Injured in a car accident in the Sunshine State? Navigating the complexities of Florida’s insurance laws can feel overwhelming, especially when you’re trying to focus on recovery. One term you’ll likely encounter is “PIP” insurance. But what does PIP insurance cover in Florida, and how can it help you after an accident? This article will break down the intricacies of Personal Injury Protection in Florida, providing a clear understanding of its coverage, limitations, and how it can assist you in getting back on your feet.
Understanding Personal Injury Protection
Personal Injury Protection, or PIP, is a type of auto insurance required in Florida. It’s designed to provide swift and efficient coverage for medical expenses and lost wages following a car accident, regardless of who was at fault. This is why Florida is often referred to as a “no-fault” state when it comes to car insurance. The primary goal of PIP is to reduce the number of lawsuits stemming from car accidents and to ensure that individuals receive prompt medical treatment without delay.
So, who exactly is covered by PIP? Your own PIP policy typically extends coverage to several individuals: you as the policyholder, family members residing in your household, certain passengers riding in your insured vehicle at the time of the accident, and even pedestrians or bicyclists who are injured as a result of being struck by your insured vehicle. This broad coverage ensures that a wide range of individuals can benefit from PIP in the event of an accident.
Medical Expenses Covered by Personal Injury Protection
The cornerstone of PIP coverage lies in its provision for medical expenses. If you are injured in a car accident, PIP can help pay for a variety of necessary medical treatments. This includes visits to your doctor, hospital stays, surgical procedures, physical therapy and rehabilitation to aid your recovery, ambulance services for emergency transport, and diagnostic tests such as X-rays and MRIs to assess the extent of your injuries. Furthermore, PIP covers prescription medications prescribed by your doctor to manage pain and aid in healing. Generally, it will cover what are deemed “reasonable” medical expenses.
A key aspect to remember is that PIP typically covers eighty percent of reasonable medical expenses incurred as a result of the accident. For instance, if your medical bills total one thousand dollars, PIP would generally cover eight hundred dollars. However, this coverage is subject to an overall policy limit. Florida PIP policies generally have a ten thousand dollar limit per person, per accident. This means that once your medical expenses and other covered losses reach this amount, your PIP coverage will cease, unless there is a deductible. It is important to consider the policy deductible when determining how much coverage you may have.
The Fourteen-Day Rule and Emergency Medical Conditions
Another crucial point to understand is the “fourteen-day rule.” To be eligible for the full benefits of your PIP coverage, you must seek initial medical treatment within fourteen days of the car accident. If you delay seeking treatment beyond this timeframe, your access to PIP benefits may be significantly limited. Even if you don’t think you are hurt, you should get checked out by a medical professional.
The existence of an emergency medical condition, or EMC, impacts access to your ten thousand dollar PIP benefit. In Florida, if a qualified medical professional determines that you have an EMC as a result of the car accident, you will have access to the full ten thousand dollars in PIP benefits for medical care. If you are not diagnosed with an EMC, your available PIP benefits may be significantly reduced, potentially limiting the scope of medical treatment you can receive.
Wage Loss Coverage Under Personal Injury Protection
In addition to medical expenses, PIP also provides coverage for lost wages. If you are unable to work due to injuries sustained in the car accident, PIP can help compensate you for the income you’ve lost. PIP covers sixty percent of your lost wages, subject to the overall ten thousand dollar policy limit. So, if you are temporarily unable to work due to the accident injuries, PIP can help offset some of the financial burden. However, this wage loss compensation is also subject to the policy limit.
To receive wage loss benefits, you will need to provide documentation to support your claim. This typically includes pay stubs from your employer, employment verification forms, or other documentation that demonstrates your earnings prior to the accident. You must also be able to show that you were unable to work because of the accident.
Death Benefits Provided by Personal Injury Protection
In the unfortunate event of a fatality resulting from a car accident, PIP provides a death benefit in addition to medical and wage loss benefits. This death benefit is generally five thousand dollars. It is paid to the deceased’s estate to help cover funeral expenses and other costs associated with the loss of life. This benefit is separate from, and in addition to, any medical or wage loss benefits that may have been paid out prior to the individual’s death.
Understanding What Personal Injury Protection Does Not Cover
While PIP provides valuable coverage, it’s essential to understand its limitations. PIP does not cover damage to your vehicle or any other property damaged in the accident. For vehicle repairs, you will generally need to rely on collision coverage (if you have it) or seek recovery from the at-fault driver’s insurance. Further, PIP does not compensate for pain and suffering experienced as a result of the accident. This is a separate type of damages that may be recoverable through a lawsuit against the at-fault driver.
As previously mentioned, PIP coverage is capped at ten thousand dollars. Once this limit is reached, PIP will cease to pay for any further expenses. Certain activities at the time of the accident could exclude you from PIP coverage. This includes if the accident occurred while you were committing a crime or driving under the influence of alcohol or drugs. Rules also differ for motorcycle accidents and PIP coverage in Florida. This is why it is important to consult a professional to discuss coverage of the accident.
Deductibles and Co-Pays Under Personal Injury Protection Policies
Many PIP policies have deductibles. A deductible is the amount you must pay out-of-pocket before your PIP coverage kicks in. For example, if you have a five hundred dollar deductible, you will be responsible for paying the first five hundred dollars of your medical expenses and lost wages, and then PIP will cover the remaining expenses up to the policy limit. The amount of your deductible will be identified in the policy. Choosing the appropriate deductible requires a balance of premium costs and out of pocket costs.
Filing a Personal Injury Protection Claim in Florida
If you’ve been involved in a car accident, promptly reporting the accident to law enforcement is a must. Immediately notify your insurance company. Start gathering documentation, including the police report, medical records and bills, and documentation of lost wages. Also be mindful of deadlines. It is important to seek medical attention within the above referenced fourteen day timeframe.
What Happens If Your Personal Injury Protection Claim is Denied
If your PIP claim is denied, you have options. First, it’s crucial to understand the reason for the denial. Contact your insurance company directly to request clarification and additional information. You can file a complaint with the Florida Department of Financial Services. You should consult with a knowledgeable attorney to evaluate your legal options. There are statutes of limitations that must be adhered to.
In Conclusion
Navigating Florida’s insurance laws after a car accident can be complex, but understanding what does PIP insurance cover in Florida is a crucial first step. PIP provides essential coverage for medical expenses, lost wages, and death benefits, regardless of fault. However, it’s important to be aware of its limitations, including the policy limits, deductibles, and exclusions. If you have been injured in a car accident and have questions about your PIP coverage, it is important to seek legal counsel from a qualified attorney who can help you protect your rights and navigate the claims process. Contact us today for a free consultation to discuss your case and explore your legal options.
