else’s car, or if you were struck by a vehicle as a pedestrian or bicyclist. Personal injury insurance will also cover family members who reside at the same address, and everyone who has access to the car should be listed on your insurance policy as a driver or excluded driver. PIP will also cover anyone who was a passenger in your car. It will cover you if you are driving a car you do not own, such as a rental.
Florida PIP provides up to $10,000 in combined medical and disability benefits, plus a separate $5,000 death benefit. The amount actually available for medical treatment can depend on whether the injured person is determined to have an emergency medical condition (EMC), and PIP benefits are subject to statutory requirements and policy terms.
PIP covers many types of medical treatment, including medical and surgical services, diagnostic services, ambulance services, dental services, and rehabilitative services when the statutory requirements are met. Florida law also excludes certain services, including massage therapy and acupuncture, from PIP medical benefits.
For non-emergency injuries, such as whiplash, Florida law generally limits PIP medical reimbursement to $2,500 when a qualifying medical provider determines that the injured person did not have an emergency medical condition (EMC). If a qualifying provider determines that the injured person had an EMC, medical reimbursement may be available up to the $10,000 PIP limit.
Florida law defines an emergency medical condition based on whether the condition could reasonably be expected to place the patient’s health in serious jeopardy, seriously impair bodily functions, or cause serious dysfunction of a bodily organ or part. The determination of whether an EMC exists can therefore affect the amount of PIP medical benefits available.
If PIP does not cover all of your medical expenses, other insurance coverage may apply depending on the circumstances and the terms of the applicable policy. Also, PIP generally requires initial services and care within 14 days of the crash for medical benefits to apply. This means it is very important to seek medical attention promptly (and also legal advice in case you need to recover damages from the other driver).
Florida law requires PIP policies to provide up to $10,000 in medical and disability benefits and $5,000 in death benefits. However, Florida law also allows a named insured to elect certain deductibles or modified coverage. For example, a policyholder may elect a $250, $500, or $1,000 deductible and may elect to exclude coverage for lost income and lost earning capacity. These choices can reduce the premium associated with the coverage.
PIP also provides a $5,000 death benefit to cover qualifying death-related expenses. It can also provide benefits for “replacement services,” meaning reasonable expenses for ordinary and necessary household services that you would have performed but for your injury.
Once your PIP coverage is exhausted, then you have to turn to other measures, including uninsured motorist coverage.
Medical Payment coverage, or MedPay, is often confused with PIP. However, the two types of coverage are not the same. PIP provides no-fault benefits required under Florida law, while MedPay is optional coverage that may provide additional benefits for medical expenses, depending on the terms of your policy.
MedPay can help pay medical expenses that are not covered by PIP, including certain out-of-pocket costs, depending on the amount of coverage you purchased and the terms of your policy. It may also help cover a PIP deductible when permitted by the policy.
However, MedPay can only be used to cover medical expenses. Unlike PIP, MedPay does not provide benefits for lost income or replacement services.
As already mentioned, treatment for injuries has to start within 14 days. Florida law generally requires an injured person to receive initial services and care within 14 days after the accident for medical PIP benefits to apply.
PIP benefits are primary for covered losses and are due as the loss accrues after the insurer receives reasonable proof of the covered loss and the amount of the expenses or loss. Generally, PIP benefits are overdue if they are not paid within 30 days after the insurer receives written notice of a covered loss and the amount of that loss, subject to statutory exceptions.
You should keep a log of all of your medical expenses. If filing a claim for lost income, then your employer will need to fill out something called a “Wage and Salary” verification, which shows your wages in the 13 weeks before the accident. Your doctor will also need to give you a note saying why you are unable to work.
Because PIP benefits are primary for covered losses, you should make sure your medical provider has the correct PIP insurance information when you receive treatment after an accident. Your health insurance may also have its own requirements for coordinating benefits, so keep records of bills, insurance information, and claim communications.
Bear in mind that your insurance company can have you examined by a medical provider of their choice.
You should make sure your medical provider knows who your PIP provider is at the time of treatment and that the treatment is related to an accident where PIP applies, so the claim can be submitted to the appropriate insurer.
Yes. Florida’s no-fault system does not completely prevent an injured person from bringing a lawsuit against an at-fault driver. However, Florida law places limits on when an injured person can recover damages for pain, suffering, mental anguish, and inconvenience.
Under Florida law, the tort threshold can be met when the injury consists of a significant and permanent loss of an important bodily function; a permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement; significant and permanent scarring or disfigurement; or death.
Medical expenses exceeding the $10,000 PIP limit, by themselves, are not the statutory test for whether the tort threshold has been met. An injured person may have additional claims depending on the nature and permanence of the injury, the damages involved, and the circumstances of the accident.
Because the ability to pursue a claim against an at-fault driver depends on the facts and the nature of the injury, it can be helpful to have the circumstances reviewed before assuming that PIP is the only available source of compensation.
If you have good bodily injury insurance, you can avoid ending up in court if another driver elects to sue you for damage. Many of these cases are settled out of court, although a lawyer is still necessary to get the best settlement possible. Never agree to a settlement quickly or on the spot; some insurance companies will pressure you to agree to one right after the accident so that you don’t get the full amount you might be entitled to. This is less common in No-Fault states but still happens.
The cost of PIP coverage varies based on factors such as the insurer, driver, vehicle, location, deductible, and coverage choices. Florida law allows certain deductible and coverage elections that can affect the premium. You can shop around different insurance companies to compare premiums and coverage options.
Before choosing a higher deductible or excluding lost-income coverage, consider whether you could pay the deductible or replace the benefits you would give up if you were injured in an accident.
Remember, PIP is mandatory in Florida. Ideally, your insurance company should explain this coverage to you and how it works, but this does not always happen. It may well be presented to you as simply part of the bundle with no more information given. As PIP can be confusing, it may be beneficial to talk to a lawyer to get a better understanding of the law as it applies to you specifically, particularly if you have a large household, teenage drivers, and/or multiple cars.
If you have a question about your PIP coverage or have been in an accident and are not sure how to properly file a claim, you should contact Herman & Wells for a free evaluation. Feel free to call us today to learn more about the services we have to offer.