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What Is PIP?

Posted on: March 13, 2023

If you’re a Florida driver, you may have heard the term “PIP” thrown around when discussing car insurance. But what exactly is PIP, and why is it important?

PIP stands for “personal injury protection,” and it is a mandatory coverage that Florida drivers must have as part of their car insurance policy. In this blog post, we’ll break down what PIP is, what it covers, and why it matters for Florida drivers. Whether you’re a new driver or a seasoned pro, understanding PIP is crucial for protecting yourself and your passengers in the event of an accident.


What is PIP?

Personal Injury Protection, or simply PIP, is mandatory medical coverage provided by your own auto insurance company in the event of an accident. Because PIP is applicable even if you are at fault, it is sometimes also referred to as “no-fault insurance.” It is also why Florida is known as a no fault state.

PIP is governed by Florida Statute Sec. 627.736(1). Pursuant to this statute, an insurance company is required to provide their insured with a minimum of coverage should they be involved in an auto accident. The minimum coverage is $10,000 per person, and it will cover or reimburse the following expenses:

  1. 80% of any and all medical bills relating to injuries sustained
  2. 60% of any loss of income (wages) or earning capacity
  3. 80% of prescriptions for medication prescribed as a result of injury
  4. Reimbursement of mileage to and from any medical facility

If you do not have an “emergency medical condition,” you will not be able to receive more than $2,500 in benefits. Florida law defines an “emergency medical condition” as a medical condition that requires immediate medical attention and could reasonably be expected to result in serious jeopardy to the patient’s health. A medical doctor or nurse practitioner will need to determine whether you qualify for this condition. If you qualify for this condition, you can receive up to the $10,000 limit of coverage.

In Central Florida, roughly 1 in 4 drivers don't have adequate insurance coverage. Are you protected from their mistake?


Who Qualifies For PIP?

In the state of Florida, all registered motor vehicle owners are required to carry personal injury protection (PIP) insurance as part of their auto insurance policy. This insurance provides coverage for medical expenses, lost wages, and other related expenses in case of an accident, regardless of who was at fault for the accident.

When involved in an auto accident, regardless of who is at fault, every person involved will report to their own insurance company for PIP benefits. PIP coverage extends to the policyholder, members of their household, and passengers who do not own a vehicle and do not have their own PIP insurance. Additionally, pedestrians and bicyclists involved in an accident with a motor vehicle may also be covered by the driver’s PIP insurance who caused the crash.

Things get tricky when the accident occurs out of state. If you are driving in your own car and get in an accident while outside of Florida, you could be covered by your personal injury protection benefits. However, if you are a passenger in another car your insurance might not cover your injuries.


How Soon After An Accident Do I Need To Seek Treatment?

After a car accident, it’s crucial to prioritize your health and well-being. Seeking medical attention as soon as possible after a car accident is important, even if you don’t feel like you have any immediate injuries or symptoms. In fact, many injuries sustained during car accidents may not become apparent until several days or even weeks after the accident.

In the state of Florida, PIP insurance covers medical expenses related to a car accident, but only if medical treatment is sought within 14 days of the accident. That’s why it’s important to see a medical professional as soon as possible after an accident. Even if you think you feel fine, it’s always better to be safe than sorry.

If you wait too long to seek medical attention after an accident, you risk losing your PIP benefits altogether. And losing your PIP benefits can have major consequences on any claims you have.

Additionally, waiting too long to seek medical attention may also negatively impact your personal injury claim. Insurance companies may use your delay in seeking medical attention as evidence that your injuries are not as severe as you claim, or that your injuries were not actually caused by the car accident.


Do I Have To Use PIP Even When I’m Not At Fault?

Yes, you are required to use your PIP coverage in Florida even if you did nothing wrong and the other driver is completely at fault.

This is because PIP coverage is the primary insurance coverage for medical treatment following an auto accident in Florida. As a driver, you have paid for PIP coverage as part of your insurance premium. The cost of this coverage is built into your premium, with the understanding that PIP will be used no matter who is at fault.

Even if you have health insurance, PIP coverage is still required to be used first in the state of Florida. In fact, most health insurers will not pay for treatment until the PIP benefits have been exhausted. That means any PIP is considered primary coverage.

While it might not feel completely fair to have to use your own insurance after an accident caused by someone else, there are some benefits. For example, you are not required to reimburse your PIP provider if you receive a recovery from another party. On the other hand, most health insurers have a right of subrogation where they are allowed to recover what they have paid. This means that if your health insurance pays for $10,000 in medical expenses, you will owe them that amount out of any settlement you receive. However, if PIP pays the same amount, you do not have to reimburse your insurer for the payments.

Dog bite injuries cost an average of $50,000 a claim.

Who Pays For The Balance Of The Bills?

PIP will only pay 80% of any medical bill. The remainder of the medical bills remains your responsibility. These outstanding balances constitute “out-of-pocket expenses”. These can be claimed as damages against the at-fault party. There may be other forms of coverage available to cover the remaining balance including Health Insurance, Medical Payment Auto Coverage, Medicaid, or Medicare.

Tell Us About Your Case

If you make a claim against the at fault insurer, this insurer may pay for the 20% balance that has not been paid by PIP insurance. In our experience, the insurer does not pay the balance until you or an attorney makes a demand for the balance. The insurance company will not pay the 20% balance after each visit and instead will make a one time settlement payment that should include funds to cover this balance.

We are also aware that at fault party insurance companies have advised our patients that they will pay the 20% balance only to later state that they will only pay a portion of the balance, due to some claimed issue by the insurer. Many times, the insurer will claim that you treated “too much” and they will not pay all of the 20%. This is one of the reasons we recommend that you seek counsel who can best protect you.

PIP will only pay 80% of any medical bill. The remainder of the medical bills remains your responsibility. These outstanding balances constitute “out-of-pocket expenses”. These can be claimed as damages against the at-fault party. There may be other forms of coverage available to cover the remaining balance including Health Insurance, Medical Payment Auto Coverage, Medicaid, or Medicare.


Will Using PIP Raise My Rates?

You are required to use PIP insurance for treatment. Therefore, the insurance company is not allowed to raise your rates for making a PIP claim. However, you are dealing with insurance companies. If they can find any reason other than the real reason – the PIP claim – to raise your rates, they will. Rarely have we seen clients’ rates rise, but when they have we learn about an at fault crash a year earlier, a recent property damage claim, or a speeding ticket that the insurer uses as a pretext to raise their rates.

Make sure the person handling your case is a licensed attorney.


Contact an Experienced Car Accident Attorney

If you have been injured in an auto accident, it is important to protect your rights and get the compensation you deserve. Whether you are dealing with PIP insurance, dealing with an at-fault party, or having difficulty getting the medical treatment you need, a car accident attorney can help you navigate the complex legal system.

If you are in the Orlando or Central Florida area, contact us here at Beers & Gordon. Our experienced attorneys have helped countless clients receive the compensation they deserve after a car accident. We will work tirelessly to ensure that your rights are protected and that you receive the best possible outcome for your case.

Don’t wait. Contact Beers & Gordon today to schedule a free consultation and discuss your case. Let us help you get the compensation you deserve.

Jim Gordon / Beers and Gordon P.A. / Civil Trial Attorneys

Jim Gordon

Jim Gordon earned his Juris Doctorate from the University of Nebraska in 1997, and two years later began working at a firm in Orlando handling insurance defense matters on cases involving vehicle accidents, negligence, product liability, and more. He established Beers & Gordon P.A. with David Beers in 2009 to represent the rights of people injured because of negligence. He is a member of the invitation-only National Trial Lawyers organization and the Million Dollar Advocates Forum.


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