Florida's No-Fault System Explained
As a trusted South Florida personal injury law firm, Weinstein Legal understands that many may not be familiar with the intricacies of Personal Injury Protection (PIP). Following an accident or trauma, the constant questions a victim is faced with can be overwhelming. At Weinstein Legal, our personal injury attorneys work to simplify this process as much as possible, so that you can focus less on medical bills and more on gaining back your health.
Our team is available at any time to answer your questions or discuss the details of your case. As an added benefit, we’ve compiled some of our most frequently asked questions about Personal Injury Protection to serve as a resource. Contact the office of Weinstein Legal today to schedule a consultation.Contact Us for a FREE Evaluation of Your Insurance Policy
Q: Is Florida a “no-fault” state?
A: Yes, Florida is one of 12 no-fault states operating under a true no-fault system. This means that a driver’s own Personal Injury Protection (PIP) coverage is responsible for paying their own medical bills and rehabilitative costs when they’ve been injured in an auto accident, regardless of which driver was at-fault. The fact that there is no requirement to prove fault to receive PIP benefits is what constitutes Florida as a “no-fault” state.
While only 12 states operate under this no-fault system, 16 states in total require drivers to carry a minimum amount of PIP coverage. In the state of Florida, this amount is at least $10,000 of coverage. If you’re in an accident in a state that does not use a no-fault system, this would be known as a tort state. In this case, the at-fault driver would be held responsible for your injuries instead of your PIP coverage.
Q: What is Personal Injury Protection coverage?
A: Personal Injury Protection, often abbreviated as PIP, is a result of Florida being a “no-fault” state. By Florida law, every vehicle owner and driver is required to have $10,000 in PIP insurance coverage. In the case of an accident, PIP benefits are paid by the individual’s respective insurance company. PIP insurance is also applicable during instances in which you’re a passenger in someone else’s car, or if you’re hit by a car as a pedestrian or cyclist.
A PIP insurance plan will cover 80% of a victim’s medical bills and 60% of a victim’s lost wages. Whatever fees or damages are leftover after PIP coverage will need to be recovered through the at-fault party in a personal injury claim.
Q: Which coverage comes first: health insurance, Medicare, or PIP?
A: For injuries incurred during an auto accident, your PIP coverage will typically be the primary coverage. PIP benefits will usually come before any other available insurance, such as health insurance or Medicare. In fact, other insurance companies may reject medical bills that are sent to them until the PIP coverage has been used in it’s entirety.
In the state of Florida, this means that health insurance companies will not accept a bill until all $10,000 of PIP coverage has been used. However, it should be noted that $10,000 is simply a minimum, and that a Florida resident can purchase a higher amount of PIP coverage if they wish. In the case of an accident, this individual would have more PIP coverage to utilize.
Q: How much PIP coverage should I purchase?
A: First and foremost, you must purchase the PIP coverage required by your state. Hence, in Florida, you must purchase $10,000. If you’re considering purchasing more, check your health insurance first. If you have a comprehensive health plan, the lowest amount of PIP coverage should suffice. However, if you don’t have health insurance, purchasing a higher amount of PIP coverage may be a good idea – this could provide you with benefits to cover medical bills in case of an accident.
Q: How is PIP coverage different from heath insurance?
A: Unlike a set health insurance plan, PIP coverage allows an accident victim to visit any licensed medical provider they choose. PIP does not have agreed-upon fee schedules to manage the cost of treatment or the treatments prescribed, as traditional health insurance would.
Unlike health insurance, PIP coverage does have a window in which it must be used. Under the Florida PIP statute, initial care must occur within the first 14 days after the accident. This does not mean all treatment must occur in the first 14 days. It means that in order to claim PIP coverage, a victim must have their initial assessment within 14 days of the accident, whether it be by emergency personnel, a hospital, or even their family doctor.
Typically, victims are taken to, or visit, the hospital immediately following an accident, so this is usually not a worry. However, if you’re experiencing pain from an accident and have not yet had your injuries assessed, it is imperative you visit a licensed medical practitioner within this two-week time frame to begin medical treatment and have your injuries documented.
Q: What medical providers can I see?
A: Following an auto accident, you can visit any type of licensed medical practitioner you prefer. Under the Florida PIP statute, initial care and services can be provided by an M.D., D.O., D.C., dentist, hospital, facility owned by a hospital, or emergency medical personnel. After you choose your initial care provider, he or she may refer you to specialists, or for certain types of care.
The amended Florida PIP statute does not allow massage therapists or acupuncturists to bill PIP for medical services rendered, even if a medical doctor is overseeing such services. The victim will either need to cover these costs through their own health insurance, or will have to file a claim with the at-fault party’s insurance company.
Q: Can a chiropractor provide initial care and services?
A: Yes. Initial care and services may be supervised, ordered, or prescribed by an M.D., D.O., D.C., dentist, hospital, facility owned by a hospital, or emergency medical personnel.
Q: Do Florida PIP benefits only cover medical treatment?
A: No. While PIP benefits can be used for medical treatment, expenses covered by PIP insurance includes:
- Out of pocket prescription costs
- Diagnostic services
- Ambulatory services
- Dental expenses
- Rehabilitative services
- Lost wages
- Death benefits
- Mileage reimbursement to and from your doctor
If you’re unsure what your PIP benefits will cover, consult with a qualified PIP attorney today.
Q: What do PIP benefits NOT cover?
A: PIP benefits may not cover accidents involving farm equipment, recreational vehicles, mopeds, and motorcycles. Likewise, PIP benefits will not cover costs for massage therapists or acupuncturists.
Q: What happens if I use all of my PIP benefits?
A: Like a credit card, your PIP coverage does have a limit. Once you’ve maxed out your PIP coverage, you are responsible for your own medical bills. In some cases, health insurance will cover some of these costs. However, if you have reached the end of your PIP coverage you should contact an auto accident attorney to explore other options. Oftentimes the at-fault driver may have Bodily Injury Liability coverage within their insurance policy to help cover a victim’s medical costs.
Q: Why is my insurance paying the bills when another driver was at-fault?
A: Due to Florida being a no-fault state, your mandatory PIP coverage is meant to pay your bills, even if another driver was at-fault. However, this doesn’t mean you have to shoulder all costs on your own. Filing a claim with an at-fault driver means you must prove liability. Essentially, neither the at-fault driver nor their insurance company is required to pay for your medical expenses until you’ve proven liability.
At Weinstein Legal, we understand that taking on that task alone can be intimidating. That’s why our dedicated team of attorneys will work with you to fight for the compensation you deserve.
If you or someone you love has recently been involved in an auto accident and is facing difficulties with their PIP coverage, contact the office of Weinstein Legal. For a free and confidential consultation, enter your details in the form to your right. We look forward to hearing from you soon.