Personal Injury Protection – Florida's No-Fault Benefits

In this article, we’re going to be talking about Florida’s No-Fault Benefits, otherwise known as Personal Injury Protection Coverage.

Some people refer to Florida as a No-Fault state. That doesn’t mean that if you’re involved in a car accident nobody is at fault. It means that if you’re involved in an accident and you’re a resident of the state of Florida and you have car insurance, your insurance will pay your medical bills and lost wages to start, not the insurance of the person that was at fault for causing the accident. That’s why you purchase PIP Coverage.

What are Florida’s No-Fault or PIP Benefits?

Well, many years ago Florida changed to a No-Fault system of insurance, which means that if you’re involved in an auto accident, you don’t have to fight about who caused the accident before you get your medical bills paid or before you get your lost wages paid. You still talk about that issue later but to ensure that citizens of the state of Florida could get immediate access to medical care to treat their injuries or receive immediate compensation for the time they’re missing from work as a result of a car accident, we have No-Fault coverage.

When you buy car insurance in the state of Florida it has to come with Personal Injury Protection and No-Fault Benefits in an amount of $10,000.00. That insurance will pay up to $10,000.00 towards both your medical bills and your lost wages but it pays out of that same $10,000.00 pot.

Medical Bills

Let’s talk about medical bills first. No-Fault benefits will pay 80% of your medical bills. If you have a deductible, your deductible comes first. If you go to the emergency room and you have a $5,000.00 bill and you have a deductible on your PIP Benefits of $1,000.00, that first $1,000.00 of the emergency room will not be paid. The remaining portion of that bill your car insurance will pay 80% of that.

But, just like the regular health insurance, you get the benefit of contractual adjustments or write-offs. So, if an emergency room charges $1,000.00 for a study, your car insurance will pay 80% of what we call the allowed amount. The bill comes in at $1,000.00; your car insurance says we only pay $500.00 for that procedure, then your car insurance will pay 80% of $500.00. It does that again, up to a limit of $10,000.00. The requirement though is that in order to benefit from that coverage you have to seek treatment of your injuries within 14 days of an accident.

Emergent Medical Conditions

In the past three years, the Florida legislature has put in a new requirement for people, in addition to seeking treatment within 14 days. If a doctor does not determine that you have what’s called an emergent medical condition, which really means you needed to get treatment for an accident otherwise you would be severely limited because of the pain for the extent of your injuries. Then, your PIP Benefits are limited to only $2,500.00 towards your medical treatment. If however, a doctor determines that you did have an emergent medical condition and many emergency rooms do this today, then you’re entitled up to the full $10,000.00 of PIP Coverage towards your medical bills.

Lost Wages

In addition to medical treatment, your PIP Coverage will also provide 60% of your lost wages that are as a result of the accident. What you’ll need is proof that you’re employed, proof of what your average weekly wage is, which your employer can provide to you, and then you need a doctor’s note confirming that you were out of work or that you need to be out of work as a result of the car accident injuries as opposed to just being sick or wanting to take a vacation. If you have that documentation and you submit it to your Personal Injury Protection carrier, they will issue you a check for the time you missed from work.

What about the remaining amount of medical bills and lost wages?

A lot of times people are concerned, “Well, what about the 20% of my medical bills that aren’t being paid or the 40% of my lost wages that aren’t being paid?” Those are the responsibility of the person who caused the accident. As we talk about in many of our other videos, at fault drivers, their insurance companies, they don’t reimburse people as the victims incur medical bills or incur lost wages. Unfortunately, they will only pay if a case settles, which can often be months to years after the date of an accident, which is why it’s so important to take advantage of your No-Fault Benefits following an accident.

Whose PIP / No-fault benefits pay?

Although the coverage that your No-Fault Benefits provide is straightforward, the next question is much more difficult and that’s “Whose PIP or No-Fault Benefits pay?” We’re going to run down a list of which possible auto insurance No-Fault Benefits will pay if you’ve been involved in an accident because here in the state of Florida it’s a lot more complex than people realize and to some extent, it’s confusing to people when they’ve been involved in an accident. They come in and we start asking questions about who they live with, do they live with a relative, what if they don’t own a car? Because whose coverage pays for your medical bills is very important.

Let’s start with the easiest example: I own a car, I live in the state of Florida, I get into an accident. It doesn’t matter whose car I’m riding in, whether it’s mine, my neighbors, or my friends, or co-workers, if I own a car in Florida and I have car insurance and I’m in an accident, my PIP, my No-Fault Benefits will pay for my medical bills.

Now, if I don’t own a car and I’m riding in somebody else’s car, the next question is, “Do I live with a family member?” What the law calls a resident relative. If I live with a resident relative and they have a car, then no matter whose car I’m riding in in the state of Florida, my resident relative’s PIP or No-Fault coverage will pay my bills. Imagine that you live with your parents or a child lives with you. If they are in an accident or you are in an accident that insurance, the resident relative’s insurance will apply if you don’t own a vehicle.

If you don’t own a car and you don’t live with any family members who own a car … And, remember they have to be relatives, they can’t be friends, fiancee, girlfriends, boyfriends … If you don’t live with a resident relative and you don’t own a car, then you get PIP Coverage or No-Fault Benefits for the car you’re riding in at the time of an accident.

If you don’t own a car, don’t live with a relative and you’re not riding in a car. Let’s say you’re just a pedestrian on the street and you get hit then the person who hit you, their No-Fault Benefits will actually apply to you because there is no other PIP coverage available. That same pedestrian, if they own a car, their PIP will pay. If they live with a relative, that relative’s PIP will pay even though they are not in a car at the time the accident occurs.

How will a PIP claim affect insurance?

A lot of times people will have concerns about filing a claim with their own insurance if they are not riding in the car when an accident happens because they’re worried that their rates are going to go up or that their insurance will drop them. The law says that an insurance company can’t raise your rates or drop you for bringing a no-fault claim if you weren’t at fault for the accident.

People are also concerned about bringing a claim on a family members policy, especially when they weren’t in that family members car. Again, the law is very clear that that insurance company for that relative has a legal obligation to pay for your medical bills. They don’t have a say in it. They don’t have a choice about it. That was the contract that that insurance company entered into with that family member.

Let The Insurance Company Know ASAP

It is important, however, if you’ve been in an accident to let your insurance company know immediately. Or, if you live with a family member who owns a car to let that family members car insurance know immediately as well because sometimes those insurance companies will want to conduct investigations to confirm whether or not they provide that coverage. The sooner you get that ball rolling the sooner they can begin to pay for your medical bills and the lost wages you’re incurring as the result of an accident.

If you or a loved one have been involved in a car accident and have questions about your No-Fault Benefits, or car insurance, or what coverage is going to provide, payments for your medical or your loss wages, give us a call today for a free consultation. You can call us at (800) 848-6168.


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