Car Accidents and Florida's PIP Law - What You Need to Know
If you are injured in a car accident, by a vehicle or because of a vehicle you may be entitled to valuable insurance benefits.
Why is Florida called a "No Fault" state?Ever wonder why Florida as referred to as a *No Fault* state? The answer is fairly simple. Florida is referred to as a *No Fault* state because it requires drivers to have a specific insurance coverage to lawfully operate a vehicle on the roadway. This insurance coverage is called Personal Injury Protection, or *PIP* for short.
PIP insurance coverage is governed by Florida Statute *627.736. It requires every driver at least $10,000.00 in benefits to help pay for medical treatment or lost wages caused by a crash. It also includes an additional $5,000.00 in death benefits. When applicable, this coverage will pay for 80% of incurred medical bills (minus any deductible) and/or 60% of lost wages. It can also be used to pay for mileage incurred going to and from doctor appointments.
PIP coverage pays for these items incurred by the insured (the persons named under the policy) and, potentially, others. PIP pays regardless of who is at fault for causing the crash. As such, the PIP coverage you purchase will pay for your medical bills, loss wages and mileage if you are injured in a crash.
When you hear people referring to Florida as a *No Fault* state, we are simply referring to this specific coverage. Your PIP coverage pays your medical bills, loss wages and/or mileage regardless of who causes the crash. Therefore fault does not matter. Hence, no fault.
Who Else Is Covered Under Your PIP Coverage?However, these extensions of coverage are not as automatic as PIP coverage may be for you automatic. For example, a pedestrian struck by a vehicle is only entitled to the vehicles PIP coverage if 1) the pedestrian does not have their own PIP coverage, and 2) does not live with anyone who has valid PIP coverage.
Example: Johnny Six Speed is riding his bicycle on usual weekend path through town. A driver fails to see Johnny and hits him. Johnny suffers injury and is transported to the hospital. There are three potential ways for Johnny to obtain PIP coverage to help pay his medical bills.
1). If Johnny has PIP coverage, Johnny will use his PIP coverage.
2) If Johnny does not have PIP coverage, but lives with a relative who does, Johnny may qualify and use his relative*s PIP coverage.
3) If Johnny does not have PIP coverage, and does not live with a relative who has PIP coverage, Johnny will utilize the PIP coverage of the vehicle that struck him.
TIP: PIP coverage is not limited to car accidents. A common misconception, even among attorneys, is that PIP benefits can only be utilized if there is a car accident. However, Florida law requires PIP benefits for injury or death arising out of ownership, maintenance or use of a motor vehicle. In Blish v Atlanta Casualty Company, 736 So.2d 1151 (Fla. 1999), the Florida Supreme Court extended PIP benefits to someone who was attacked while attempting to change a tire on their vehicle after a blowout. In doing so, the Court looked to the underlying circumstances which caused Blish*s injuries. Ultimately, they held that the injuries sustained while trying to change a tire arose *out of ownership, maintenance, or use of a motor vehicle.*
Some PIP LimitationsLimitation on Benefits. Florida requires you carry a minimum of $10,000.00 in PIP coverage. This is what you must purchase. However, the same law allows your insurance company to pay only 1/4 of the benefits you purchase, or $2,500.00. As determined by Medical Center of the Palm Beaches v USAA Casualty Insurance Company, 202 So.3d 88 (Fla. 4th DCA 2016), the law limits your benefits to $2,500.00 unless you have sustained an *Emergency Medical Condition.* If you have been injured in a car accident, your doctors will determine if your injuries constitute an Emergency Medical Condition. As such, be sure to tell them about every pain complaint or unusual feeling you have.
Must Treat Within 14 Days of Crash. Florida*s PIP law requires injury victims to seek treatment within 14 days. Treating 15 days or longer after the crash jeopardizes your ability to use your own PIP benefits.
Limitation on Medical Treatment. If you have been injured in a car accident, seek medical treatment with a doctor you trust. However, your PIP coverage may not pay for the treatment you receive. It is common for injury victims to feel stiff and sore after a crash. Sometimes they will visit a masseuse or holistic treater for the pain. However, PIP will not pay for massage * it is specifically excluded under the law. As for holistic healing, payment may be withheld depending on the doctor*s licensing credentials and/or medical services provided.
Insurance Medical Examinations. You may be asked by your insurance company to see a doctor for an insurance examination. Insurance companies often utilize third party vendors to schedule these insurance examinations. Take these examinations seriously. While the insurance company or third party vendor may refer to it as an *Independent Medical Evaluation/Examination,* it is anything but. Insurers schedule these examinations because the law allows insurance companies to refuse payment of medical bills if a doctor finds treatment is no longer reasonable, necessary or related to the crash. I have seen many of these reports. They all essentially say the same thing. 99% will say no more treatment was reasonable, related or necessary.
Examinations Under Oath. Your insurance company can ask for an examination under oath. You may have to comply. It is important to have an attorney present for your examination. Insurance companies have been known to abuse unrepresented individuals in these examinations. In De Leon v Great American Assurance Company, 73 So.3d 585 (Fla. 3d DCA 2011), the court chastised the insurance company for *making unwarranted and intrusive inquiries into the personal life* of its insured.
ConclusionIf you are confused, you are not alone. Determining where insurance comes from is not always straight forward. This is one of the reason you need to hire an attorney if you are injured. If you have been injured in a car accident, failing to hire an attorney can hurt your case.