After a car accident in Florida, the first source of insurance coverage for your medical bills comes from your own policy, regardless of who caused the crash. This is your Personal Injury Protection, or PIP, coverage.
This system is designed to provide quick access to benefits for immediate medical needs. However, the rules for understanding PIP benefits in Florida are specific and often confusing for those unfamiliar with the law. Our firm helps injured people file and manage their PIP claims to secure the benefits they are entitled to under their policy.
Your quick guide to PIP coverage
- Florida law requires most vehicle owners to carry a minimum of $10,000 in Personal Injury Protection (PIP) coverage.
- PIP is no-fault coverage, meaning you use your own policy for initial medical bills and lost wages even if the other driver was 100% at fault.
- You must seek initial medical care within 14 days of an accident to be eligible for PIP benefits. Failure to do so may result in a complete denial of your claim.
- To access your full $10,000 in benefits, a qualified medical provider must determine that you have an "Emergency Medical Condition" (EMC).
The Foundation of Florida’s No-Fault System: Personal Injury Protection (PIP)
Florida operates under a no-fault car insurance system. The central component of this system is Personal Injury Protection. The goal of this law, found in Florida Statute § 627.736, is to ensure that anyone injured in a car accident has a swift and direct way to pay for their immediate medical needs.
Instead of waiting for a lengthy fault investigation to conclude, you can get treatment right away using your own coverage.
Who is required to carry PIP?
The law requires the owner of nearly every motor vehicle in Florida to carry PIP insurance. This applies to private passenger cars, trucks, and most other four-wheeled vehicles. This requirement ensures that a baseline of medical coverage is available in the vast majority of traffic accidents across the state. The mandatory nature of this coverage is a cornerstone of the no-fault system.
How does no-fault coverage work in practice?
The no-fault concept can be counterintuitive. If another driver runs a red light and T-bones your car, your first call for medical bill payment is not to their insurance company, but to your own.
You file a claim under your own PIP policy to cover your initial costs. This process happens independently of any claim you may later file against the at-fault driver for property damage or for injuries that exceed what PIP covers. It is a system of pay first, determine fault later.
Who Does Your PIP Policy Cover?
A standard PIP policy in Florida provides a broad umbrella of coverage. It does not just protect you, the policyholder, when you are driving your own car.
Your PIP policy generally extends to several groups of people.
- You, the policyholder. You are covered whether you are driving your own car, driving someone else’s car, or are a passenger in another vehicle.
- Your resident relatives. Any family members who live in your household are typically covered under your PIP policy, even if they are injured in someone else's car.
- Passengers in your vehicle. If you have a passenger in your car who does not own a vehicle and is not covered by another resident relative’s PIP policy, your policy will cover them.
- You as a pedestrian or bicyclist. Your PIP policy also covers your medical bills if you are struck by a motor vehicle while walking or riding a bike.
This structure is designed to make sure that nearly everyone involved in a crash has a direct line to insurance benefits without having to immediately resort to litigation.
The Specifics of Your PIP Benefits: What is Actually Covered?
While PIP provides a crucial safety net, it is important to know its specific limitations. The standard $10,000 policy does not mean you will receive a $10,000 check. The benefits are paid out according to a strict formula for specific types of losses, and they cap out at that total amount.
The 80/60 payout formula
PIP does not cover 100% of your bills. Instead, it pays a percentage of your documented losses. The standard formula is 80% for medical expenses and 60% for lost wages.
This means that even with PIP, you are still responsible for the remaining 20% of your medical bills and 40% of your lost income. This gap can be a significant financial burden, especially if you miss a lot of time from work.
Medical expenses covered by PIP
PIP is primarily for medical care. It covers a wide range of services that are deemed medically necessary as a result of the car accident. This can include bills from the ambulance service, the emergency room, your primary care physician, chiropractors, and physical therapists. It also covers the cost of diagnostic imaging like X-rays and MRIs, as well as necessary medical supplies.
Lost wages and replacement services
If your doctor places you on a no-work restriction because of your injuries, PIP can help replace a portion of your lost income. You will need to provide your insurance company with documentation from your employer verifying your rate of pay and the time you have missed.
PIP provides benefits equal to 60% of this documented lost income. In addition, PIP may cover the cost of hiring someone to perform household services that you are no longer able to do yourself because of your injuries, such as cleaning or lawn care.
The death benefit
In the tragic event that a person dies as a result of injuries sustained in a car accident, their PIP policy provides a death benefit. This benefit is in addition to the medical and disability benefits paid out before the person’s passing.
