How does PIP work?

Published July 1, 2019 by Englander Peebles
How does PIP work in florida?

When someone gets into a car wreck in Florida, it’s a little different from what happens in many other states. As a no-fault insurance state, Florida law has a number of extra steps that can create obstacles and challenges. Injured people and medical providers alike often struggle to make sense of the personal injury protection (PIP) system.

At Englander Peebles, our experienced Florida car accident lawyers want you to understand your rights. Among some of the most frequently asked questions, people often want to know more about how PIP actually works in practice.

What is Personal Injury Protection (PIP)?

This is a basic type of auto insurance coverage that is designed to protect injured people pay for their medical expenses after a car accident. Years ago, Florida’s lawmakers decided to change the structure of the insurance system within the state. In a no-fault system, each party to an accident must first file an insurance claim with their own insurance carrier, rather than filing a claim against the other driver, regardless of who is at fault.

How does PIP Work?

Here’s a brief explanation of how PIP works in real life.  If you get into a car accident, you first file the claim with your own insurance company.  Florida drivers are required to carry a minimum of $10,000 worth of PIP coverage in order to pay for their own injuries from a car accident. This means even if someone else was completely careless or texting and driving, your own insurance policy must legally pay for your injuries first.

If you are exempt from PIP for some reason, you may still be able to bring your claim directly against the other driver. Remember that PIP is designed just to cover emergency medical conditions (EMC) that occur after a car accident.

According to FLA STAT. 627.727, you can’t sue the other driver unless you meet certain threshold requirements, namely:

  • You have suffered some substantial injury or permanent loss to a critical bodily function
  • Your doctors determine that you have a permanent injury
  • You suffer significant scarring or disfigurement
  • Death

Of course, the law’s definitions are subject to a bit of interpretation, which is why it’s often helpful to have an attorney working with you from the beginning of your case.

PIP Exemptions

There are generally four groups that are expressly exempt from PIP. These are

  • Pedestrians
  • Bicyclists
  • Motorcyclists
  • Out-of-state Drivers

For obvious reasons, there are times when a Florida driver strikes someone who is not covered by PIP. This may include someone who does not own a vehicle, like a pedestrian or bicyclist. The law carves out special exemptions for these individuals. Plus, their injuries are usually catastrophic anyway, so they would likely exceed the threshold limitations of PIP.

What is an Emergency Medical Condition (EMC)?

We mentioned EMC’s earlier, but what exactly is considered an emergency medical condition in Florida? To start with, ask these questions:

  • EMC’s defined. An EMC is an acute medical condition that manifests itself within 14 days and requires medical treatment. There’s more to it than this, but in general, it just means it can’t be a disease, long-term chronic condition, or degenerative change. It must be a directly related medical condition that requires medical care.
  • Did you seek medical treatment within 14 days of the accident? If not, the insurance carrier will deny any medical expenses.
  • Were you the owner of the vehicle that you were in? If so, your PIP insurance applies.
  • Is the owner of the vehicle a blood relative, or does that person reside with you? If so, you can still use their PIP insurance to pay for medical treatment.
  • Were you a passenger in someone else’s vehicle, but neither you nor anyone in your household owns a vehicle?  This is a fairly unlikely scenario, but where it happens, then you would file for PIP benefits through the vehicle owner’s policy.
  • Can Bicyclists, Pedestrians, and Motorcyclists Use PIP? Yes. If they own a covered vehicle and carry PIP insurance, they can indeed use it. But they may not be required to meet all the same threshold requirements to file a claim against the other driver.
  • Who provides emergency medical care?  It’s up to you, but any ambulance or hospital charges will usually be covered, as will chiropractors, surgical centers, and primary care physicians. But the care must be initiated within 14 days.  
  • What happens if medical bills exceed PIP?  Since PIP is only $10,000 in most cases, once you meet the threshold requirements listed above, such as a permanent injury or a substantial loss of bodily function, then you have a right to file suit against the other driver immediately. You do not need to wait for any other contingencies. Therefore, it’s helpful to work with an attorney who can help you position your case so that you preserve your right to hold the other side accountable for serious injuries.

How the Firm Can Help with a Car Accident Case

After a car accident, the attorneys of Englander Peebles get to work fast. When working with our clients to resolve an auto accident claim, these are just a few of the ways we can help:

  • Gather Evidence. We work swiftly to acquire as much evidence as possible, including crash reports, witness statements, video and photographic evidence, and anything else we think might help to prove your case.
  • Medical Treatment. We can often help our clients locate medical providers who understand PIP and will work with them to get the treatment they need.
  • Negotiations/Liens. We can negotiate with insurance companies to help you maximize your benefits while preserving your right to pursue justice by filing suit against a negligent driver. Likewise, we routinely help our clients resolve complex healthcare liens and government reimbursement rights.
  • Fierce Litigation Support. Finally, if insurance companies won’t treat you fairly, we stand ready to fight for you in court. Our experienced team of trial lawyers has the experience necessary to stand up to the big insurance companies.

For help after a Florida car accident, call Englander Peebles to speak with an attorney about your case. The call is free, and we have conveniently located offices throughout South Florida. So, contact our firm today.

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At Englander Peebles, we understand the pressure people face when they are seriously hurt in an accident and are facing off against a large insurance company. As the bills mount, so does the stress. And the most frustrating part is that you can be victimized a second time if the insurance company refuses to pay in full, putting your financial future in jeopardy.

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