Frequently Asked Questions about Florida’s Personal Injury Protection (PIP) Insurance

If you happen to possess a vehicle in Florida, you might have encountered the requirement for Personal Injury Protection (PIP) coverage. PIP policies entail an extra yearly cost of a few hundred dollars in premiums. So, why is this expense obligatory, and what precisely does PIP insurance entail, and how does it function?

The intricacies of PIP benefits can be perplexing, leading many Florida residents to be uncertain about the steps to take to secure these funds. In the following sections, we’ll address common queries about PIP insurance, elucidating its components and the steps necessary to approve your claim.

What Exactly Is PIP?

Personal Injury Protection insurance, often known as PIP, represents a type of insurance coverage aimed at helping individuals manage expenses when facing personal injuries. Frequently, after sustaining an injury, individuals find themselves grappling with overwhelming medical bills, particularly when they are unable to work during their recovery, leading to a loss of income.

PIP acts as a financial bridge during this recovery period, covering various costs, including medical expenses, lost wages, and other expenses incurred due to the injury.

What Does PIP Cover?

PIP insurance is designed to cover medical expenses and lost income during the recovery phase. For those with minimal coverage, it can contribute up to 80 percent of:

1. Hospital expenses
2. Costs associated with physical therapy
3. Home health care expenses
4. Medication costs

Furthermore, this insurance can also provide compensation for up to 60 percent of lost wages, with a maximum limit of $10,000.

Is PIP Mandatory in Florida?

Florida operates as a no-fault state, meaning that fault is not taken into account in car accidents. This approach streamlines the processing of insurance claims and reduces the number of cases brought to court. Given that accident victims may struggle to cover their expenses without waiting for liability settlements, Florida mandates PIP coverage for all drivers.

What Is the Cost of PIP?

The cost of PIP coverage hinges on the chosen deductible level, but on average, it results in an additional annual car insurance expense of approximately $300 to $400, roughly equivalent to $30 per month. Lower deductibles tend to push the annual cost closer to $400, while higher deductibles may bring it closer to $300.

How much time do you have to treat for PIP to apply in an auto accident?

If you’re a Florida driver, you may have heard of the 14-day rule. Under Florida’s no-fault system, you have 14 days to seek medical attention after a car accident. The time deadline is a requirement to make a claim for compensation through your no-fault, personal injury protection insurance. All Florida drivers should be familiar with the 14-day rule so that they can take full advantage of their personal injury protection (PIP) benefits.

Why Does the 14-Day Rule Exist?

Florida’s 14-Day Rule requires that any injured victim must seek medical care of some kind within 14 days of a car accident to be able to access any PIP benefits provided under the required coverage.
That means if you were in an accident and did not go to a doctor within two weeks of the accident, then Florida says you probably cannot get the PIP coverage you have, even though you are already paying for that coverage.
For many people, that window of time seems short and unfair, but that is the law. The result of a rule like this is that many people who have legitimate injuries from an accident but were unable to seek medical attention within that 14-day window miss out on the insurance coverage that they deserve and have consistently been paying for.

When Is Your 14 Days Up For PIP Benefits?

(1) Period Stated in Days or a Longer Unit. When the period is stated in days or a longer unit of time
(A) exclude the day of the event that triggers the period;
(B) count every day, including intermediate Saturdays,
Sundays, and legal holidays; and
(C) include the last day of the period, but if the last day is a Saturday, Sunday, or legal holiday, the period continues to run until the end of the next day that is not a Saturday, Sunday, or legal holiday. Fla. R. Gen. Prac. & Jud. Admin., Rule 2.514

Do I Need to Consult a Doctor to Claim PIP Benefits?

Before initiating a PIP claim, it is imperative to undergo a medical assessment to gauge the severity of your injuries. To be eligible for PIP benefits, you must consult a medical professional within fourteen days of the accident. It’s worth noting that the treatment itself does not necessarily need to conclude within the fourteen-day window; you simply need to have consulted a medical practitioner during that timeframe.

What Types of Healthcare Providers Qualify?

Most healthcare providers meet the requirements for PIP benefits. Depending on the nature of your injuries, you can seek advice from an MD, DO, dentist, hospital, or EMS service. Acupuncturists and massage therapists are exceptions and are not covered under PIP benefits, but chiropractic care can be.

What Constitutes an Emergency Medical Condition (EMC)?

To receive full PIP benefits, a medical professional must confirm that you have an emergency medical condition (EMC). Officially, an EMC is defined as “A medical condition characterized by acute symptoms of sufficient severity, which may encompass severe pain or other acute symptoms, to the extent that the absence of immediate medical attention could reasonably be expected to result in one of the following:

1. Significant endangerment to the patient’s health, including a pregnant woman or a fetus.
2. Significant impairment of bodily functions.
3. Major dysfunction of any bodily organ or part.”

In simpler terms, an EMC refers to a medical condition that puts your health at serious risk if immediate medical attention is not provided.

How Much Compensation Can I Receive Without an EMC?

In cases where an EMC is not determined, you can still receive some PIP coverage. However, instead of the full $10,000 benefit, you will receive only $2,500 without an EMC diagnosis. Importantly, you can still receive an EMC diagnosis even if it is determined after the initial fourteen-day window, as long as you began treatment within that timeframe.

How Do I Initiate a PIP Claim?

Following an accident, it is crucial to promptly contact your insurance provider and inform them of your intent to seek PIP benefits. Typically, you will need to submit your claim within the fourteen-day window to ensure approval. Your insurance provider will provide guidance on the necessary documents to include with your claim submission.

What Happens Once My PIP Coverage Is Exhausted?

Regrettably, in the current healthcare system, $10,000 is often insufficient to cover substantial medical expenses. If you deplete your PIP benefits and still require additional coverage, you may pursue a liability settlement. It is advisable to consult with a personal injury attorney as soon as possible after your accident to explore potential compensation options.

Secure a Fair Settlement in Your Case

Personal Injury Protection insurance (PIP) can offer crucial financial assistance following an accident when liability settlements are not immediately accessible. PIP is compulsory for all Florida drivers and can extend coverage to you or your entire household. To qualify for PIP benefits, it is imperative to consult a healthcare professional within fourteen days of the accident.

If your PIP benefits fall short of covering your expenses and another party is liable for your injuries, you may be entitled to compensation. Our legal team can advocate for your rights against insurance companies and help you secure the compensation you deserve. Schedule a complimentary consultation with Kemp Law Group today to discuss the specifics of your case.