While it cannot compensate for the loss of a loved one, it can help the surviving family members with immediate expenses.
Critical Deadlines and Requirements for Your PIP Claim
Strict rules and deadlines govern the PIP system. An insurance company can rightfully deny your entire claim if you fail to follow these procedures. Knowing these rules from the outset can help protect your access to the benefits you have paid for.
The 14-day rule for initial treatment
This is arguably the most important rule in the entire PIP statute. You must seek initial medical services and care for your injuries within 14 days of the motor vehicle accident.
If you wait until day 15 to see a doctor for the first time, your PIP insurer has the legal right to deny all benefits. This deadline is absolute. Even if you have a serious injury, a delay beyond this window can be fatal to your PIP claim.
The emergency medical condition (EMC) determination
To unlock the full $10,000 in available PIP benefits, the law requires a specific medical determination. A qualified physician, such as a medical doctor or a doctor of osteopathy, must state that you have sustained an Emergency Medical Condition.
The law defines an EMC as a condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health. If a doctor does not make this specific determination in your medical records, your PIP benefits will be capped at just $2,500.
Attending an independent medical examination (IME)
Your insurance company has the right to have you examined by a doctor of their choosing. This is called an Independent Medical Examination, or IME. The purpose of an IME from the insurer's perspective is to have a physician review your case to determine if your injuries are related to the accident and if your ongoing treatment is medically necessary.
You are contractually obligated to attend these appointments. If you fail to show up for a scheduled IME, your insurer can cut off your benefits.
When PIP is Not Enough: Moving Beyond the No-Fault System
The no-fault system is intended to be a simple solution for minor accidents. However, when injuries are serious and the costs are high, the $10,000 in PIP benefits is often exhausted almost immediately. At this point, the only path to a full financial recovery is to file a personal injury claim against the driver who caused the accident.
Filing a claim against the at-fault driver's insurance
Once your injuries meet the serious injury threshold as defined by Florida law, you can pursue a claim against the negligent driver. This claim is filed with their Bodily Injury (BI) liability insurance carrier.
This is a fault-based claim where you must prove that the other driver’s actions caused your injuries. This claim allows you to pursue compensation for all the damages that PIP does not cover, including 20% of medical bills and 40% of lost wages that PIP left behind, as well as your pain and suffering.
The importance of bodily injury and uninsured motorist coverage
While PIP is mandatory, Bodily Injury (BI) liability coverage is not required for all drivers in Florida. This is the coverage that protects your personal assets if you cause a serious injury to someone else.
Uninsured/Underinsured Motorist (UM) coverage is also optional, but it is one of the most important coverages you can buy. UM coverage steps in to protect you when you are hit by a driver who has no BI coverage or not enough to cover your damages. We always recommend that drivers carry as much BI and UM coverage as they can afford.
FAQ for Understanding PIP Benefits in Florida
If I use my PIP benefits, will my insurance rates go up?
It is possible that any claim, even a no-fault one, could affect your future insurance rates. However, the immediate need for medical care after an accident should be your first priority. Failing to use your benefits for fear of a rate increase could leave you with unpaid medical bills and could harm a future personal injury claim.
Can my health insurance refuse to pay for car accident injuries until my PIP is used up?
Yes, in most cases. Your auto insurance, through your PIP coverage, is considered the primary payer for injuries sustained in a car accident. Most health insurance policies have a coordination of benefits clause that states they will only pay for costs that are not covered by other insurance, so they will typically require you to exhaust your PIP benefits first.
What happens if multiple people in my car are injured? Does the $10,000 get split?
No, the $10,000 PIP limit is per person, per accident. Each injured person who is covered under your policy has their own $10,000 in potential benefits. The limit is not shared among all the occupants of the vehicle.
Do I have to pay back my PIP benefits if I win a settlement from the at-fault driver?
Generally, no. Your PIP carrier paid benefits that you were entitled to under your own policy. However, if your PIP carrier makes a claim for reimbursement, known as subrogation, this can be a complex issue. Our firm handles all communications with insurers, including any subrogation claims, to protect your settlement.
Your First Step Toward Recovery
The rules surrounding Personal Injury Protection in Florida can seem complicated, especially when you are also trying to recover from an injury. The deadlines are strict, and the financial stakes are high.
Getting the process right from the beginning can make a significant difference in your physical and financial recovery. Our firm helps people manage their PIP claims and, when necessary, build a strong case against a negligent driver to pursue full compensation.
If you have questions about your insurance coverage or your legal options after a crash in Florida, we invite you to reach out through our contact page. A conversation with our personal injury lawyer can provide the clarity you need.