Understanding Personal Injury Protection (PIP) in Florida: What You Need to Know After a Motor Vehicle Crash

People who are involved in motor vehicle crashes within the State of Florida frequently ask us, what is Personal Injury Protection (PIP)?  The literal answer is that Personal Injury Protection (PIP) is a type of insurance coverage that is contained within any motor vehicle (auto) insurance policy issued within the State of Florida and is one of only two types of insurance coverages required to be maintained on your motor vehicle under Florida law. The other required type of coverage is Property Damage Liability coverage.  Everyone who owns a “motor vehicle” licensed with/by the State of Florida is required to obtain a motor vehicle insurance policy that contains $10,000 in PIP coverage for payment of medical and disability (lost wage) benefits or $5,000 in Death benefits and $10,000 in Property Damage Liability coverage in order to be able to lawfully drive on the public roads within the State of Florida. The State of Florida is one of many (but certainly not all) states that utilize, for motor vehicle insurance coverage purposes, what is generally referred to as a “No-Fault Law” and PIP insurance coverage is one of the primary components of this type of insurance approach.

The Florida Motor Vehicle No-Fault Law is codified within Florida Statutes Sections 627.730-627-7405 and its primary purpose is “to provide for medical, surgical, funeral, and disability insurance benefits without regard to fault, and to require motor vehicle insurance securing such benefits, for motor vehicles required to be registered in this state, and with respect to motor vehicle accidents, a limitation on the right to claim damages for pain, suffering, mental anguish, and inconvenience.”

What all of this means is that if you are a Florida resident and/or own a motor vehicle that is licensed in Florida, it is also insured under a motor vehicle insurance policy issued by a carrier (insurance company) operating under Florida law, if you are involved in a motor vehicle crash and you are injured and require treatment for those injuries or sustain lost wages related to the crash, regardless of whether you are at fault or the driver of any other vehicle involved in the accident is at fault, you will utilize the PIP coverage contained within your own insurance policy to pay for your accident-related medical treatment and lost wages.

Why Do I Have to Use My Own Insurance After a Crash That Wasn’t My Fault?

We have many clients who say to us that this does not make any sense. They say, “The crash was not my fault, why should I have to use my own car insurance to pay for my crash-related medical treatment? Why shouldn’t the at-fault driver’s car insurance company have to pay for my medical bills and lost wages?” The answer is that while we can understand why you think that it this law doesn’t seem fair, the Florida Legislature, way back in 1971, decided to change the law in Florida and create the Florida Motor Vehicle No-Fault Law. Since that time through the present, Florida’s No-Fault Law has existed in some form or another and it requires you to use the PIP coverage within your own motor vehicle insurance policy to pay for these types of crash-related expenses. The overall philosophy behind the No-Fault Law in general, and PIP insurance coverage specifically, is to make sure that your medical bills get promptly paid without requiring you to fight with the drivers of any other vehicles involved in your crash (and their insurance companies) about who was at fault for the crash. Those kinds of disputes and disagreements frequently arise after car crashes occur and if the No-Fault law was not in effect, then a lawsuit would then have to be filed to get your medical bills and lost wages paid. Lawsuits take time and money and require attorneys to be involved. The No-Fault law seeks to avoid that problem by mandating that your own car insurance and its PIP coverage, regardless of who is at fault for the crash, will be used to make sure that your accident-related medical bills and lost wages get paid. So, it’s a trade-off and unless and until the legislature changes the law, that’s the way payment of these expenses has to be handled.

The 14-Day Rule for PIP: Why Prompt Medical Attention After a Car Crash is Crucial in Florida

To qualify for PIP, you must report the injury to your policy and seek some type of crash-related medical attention within 14 days of the date of your motor vehicle crash in order to be eligible to receive any PIP coverage benefits contained within your auto insurance policy.  If you do not receive any accident-related medical treatment within 14 days of the date of your motor vehicle crash, then under Florida law you have forfeited your right to have any of your accident-related medical bills paid for by the PIP coverage contained within your Florida motor vehicle insurance policy.  Therefore, this is yet another very important reason for you to promptly seek medical treatment for any injuries or symptoms you have as a result of the motor vehicle crash. Our recommendation, if for no other reason than to avoid losing your entitlement to use insurance coverage that you have paid for, is that you go to a hospital, urgent care facility, or some type of physician or medical/chiropractic provider within 14 days of your crash and get checked out. Be sure to tell them that you were involved in a motor vehicle crash, give them the date and general location of the crash, and if you have pains or symptoms in certain areas of your body that have come on since the crash, tell them about those specific symptoms. If you are not feeling any specific pains, tell them that you just want to get examined so they can see if you have any problems that might have been caused by the crash. Many times, pain and symptoms caused by auto crashes or other types of accidents do not immediately cause pain or symptoms. It may be days or weeks later before you fell anything. But, due to this 14-day treatment requirement under Florida’s PIP law, in our opinion it’s better to be safe than sorry so this how we recommend you handle the situation. Feel free to call or email us, or contact us on the Web, if you’d like to discuss this further.

