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Navigating Through the Nuances of the Florida PIP Law

Most states (38 in fact) require owners of motor vehicles registered in their respective states, to carry a statutory minimum amount of bodily injury (BI) insurance to cover injuries caused by the negligent acts of the insured. Under Florida’s no-fault vehicle insurance laws, there is no requirement for a vehicle owner to carry any BI coverage at all. However, all Florida insurance companies must provide insurance coverage of $10,000 (also referred to as “PIP benefits”). PIP also includes a separate no-fault $5,000 death benefit. The purpose of the no-fault insurance is to provide the injured party with immediate access to medical treatment regardless of whether they were at fault or have medical insurance. For those located in the other 38 states with mandatory BI coverage, Plaintiffs must prove liability before BI insurance will cover the medical expenses of the injured party.

Florida’s no-fault insurance statutes came into being in the early 1970’s as part of The Automobile Reparations Reform Act. The $10,000 PIP coverage amount was set in 1979 and certainly has not kept up with inflation, much less the increased costs of medical care.

When one buys an insurance policy in Florida, as stated above, it MUST include PIP and death benefit coverage of $10,000 and $5,000 respectively. There are still some options however for the purchaser.

The named insured may elect to purchase PIP coverage with a deductible for $250, $500 or $1,000. This deductible will only apply to the named insured and any dependent relatives of the named insured. The deductible applies to 100% of the initial medical expenses up to the deductible amount. Once the insured has paid his or her deductible, the $10,000 PIP coverage kicks in at its 80% reimbursement level.

The named insured may also elect what is called modified PIP coverage, where the 60% lost wage reimbursement portion of PIP is eliminated for the named insured and any dependent relatives. Choosing either a PIP deductible or modified PIP coverage will result in a reduced premium.

PIP covers the following people:

1.) named insured, but it also provides coverage for

2.) relatives living in the same household,

3.) persons operating the insured’s vehicle, and

4.) passengers in the vehicle and other persons struck by the insured motor vehicle and injured while they were not an occupant of a self-propelled vehicle, i.e., a pedestrian or bicyclist.

For PIP coverage under instances described in paragraphs 2-4 above, PIP coverage will be under the owner of the motor vehicle’s policy they were occupying or struck by unless the injured party owns a vehicle registered in the state of Florida. In that instance, coverage will be under the injured party’s PIP. If the injured party has a vehicle registered in Florida and they have let their insurance lapse, then that party will have NO PIP coverage, and the at-fault party will have a set-off of $10,000 against any claim brought by the injured party against the at-fault’s BI coverage. PIP coverage for the owner and their relatives, who live in the same household, extends through the U.S., its territories and Canada for instances where the owner or relative was an occupant of the owner’s vehicle. The PIP protections for pedestrians, bicyclists, etc. only extends within the boundaries of Florida.

What does one do to secure their PIP coverage after a collision? The most important is to seek initial medical treatment within 14 days of the collision. Medical treatment must be rendered by a doctor, dentist, chiropractor, Emergency Medical Service provider (i.e., an ambulance), or a hospital or facility that owns, or is owned, by a hospital (i.e. an ER).

If one received initial services through a chiropractor, it is important to have an examination performed by a physician, dentist, physician’s assistant or an advanced registered nurse practitioner (ANRP) to determine whether you have suffered an “emergency medical condition.” An Emergency Medical Condition (EMC) is an acute condition that requires immediate medical treatment. A finding of an “EMC” allows the insured coverage for the full $10,000 PIP benefit. Without such a finding, PIP benefits are limited to $2,500.

PIP payments are unique in that they are not subject to subrogation claims by your insurance. For example, if you have health insurance through Blue Cross/Blue Shield, and Blue Cross pays your medical bills on your behalf due to an injury caused by the negligence of another, your insurance company is entitled to reimbursement from your settlement.

As stated at the beginning of this post, the $10,000 PIP coverage is woefully inadequate to cover medical expenses one incurs when injured as the result of a motor vehicle collision. A single trip to the ER, with a radiological exam such as a CT scan, can easily run more than $10,000. For this reason, it is imperative that you contact a law firm that has experienced attorneys and staff, as well as a proven track record in the personal injury arena, to ensure your claim has the best chance for a successful outcome.

Attorneys Aaron Watson, Eric Van Loock and the rest of The Watson Firm team will work hard on your car accident case. Contact The Watson Firm for a free consultation for your car accident case. Nothing is owed for our services unless we first make a recovery in your claim.