The Florida Motor Vehicle No-Fault System – Personal Injury Protection (PIP) Explained
As a Central Florida area motor vehicle accident and insurance claims attorney, I am often asked by my clients as to who is responsible for the payment of their medical expenses and lost wages incurred as a result of the injuries they sustained in an accident. According to Florida law, if you own a motor vehicle with four or more wheels you are only required to carry $10,000 of personal injury protection (PIP) insurance and a minimum of $10,000 of property damage (PD) liability insurance. The Florida Motor Vehicle No-Fault System, also known as PIP insurance, covers you regardless of whether you cause an accident (are "at-fault") up to the limit of $10,000. PIP insurance requires that your medical bills be directed to your own automobile insurance carrier or that of your household relative if you do not own your own car. You may have up to a $1,000 deductible under this coverage. However, it is not advisable that a deductible be purchased for this coverage, as you would be then be held responsible or "self-insured" for the amount of the deductible you elected and may not be able to claim or recover this amount from the at-fault party or their insurance company. After the deductible, if any, has been applied, your insurance company will pay seventy-five percent (75%) of the usual and customary charges for emergency services and care provided by any hospital, eighty percent (80%) of all reasonable, necessary and lawful medical, chiropractic, diagnostic, and transportation services related to injuries suffered from your car accident, and sixty (60%) of your lost wages up to a total of $10,000.
Since PIP insurance does not cover all of the medical expenses, insurance companies offer medical payments insurance that covers medical expenses beyond those covered by PIP which result from accidental injury. Medical payments insurance covers the medical expenses of you, members of your family, and your passengers, regardless of who is "at- fault." This applies whether you’re in your car, someone else’s car, or are struck by a car while walking. If you purchased this optional coverage on your auto insurance policy, then the medical payments coverage will be secondary to PIP coverage. For more information about other common optional coverages available, please review my recent blog entry: Automobile Insurance in Florida – What You Need to Know to be Fully Protected.
It is important to note that the at-fault party or tortfeasor can also be held accountable for the portion of your medical expenses and lost wages that is not covered by PIP or exceeds the amount of coverage permitted by PIP. This can be done by making a bodily injury liability insurance claim to the at-fault person’s insurance company. If the at-fault person purchased bodily injury liability insurance coverage, it would pay for serious and permanent injury or death to others when their car is involved in an accident, and the driver of their car is found to be at fault to some extent. The insurance company will pay for injuries up to the limits of the policy and will also pay for their legal defense if they are sued. You may also be able to receive compensation directly for the at-fault party should your damages exceed the amount of available bodily injury liability insurance coverage.
Mandatory PIP insurance coverage has far reaching implications beyond those of providing the injured person with a recourse to seek medical attention without the fear of not being able to pay for the medical expenses they incur. PIP insurance is also intended to limit motor vehicle accident claims and lawsuit. By making PIP mandatory under Florida law, it also places what is commonly referred to as a tort liability (no fault) threshold on automobile accident injury cases. This "threshold" is crossed if an injury from an automobile accident results in a significant and permanent loss of an important body function, permanent injury, significant and permanent scarring, disfigurement, or death. This can severely limit the injured person’s claim for damages from the at-fault party or their insurance company.
If you have been involved in an accident, it is vital that you do not talk to any insurance investigator, sign any papers, or accept a settlement before talking to a car accident insurance lawyer. Insurance companies have become more and more adept at using The Florida Motor Vehicle No-Fault law against their insureds. Florida law permits insurance companies to request recorded statements or examinations under oath (EUO), in which they are given the opportunity to question their insureds about the facts giving rise to the PIP claim. This is were insurance adjusters or investigators may attempt to take advantage of unrepresented individuals and extensively question them in an effort to obtain information they may not legally be entitled too and that may be used against them to limit or deny the claim. Florida law also affords insurance companies the opportunity to cut off PIP benefits for their insureds by requesting that they attend an independent medical examination (IME) with a doctor of their choosing. This doctor is hired and paid by the insurance company to render opinions that will more than likely not assist the insured’s claim and the failure to attend this IME appointment may result in a termination of PIP benefits by the insurance company. Insurance companies have a team of adjusters, investigators, doctors, and attorneys whose goal is to minimize the amount of money they pay to accident victims. Therefore, it is crucial that you seek the advice of an attorney to protect your right to just compensation.