What is Personal Injury Protection (PIP) Coverage?

Under Florida law, all licensed drivers who own a car must carry personal injury protection (PIP) coverage with their insurance company. Why? Because Florida is one of 12 no-fault states. In no-fault states, every driver must have insurance to cover their own injuries and car damages in the event of a car accident. No matter who was at-fault in a car crash, you’re responsible for calling your own insurance to file a claim and receive compensation for medical bills and car repairs.

PIP coverage is the portion of your car insurance that’s responsible for covering the costs of medical visits and treatments you need for injuries after a car collision. Unfortunately, PIP laws are not very cut and dry — there’s a lot of information you need to know about how and when you can use PIP. And it’s much better to learn the rules and limitations now, so you will be better prepared if you’re in a car crash. That’s why we’ve created this helpful guide. 

WHAT IS PIP COVERAGE?

All Florida drivers are required to hold $10,000 worth of personal injury coverage with their insurance company. Because Florida is a no-fault state, drivers must use their own insurance to pay medical bills for injuries after a car accident, regardless of who was at-fault. PIP can be used to pay for medical costs (doctors’ visits, medications, surgery, rehabilitation, diagnostic services), lost wages and death benefits. PIP can also be used to pay for replacement services — like an aide to cook and clean for you — if you’re unable to perform these tasks due to an accident injury. 

However, there are limitations to how much you can collect on PIP after an injury accident. In Florida, your insurance coverage will pay for the following under a PIP claim:

• 80% of medical costs (up to a limit of $10,000)
• 60% of lost wages (up to a limit of $10,000)
• $5,000 worth of funeral and burial costs

Additionally, if your injuries aren’t considered to be an “emergency medical condition (EMC),” you’re only eligible to collect $2,500 from PIP coverage. Under Florida PIP Statute §627.732, an EMC is defined as a condition that would cause serious jeopardy to the patient’s health, serious impairment of bodily function or serious dysfunction of any bodily organ or part in the absence of immediate medical attention.

If you sustain injuries in a car crash, file a claim for PIP benefits as soon as possible. After an accident, you only have 2 weeks to receive medical treatment to collect PIP benefits. Your insurance company has 30 days to pay out your expenses after you file a claim. Your PIP policy covers you if you’re the driver in a car accident or a passenger in another car that gets into an accident.

WHAT ARE THE BENEFITS OF PIP?

The primary benefit of PIP is that it allows you to receive swift reimbursement for medical bills and injuries after a car crash. This is especially beneficial if you weren’t the at-fault driver, because trying to collect payment through the courts or the other driver’s insurance company can be a long and challenging process. With PIP, you can seek immediate treatment for injuries instead of delaying treatment due to financial issues. 

Car crashes can lead to multiple significant injuries like whiplash, concussions, soft tissue damage and spinal injuries, and delaying treatment may cause injuries to worsen and require longer to heal. Just remember to keep all documentation of your out-of-pocket medical expenses. In order to collect PIP benefits, you’ll need to show proof that you received treatment within 2 weeks. You’ll also need to provide documentation like original receipts, doctors’ orders and prescription labels to your insurance company.

A second benefit of PIP is that you can use your coverage for other members of your household, like your children. If your children were passengers in your car when you got into an accident, or if they were passengers in another car that was in an accident, your PIP benefits extend to their care and treatment.

WHAT ARE THE LIMITATIONS OF PIP?

Unfortunately, there are significant limitations to PIP coverage. First, PIP doesn’t cover all of your medical or wage expenses — insurance coverage is only responsible for 80% of medical costs and 60% of lost wages. Therefore, you’ll still be responsible for 20% of your medical expenses, an amount that could still be several hundred or thousand dollars. Your healthcare insurance may cover the remaining 20%, but that’s not a guarantee. And if you have to miss several days or even weeks of work, you’ll be receiving 40% less money than you would have made while working.

Additionally, PIP limits the amount of time you have to get medical care and treatment. While it’s always a good idea to get a complete medical examination following a car crash, injuries might not be present right away. It could take weeks or even months for the full extent of your injuries to be realized. Or new injuries may appear after the 2-week limit you have to collect PIP benefits. 

One final problem with PIP is interpreting the definition of an emergency medical condition. If your injuries aren’t considered an EMC, PIP limits the amount of compensation you’re allowed to collect to $2,500. Unfortunately, Florida PIP Statute §627.732 doesn’t include a definitive list of conditions that qualify as emergency conditions. It’s up to the opinion of a qualified doctor or the courts to make the call. These guidelines mean that the process of determining an EMC is imprecise, subjective and open to much interpretation. 

DO I NEED A LAWYER?

If you’ve been injured in a car accident, consider hiring a personal injury lawyer to represent you. An accident attorney will work on your behalf to ensure that you receive the full amount of compensation you’re entitled to under PIP. Additionally, an experienced attorney can help you navigate the grey areas of determining if your injury is an emergency medical condition.

Lastly, you’ll need a personal injury attorney if you have a case to sue an at-fault driver outside of PIP. Florida law allows you to sue the negligent driver if you suffer injuries that result in serious, permanent, life-changing injuries. These injuries may include traumatic brain injuries, paralysis, disfigurements, amputations, fractures, or back and spinal cord injuries. In cases like these, medical costs usually come out to way over the limits of what PIP will cover. In addition to medical costs, you can also sue the other driver for intangible costs like emotional pain and suffering.

INTEGRITY SPINE AND ORTHOPEDICS TREATS CAR CRASH INJURIES

If you’ve been injured in a car accident, don’t wait to seek medical care and treatment. At Integrity Spine and Orthopedics, our board-certified orthopedic surgeons have the training and expertise to diagnose and treat whiplash, concussions, soft tissue injuries, fractures and spinal damage caused by car collisions. We have multiple treatment options in our Jacksonville, Florida, clinics to help you get back on your feet and back to doing the activities you love as soon as possible.

If you’ve been involved in a car crash, call us at 904-456-0017 or fill out our online contact form to request an appointment.