How Does PIP Coverage Work in Florida?

24Mar
Sad disabled woman claiming on phone about notice

How does PIP coverage work in Florida? Personal injury protection, or PIP, is the first part of the compensation process in a car accident. To legally operate a motor vehicle, every registered vehicle owner must retain the state’s minimum coverage, and that includes a PIP policy. The amount a victim is awarded through PIP is based on the severity of the accident. Personal injury attorneys are the support system a car accident victim needs to navigate the often difficult insurance claim process. 

Sad disabled woman claiming on phone about notice

What Is Personal Injury Protection (PIP)?

Personal Injury Protection is a form of no-fault insurance. PIP insurance is the primary coverage for a victim’s economic damages post-accident.

Florida requires drivers to retain a minimum amount of $10,000 in PIP coverage through their auto insurance provider. PIP covers eligible victims for up to 100% of household services (a limit of $10,000), 80% of medical bills, 60% of lost wages, travel reimbursement for medical appointments, and $5,000 in death benefits. 

Victims must seek professional medical treatment within 14 days of their auto accident. Benefit limits are set to $2,500, unless there was an emergency medical condition (EMC) present. PIP policies will not cover non-economic losses. Non-economic losses are often referred to as pain and suffering, and do not have direct fiscal costs.

How Does PIP Coverage Work?

Accident claims must be reported within 24 hours for PIP coverage to work. Medical treatment must be sought within 14 days of the accident. Proceeding with contacting his or her auto insurance company, a victim must provide any evidence and relevant paperwork to support his or her claim within 35 days from the date of the accident. 

Seeking Initial Medical Treatment

An initial diagnosis must be provided in a hospital or medical facility owned by a hospital, or given by a member of a list of qualified medical professionals.  In Florida, these professionals may include a licensed medical doctor (M.D.), Doctor of Osteopath (D.O.), Dentist (DMD), Doctor of Chiropractic (DC), Physician Assistant (PA), or Advanced Registered Nurse Practitioner (ARNP).

Follow-Up Appointments

A medical professional may want to check on a patient’s progress at a later date. To be covered under PIP, follow-up care and services require an (M.D., D.O., DMD, DC, PA, and ARNP) referral. PIP coverage limits any of a victim’s post-accident care to treatment compatible with his or her initial medical diagnosis. Acupuncture and massage therapy were eradicated from the eligibility list for PIP benefits, meaning victims must pay via health insurance or out-of-pocket for these services.

PIP Compensation

A victim is limited to $2,500 in PIP benefits if he or she is not diagnosed with an emergency medical condition (EMC). An EMC is any symptom, condition, illness, or injury severe enough to require a reasonable person to seek immediate medical attention. Qualifying EMCs feature intense pain and, in the absence of prompt medical care, could result in jeopardy of the victim’s health, serious impairment of his or her bodily functions, or dysfunction of any bodily organ or part. A victim that is diagnosed with an EMC will be eligible for his or her full $10,000 in PIP insurance benefits.

Examination Under Oath

Insurance companies may require a participatory examination under oath (EUO). Questioning can be a lengthy and invasive process, discussing a victim’s complete medical history. EUO questions should be limited to suitable information. Questions may include any material that could reasonably be anticipated to lead to other relevant data.

Will I Qualify for PIP Benefits After a Car Accident?

PIP is no-fault insurance, and a driver believed to be at fault for an accident can still be eligible for compensation. As this is a mandatory form of insurance in Florida, injured victims with acceptable insurance coverage will qualify for PIP benefits. To recover through PIP, victims must seek medical treatment within 14 days from the date of the accident. 

For a successful claim, an insurance company is required to award PIP benefits within 30 days. If there is reason to believe a victim is committing insurance fraud, the company will be allotted up to 60 days to further examine the claim.

When Is Someone Covered Under PIP?

PIP insurance can protect multiple parties involved in a motor vehicle accident. PIP covers the driver and other passengers, unless they carry their own PIP policy.

Passengers, Pedestrians, and Cyclists

PIP applies to passengers in the vehicle, pedestrians or cyclists hit by a driver, and anyone who has been given permission to drive the policy owner’s vehicle. PIP insurance may also cover family members living with the policyholder. 

Family members qualify for coverage under Florida law if they meet the definition of a resident-relative. Florida defines a resident-relative as a relative of any degree (by blood or by marriage) who ordinarily makes his or her home in the same family unit, regardless of temporarily living elsewhere. As a resident-relative, a victim may be covered while driving with permission from the vehicle’s owner, when riding in another party’s vehicle, or if injured in an accident as a pedestrian. PIP insurance also covers any child(ren) a policyholder may have who were injured riding a school bus

Uninsured and Insured Victims

An uninsured driver may be covered under his or her domestic partner/spouse’s policy or under his or her parent’s/sibling’s PIP insurance policy. Roommates and live-in boyfriends/girlfriends are less likely to be covered by the vehicle owner’s policy, as they do not meet the definition of a resident-relative. Uninsured parties with no vehicle are most likely to be covered under their parent’s policy if they maintain the same address. If a passenger carrying his or her own PIP insurance is involved in an accident, he or she will be shielded by his or her own PIP policy. 
Trying to navigate the legal process of a car accident settlement can be difficult. An experienced Clearwater car accident attorney can ease the mental toll of post-accident obligations and assist in speeding up the claims process.

Photo of Jim Magazine
James (Jim) Magazine is a Florida Board Certified Civil Trial lawyer who has spent his career helping injured victims. Jim is licensed to practice law in the State of Florida since 1990 and is also admitted to practice at the Appellate level and admitted to the United States Supreme Court.