New clients are sometimes unconcerned about liability issues, that is, who was at fault or responsible for the motor vehicle crash which caused their injuries. These clients invariably repeat the phrase that “Florida is a no-fault state.” While Florida does have a very limited no-fault system, which requires a type of insurance coverage called Personal Injury Protection or “PIP,” liability is always an extremely important issue.
PIP is no-fault insurance which the State of Florida requires all drivers to carry. The minimum and maximum amount of PIP coverage is $10,000.00. Beyond this limited amount, Florida is what is known as a “pure comparative negligence” jurisdiction. This means that in any incident in which someone is injured, there is 100% of fault to be apportioned between all of the parties involved. Each party can recover the amount of their damages, reduced by their apportionment of fault. For example, if someone was injured in a car crash and the total value of their damages was $100,000.00, but they were 70% at fault, they could still recover the remaining $30,000.00 from the other parties who contributed to the crash. If they were 99% at fault, they could still recover $1,000.00.
In general, PIP provides for $10,000.00 of insurance coverage to pay medical bills and economic damages. Regarding medical expenses, PIP pays 80%. If a PIP carrier accepts 1 $10,000.00 in medical expenses, it will only pay $8,000.00, and the insured will still have $2,000.00 in outstanding medical bills to pay. These medical expenses must also be “reasonable” and “medically necessary.” Therefore, a PIP carrier may deny payment for certain services it deems to be unreasonable, or not medically necessary.
For lost wages and other economic damages, PIP pays 60%.
If an insured dies, PIP also provides for $5,000.00 in funeral and burial expenses.
To further elaborate, PIP carriers do not simply pay 80% of all bills submitted by medical providers. PIP carriers use a fee schedule, which establishes a price for each medical service. PIP carriers reduce, or adjust the medical bills to the “allowed amount” pursuant to their fee schedule. The PIP carrier then pays 80% of the allowed amount. If a medical provider accepts the payment, they must waive the amount their bill was adjusted.
Notably, PIP does not cover future medical expenses, future economic damages, nor will it compensate claimants for pain and suffering. As these are often the most significant parts of a claim, it is very important that you protect yourself and your family by purchasing Uninsured/Underinsured Motorist (“UM”) coverage.
Let’s Recap with some of our most Frequently Asked Questions about PIP Insurance:
PIP insurance stands for Personal Injury Protection Insurance and in Florida it is mandatory coverage for all drivers. Everyone is required to carry at least $10,000. PIP coverage is no fault insurance and the purpose is to allow individuals to have their initial medical treatment and lost wages covered regardless of who was at fault in the accident.
PIP Insurance covers named insureds, relatives residing in the same household, as well as passengers and drivers of the insured vehicle. The PIP statute permits policy exclusions for: (1) injuries sustained by the insured and resident relatives in other vehicles owned by the insured, but insured under a different policy; (2) injuries sustained by anyone while using the insured vehicle without consent; (3) injuries sustained by anyone intentionally; and (4) injuries sustained by anyone while committing a felony.
Bicyclists and pedestrians who are injured by motorists will have PIP coverage through their own policies, or through that of their resident relatives. If they do not have car insurance and do not live with anyone who does, they are entitled to PIP coverage through the policy of the motorist who injured them.
PIP is intended to cover 80% of medical expenses that are related to an automobile accident and 60% of your lost wages.
To be eligible for PIP benefits, Florida law requires that people seek medical attention within fourteen (14) days after a motor vehicle crash. If they fail to do so, the PIP carrier will deny coverage. While this requirement is aimed at deterring fraudulent claims, it often harms people who have severe, permanent injuries, but did not immediately seek medical attention. It often takes a number of days for the real pain to set in, and real-life events can sometimes force people to put their health on the back-burner. These people often do not appreciate the severity of their injuries and naively believe they will make a full recovery. Most people do not realize that even a small crash with relatively minimal property damage can cause significant injuries. This is why it is a good idea to get checked out by medical professions immediately following a motor vehicle crash. Hopefully, there are no injuries, but you will preserve your PIP coverage if you require additional treatment in the future.
You should still seek treatment. The 14 days is just for your PIP protection. If you were hit by another driver they will likely have bodily injury coverage from which you may be able to obtain compensation. Just because you miss the 14 day period you have not lost your right to bring an action. Typically, you have four years to bring an action for negligence.
The primary purpose underlying Florida’s no-fault PIP system is to ensure that people injured in motor vehicle accidents are able to obtain immediate medical attention without having to establish liability, which can sometimes be a long and tedious process in litigation. Thus, a party will be afforded PIP coverage even if they were solely responsible for a crash.
Another purpose underlying our PIP law is to make it more difficult to pursue certain types of cases. Thus, to pursue a claim for pain and suffering, people must prove that they have a permanent injury, disability, or disfigurement. If their injuries are not permanent, they can only seek to recover for their past economic damages.
If you are in a car accident you present your car insurance card to the doctor and they will bill their services to your PIP coverage rather than bill you or your health insurance.
After your coverage is exhausted you should still continue treating because you may be able to bring a claim against the at fault driver’s bodily injury coverage or your own uninsured motorist coverage.
While Florida drivers must carry $10,000.00 in PIP coverage, only $2,500.00 is immediately available after a crash. To unlock the remaining $7,500.00, the claimant must show the existence of an “emergency medical condition” or “EMC.” Florida’s PIP statutes define an EMC as:
… a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
(a) Serious jeopardy to patient health.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.
PIP is primary. People injured in car crashes must first submit their medical bills to their PIP carrier, even if they have health insurance. Health insurance companies will refuse to cover medical expenses until PIP has been exhausted.
It is also important to note here that health insurance works much differently in the context of a personal injury case. Typically, people pay some combination of premiums, co-pays, and deductibles, and in exchange, the health insurance company is responsible for paying for any medical bills. In the context of a personal injury case, however, health insurance companies have a “right of subrogation.” This means they have a lien on your case, or the right to be repaid out of your settlement money for any bills they paid related to your claim. Unlike health insurance, PIP carriers do not have a right of subrogation.
PIP carriers will sometimes deny coverage based on a number of reasons. For example, there may have been a lapse in coverage for non-payment. Also, PIP carriers will often deny coverage by claiming some sort of fraudulent misrepresentation in the policy application. A common example is that an adult living in the home was allegedly not disclosed to the PIP carrier. Another basis often alleged is that the insured failed to disclose that they were using their vehicle for commercial purposes.
The denial of PIP coverage can be challenged by PIP attorneys, but if coverage is properly denied, the significance varies from case-to-case. The denial of PIP will mean that there is $10,000.00 less money to go towards compensating the person for the medical expenses and economic damages. This may be a big deal in a case with serious injuries and minimal coverage, but not such a big deal where there is adequate insurance available from other sources.
Additionally, Florida courts do not all handle the denial of PIP in the same way, depending on the basis of the denial. In some counties, if the plaintiff failed to have the required PIP coverage, their claim against the defendant will be reduced by the $10,000.00 in PIP coverage that they were required to have, but failed to obtain. These courts view PIP coverage as providing limited tort immunity to the defendant. Other counties do not give the defendant a set-off for PIP coverage which should have, but was not available. The plaintiff can recover the full value of their case. Other courts have not addressed the issue and it is unclear which approach they would apply.
We hope you found this article written by our very own Tampa Personal Injury Attorney, John McKnight, helpful and informational. Please reach out to us if you have any additional questions regard Personal Injury Protection (PIP Insurance) or any questions regarding your case.