How Does Florida PIP Insurance Work?

Many of my potential clients don’t know about Florida PIP. They tell me they couldn’t afford to pay for medical bills for treatment. This is frustrating. This is usually the explanation they give for why they were hurt after their recent car accident but did not get in to see a doctor in a timely fashion.

The problem is that these poor souls do not understand the coverage provided to them by law. All personal automobile insurance policies afford Personal Injury Protection insurance coverage. 

So what is Florida PIP (Personal Injury Protection)?

Personal Injury Protection (“PIP”) is insurance provided to Florida automobile insurance holders. It is intended to cover an injured person’s medical expenses after they have been involved in a motor vehicle accident. PIP coverage is typically $10,000.00, though there is often an option to purchase additional coverage. There are other states that provide more (or unlimited coverage) after automobile accidents. However, those aren’t really pertinent to our discussion of Florida PIP.

However, there is not an unlimited time window in which one can seek treatment. In Florida, a person must seek medical treatment within 14 days of the date of loss. Without treatment in the first 14 days, auto insurance carriers won’t pay their medical bills. 

This requirement is often one of the reasons I (and other personal injury attorneys) recommend that potential claimants seek treatment immediately following a crash. Victims of negligence should get in to see a doctor early. This will provide you with medical coverage in the future should your injuries linger.

Additionally, at some time during the person’s treatment, a qualified medical professional (essentially anyone but a chiropractor) must determine that the person suffered something referred to as an “Emergency Medical Condition” (or “EMC”). 

When a doctor declares an EMC, insurance companies pay for medical services reasonably related to the injuries suffered in the crash. However, it is important to know that auto insurance covers only 80% of a reasonable medical charge. This often means that the patient will owe a copay to the doctor’s office or hospital for the treatment they receive.

Determining Reasonable Medical Charges and Reimbursements under Florida PIP

It is important to remember that Florida PIP isn’t like health insurance. Health insurance companies work with medical providers to determine the amounts both are willing to agree on for medical services. But the State of Florida decided not to negotiate with the millions of medical providers across the state. Instead decided to use the term “reasonable medical charge” and Medicare Fee Schedules to determine their reimbursement amounts.

You might be thinking that the term “reasonable medical charge” is vague. However, the legislature determined that Florida Personal Injury Protection coverage would pay for 80% of 200% of Medicare’s reimbursement amounts. What that means is that in the state of Florida, PIP insurers determine what medicare would typically pay for a certain treatment, double that amount, and then pay 80% (leaving the other 20% to be paid by the patient).

This calculation may seem simple. However, billing practices are tricky and there are often issues to fight over with insurance companies. 

Florida PIP reimburses hospitals for bills incurred related to a car crash

Other Benefits of Florida PIP Insurance Coverage

One of the other key benefits of Florida Personal Injury Protection insurance coverage is reimbursement of lost wages. Essentially, if your injuries cause you to miss work, PIP will reimburse you for 60% of your lost wages (subject to the $10,000.00 cap). 

This is not a separate $10,000.00 of coverage. It is instead coming from the same place as the coverage for medical bills. This means that if an injured person recoups a great deal of lost wages, there will be less money available to pay for their medical bills. This is sometimes a costly tradeoff. 

The PIP benefit that comes up least frequently, however, is the death benefit. Florida PIP policies allows for a $5,000.00 death benefit to be paid to the survivors of the person that died. This certainly will do almost nothing for a grieving family. But it can often help alleviate the expenses associated with an unexpected funeral.

Know Your Rights and Insurance Coverage

I’ve personally seen people lose hundreds of thousands of dollars (potentially millions) by failing to understand that their auto insurance policy provides them with medical coverage following an accident. It is important that Florida consumers know the coverages afforded to them. Especially those afforded by the laws of the state.

If you, or someone you know, has been injured in a motor vehicle accident and you wish to discuss these coverages and other potential aspects of a personal injury case, call Knapp Accident & Injury Law at (813) 568-3724.

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