Why It Only Covers 80% of Medical Bills and How to Recover the Rest

You should be aware that the PIP coverage under your motor vehicle insurance policy does not pay for 100 percent of your accident-related medical bills.  Rather, under Florida law, your PIP carrier ( your auto insurance company) is only required to pay 80 percent of the “reasonable amount” of any medical bills associated with any “reasonable and medically necessary medical treatment” that was necessitated by the motor vehicle crash after any PIP deductible contained in your policy is factored in.  There is a Fee Schedule contained within the PIP statutes that is used to help determine what constitutes a “reasonable amount” of medical expense for a given type of treatment. Again, this is a topic that is subject to a fair amount of dispute and therefore a fair amount of litigation. Since the PIP carrier only pays 80% of your “reasonable bill amounts”, the remaining 20 percent is essentially a co-pay percentage that you are personally required to pay. The good news is that this co-pay percentage is an expense that can then be included within any claim that you file against the at-fault party, assuming that the crash itself was not your fault but instead was the fault of the driver of another motor vehicle involved in the crash. We can help you recover for these and other types of financial losses and damages that you sustain and also help you obtain compensation for any injuries you incur in the crash that are a result of someone else’s fault.

PIP Coverage Limits and Emergency Medical Conditions

The amount of PIP coverage required under Florida law is $10,000. While you are allowed to obtain PIP coverage with policy limits higher than $10,000, our experience is that few people do so. Therefore, for most people, once your PIP carrier has paid out its full $10,000 in PIP benefits, then generally speaking your PIP coverage will then be deemed “Exhausted” and you will thereafter have to find some other way to pay for any additional crash-related medical treatment, lost wages or loss of earning capacity that you incur. We invite you to contact our office to discuss whether we can be of assistance to you in this regard as depending on the facts of your crash ( i.e. Who was at fault), the types and amounts of insurance coverages that any other person or entity involved in the crash may have, as well as the other types of insurance coverages you may have under your own auto policy or potentially other types of insurance policies, we may well be able to help you obtain a financial recovery for these types of losses and for your crash-related injuries. Please be aware that in order to be eligible to receive the full $10,000 in PIP benefits, at some point in time after the crash occurs, you must have been deemed to have undergone an “Emergency Medical Condition (EMC)” as a result of the crash by a medical doctor, osteopath, dentist, physician’s assistant or nurse practitioner. If no such medical provider says that your injuries were of a magnitude that you sustained an EMC, then instead of being eligible for the full $10,000 in PIP benefits, that amount will be reduced to $2,500.

Vehicle Exclusions from PIP Coverage: Why Additional Insurance is Essential in Florida

Not every motor vehicle that travels on Florida roads is required to have PIP insurance coverage.  For instance, the No-Fault Law contains several vehicle “exclusions”, such as a taxi cabs, school buses, any type of public transit bus, or motorcycles or motor scooters.  Those vehicles are not required to have PIP coverage under their insurance policies. And, with respect to motorcycles or motor scooters, no insurance company will even write a policy on them that includes PIP coverage.  However, with the exception of those specific types of vehicles and perhaps a few others, every other “motor vehicle” licensed within the State of Florida must have a motor vehicle insurance policy that includes $10,000.00 in PIP coverage and $10,000.00 in property damage liability coverage. This does Not mean that every vehicle driven on Florida roads actually contains these coverages, or any coverage for that matter. This is why we strongly suggest that you obtain Uninsured Motorist (UM), Bodily Injury and Collision and Comprehensive coverages within your own auto insurance policy. You do Not want to have to rely upon the other driver/vehicle being properly insured in order to be able to be fairly compensated for any financial damages and/or injuries you sustain in a motor vehicle crash caused by another’s negligence. However, that is a topic for another day, or at least for another article on our website.