Frequently Asked Questions - What is Personal Injury Protection PIP?
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." (emphasis added)
Practically speaking, what all of this means is that if you are a Florida resident and/or own a motor vehicle that is licensed in Florida which is also insured under a motor vehicle insurance policy issued by a carrier (insurance company) operating under Florida law, in the event that you are involved in a motor vehicle crash that occurs within the State of Florida 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. 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.
Other issues of significance that involve the PIP insurance coverage contained within your insurance policy include the fairly recent requirement that you must 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.
In addition to the above, there are a number of other things that you need to know if you are involved in a motor vehicle accident within the State of Florida. For instance, the insurance coverage provided under the PIP portion of your motor vehicle insurance policy is generally "primary" over all other sources of insurance, including any health insurance, Medicare, Medicaid, etc. Therefore, you need to contact your motor vehicle insurance company as soon as possible after your accident occurs to report your accident and to obtain a Claim Number from them as this Claim Number is what you will provide to your medical providers (MPs), including any hospital emergency room that you go to or any chiropractor, orthopedic surgeon, physical therapist or other crash-related medical provider that you may treat with following the crash. The offices of these MPs will then utilize that claim number and other information they obtain from you to submit your bills directly to your motor vehicle insurance company, which should then pay these bills within 30 days of receipt. It doesn’t always work that way, but that’s the way it’s supposed to work. Our firm has attorneys who handle PIP claims against insurance companies who fail to pay, or timely pay, for your crash-related bills and lost wages, so feel free to contact us if any problems arise.
Other issues you should be aware of include the fact 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. This is where Trial Pro comes into play. 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.
As previously referenced, your PIP insurance coverage does not only pay for a portion of your auto accident-related medical bills, it can also be used to help pay for a portion of any lost wages or loss of earning capacity that is caused or related to injuries that you receive in the motor vehicle crash. Under Florida's No-Fault Law, your PIP coverage can be used to pay for 60 percent of any accident-related lost wages that you incur as a result of injuries received in the crash but generally only if you are able to prove that your inability to work was as a result of injuries you received in the crash. Practically speaking, your auto insurance company will generally require you to have a written "no-work slip" or something similar from one of your treating physicians or a hospital emergency room physician before it will agree to pay you lost wage benefits under the PIP portion of your motor vehicle insurance policy. This is one of many reasons why we strongly suggest that you seek medical treatment as soon as possible after your motor vehicle crash if you have sustained injuries in the crash that you believe will keep you from going to work or from fully performing any or all of your work responsibilities.
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 Trial Pro to have discussions about 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.
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.