How Do Personal Injury Protection Benefits (PIP) in Florida Work?

March 30, 2019
patondev
Personal Injury

One of the first concerns a lot of my clients have after an automobile accident is making sure that their personal injury protection (PIP) application forms are provided to their insurance carrier. This is extremely important to ensure timely payment of benefits. In Florida, PIP coverage is required to be purchased by all owners of motor vehicles registered in the state. PIP coverage makes the individual responsible for their own injuries in an accident regardless of fault.

What is PIP?

Personal injury protection is a type of “no-fault” insurance and is required in Florida. “Nofault” means that regardless of which driver was at fault, some of the medical expenses for the policyholder and others in the policyholder’s car may be covered by insurance. With PIP coverage, no blame needs to be assessed. If it is a covered incident, medical and lost income payments are made as soon as possible, and you deal only with your insurance company.

Who is Covered Under PIP?

If you are the insured on your policy, then PIP pays for your injuries if you are hurt in a car accident regardless of whether you are a driver or passenger of your own car or anyone else’s. It also covers relatives residing in your same household, persons operating your vehicle, and passengers.

Who Can Provide Medical Services Under Florida PIP law?

Medical doctors, Doctor of Osteopathic Medicine, chiropractors, hospitals, and EMS services. The Florida PIP statute does not allow massage therapists or acupuncturists to bill PIP for medical services rendered.

What are the Limitations?

In Florida, your PIP auto insurance will cover you up to the statutory limit of $10,000 or more for medical treatments, car repairs, and any other damages that are covered by your policy.

Medical Benefits

PIP covers 80% Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital, and nursing services if the services are received within 14 days after the motor vehicle accident. However, if the insurance carrier reviews your medical records and determines you’re your injury is a “non-emergency” than your PIP coverage may be limited to just $2,500.

Death Benefits

PIP Covers $5,000 in death benefits. per individual. Death benefits are in addition to the medical and disability benefits provided under any insurance policy. The insurer may pay death benefits to the executor or administrator of the deceased, to any of the deceased’s relatives by blood, legal adoption, or marriage, or to any person appearing to the insurer to be equitably entitled to such benefits.

How Long Does My Insurance Carrier Have to Pay PIP Benefits?

Under Fla. Stat. § 627.7401(1), an automobile insurance carrier must provide its insured with notice of all benefits provided by PIP coverage, when payments are due, how benefits will be coordinated with other insurance benefits, the penalties and interest imposed for untimely payments, and the rights of the parties regarding disputes. The notice must be mailed or delivered to the insured within 21 days after receiving notice of a claim.

Generally, once a carrier has been provided with written notice of a covered loss and the amount, it has 30 days to pay PIP benefits. Fla. Stat. § 627.736(4)(b). However, for the first 30 days after the PIP carrier is given notice of the accident, it must reserve $5,000 of PIP benefits for payment to physicians or dentists who provided emergency services or hospital inpatient care to the client. After this 30-day period, if the insurer has not received a claim for such emergency or inpatient care services, the insurer can then use any amount of the reserve that remains for other claims.

Speak with a Personal Injury Attorney

Those who have been involved in an accident of any kind could suffer serious injuries that may take months or years to recover from, and continued treatments and expensive medical bills can take a large toll on a person’s quality of life. Talking with an attorney may make it easier to get the money or other resources they need in order to make a full recovery, or as close to a full recovery as possible.

After any type of crash, you should consider talking to a car accident lawyer to learn what your rights and obligations are under the law. Let the personal injury attorneys at Suarez & Montero review the circumstances of your case and discuss your legal options. Our attorneys are ready to provide proven legal representation in pursuing your claim and stand ready to protect your rights.