How Does Florida Personal Injury Protection Work after a Car Accident?

how florida pip insurance works

Florida is one of a minority of states that makes personal injury protection (PIP) coverage mandatory for anyone who registers a vehicle in the state. The PIP requirement aims to cut down on lawsuits and make compensation more quickly and easily available for people who sustain injuries in car accidents. In fact, a person who is injured in a Florida car accident generally can’t file a personal injury lawsuit against the responsible party unless his or her injuries are serious.

This no-fault insurance covers the policyholder, any relatives living with the policyholder who are not required to carry their own PIP insurance, anyone driving the policyholder’s car with permission, and anyone struck by the car who was not in an automobile at the time of the collision.

Florida PIP Benefits

Benefits under Florida’s no-fault law are very limited. All PIP benefits fall into one of three categories:

  • Medical Benefits: PIP will cover up to $10,000 in medical expenses after a car accident, provided that the injury constitutes an “emergency medical condition.” For non-emergent medical conditions, medical coverage is limited to $2,500. PIP also works more like medical insurance than automobile liability insurance, in that it covers only 80% of eligible medical expenses.
  • Disability Benefits: PIP benefits cover 60% of wages lost due to a covered injury, along with the costs of housekeeping and other necessary tasks the injured person may be unable to perform as a result of the accident. However, the combined total of disability benefits and medical benefits is limited to $10,000.
  • Death Benefits: PIP pays $5,000 per individual in death benefits. Death benefits are in addition to any medical or disability benefits paid, and are payable to the deceased’s estate, a surviving spouse, or other family member.

With the average cost of an overnight stay at a non-profit hospital in Florida running upwards of $2,300 and 60% of the median income for an individual earner in the state at just over $567 per week, it’s easy to see how quickly those benefits could be exhausted. Fortunately, those with more serious injuries requiring more extensive care and more time off work have other options, such as retaining a car accident lawyer to pursue a personal injury claim against the person responsible for the crash.

Exclusions Under the No-Fault Law

An insurer may deny PIP benefits to the insured and relatives living in the same household if they are injured in another motor vehicle owned by the policyholder but not included on the policy. And, coverage may be denied if the injured party intentionally caused the injury or the injury occurred in the commission of a felony.

Claiming PIP Benefits after a Florida Car Accident

Because personal injury protection is no-fault–meaning that a claimant needn’t prove that someone else was responsible for his or her injuries–PIP fraud is among the most common types of insurance fraud. Thus, there are some special procedural requirements for PIP claims.

  • Seek Medical Assessment within 14 Days: This requirement places the strictest limitation on PIP claims, since it is not uncommon for people who have been injured in car accidents to realize over time that their injuries are more serious than they originally recognized. In a personal injury case, that may create problems with evidence and credibility, but it doesn’t automatically cut off the claim. To qualify for PIP benefits, though, you must see a medical professional within 14 days.
  • Get an Emergency Medical Condition Determination: The medical professional you consult should assess whether or not your injuries constitute an emergency medical condition under the definition set forth in the PIP statute, and note emergency or non-emergency classification.
  • Submit a Claim with Your PIP Insurance Carrier: Your PIP carrier is required to pay benefits within 30 days of written notice of your claim and the amount of your claim.
  • Be Careful What You Sign: Some insurance carriers may ask you to sign a release of claims in exchange for payment under your PIP policy. But, if you have more extensive injuries or property damage, this could turn out to be a serious mistake. If you’re asked to waive or release claims, it is in your best interest to check with an attorney before signing.

The no-fault law imposes procedural obligations on medical providers as well. With limited exceptions, the PIP carrier is not required to pay charges incurred more than 35 days prior to the postmark date of the provider’s statement. And, Florida’s PIP law excuses the injured person from paying those charges as well.

Pursuing Compensation for More Extensive Injuries

Florida’s personal injury protection insurance, combined with no-fault property damage coverage, offers a safety net for those involved in relatively minor car accidents, or who have been involved in more serious accidents and need some compensation right away. But, for those who suffer more serious injuries, need ongoing medical care, or have a longer-term loss of income, PIP will likely be insufficient.

If you’ve been injured in an accident, it’s in your best interest to speak with an experienced auto accident attorney as soon as possible. It may not always be necessary to work with a personal injury attorney to pursue a PIP claim. But, when that claim is just one piece of securing compensation for a more serious injury, it’s usually best to talk to an attorney right away and get some guidance on how to coordinate and protect your claims.

Schedule Your Free Consultation With a Personal Injury Attorney

The experienced auto accident attorneys at Harrell & Harrell, P.A. offer free consultations to ensure that people who have been injured in Florida car accidents have the information they need to make good decisions for their futures. You can schedule yours right now by calling 800-251-1111 or clicking on the chat icon at the lower right corner of this page. We’re available 24 hours a day to help you take the first step toward pursuing the compensation you need to rebuild after a serious car accident.

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