Personal Injury Protection PIP in Florida

July 13, 2019


What is Personal Injury Protection (PIP) in Florida?


In the state of Florida, all auto insurance policies are required to provide Personal Injury Protection or PIP as required by Florida Statute 627.736(1). Many people have heard about PIP, or maybe heard commercials of lawyers saying people have 14 days to seek treatment, but not everyone fully understands what all this means and how it affects them. This blog will delve into the details of PIP in the state of Florida and how it affects those in an auto accident.


What are Florida PIP benefits?


As stated above, PIP is required by all Florida auto insurance policies. PIP’s purpose is to help reimburse out-of-pocket expenses as a result of an accident. When you are in an accident, you would use the PIP benefits that are on your own insurance policy, even if you are not at-fault for the accident. This is why Florida is called a “No-Fault” PIP state. You can use the benefits whether you were at-fault for the accident or was just an innocent party. Additionally, PIP reimburses your out-of-pocket medical bill expenses at an 80% reimbursement rate. This means, for example, if you have a $10,000 hospital bill, your PIP benefits will pay for 80% of that bill, resulting in $2,000 left over that you are responsible for. PIP benefits cover many other categories, and they are not all reimbursed at the same rate. Below is a list of some of the different categories PIP reimburses for and the rate at which they are reimbursed.

  1. Medical Bills (including hospital bills) – 80% reimbursement
  2. Mileage (to and from the doctors) – 80% reimbursement
  3. Wage Loss (due to the accident) – 60% reimbursement

Also, in the state of Florida, within the past 10 years an amendment to the Florida PIP statute requires now that only $2,500 of PIP benefits will be afforded to a person, unless they qualify for an Emergency Medical Condition, or EMC. Once a doctor has determined that someone qualifies for an EMC, their PIP benefits will now jump up to $10,000. If you do not use all of your PIP benefits, you are not entitled to a cash payout of the remaining amount. Rather, the remainder of your PIP benefits will just sit there until you incur enough bills to use it, or an adjuster at your insurance company will close out the claim.


How will a deductible affect my PIP benefits?


A majority of people have deductibles on their insurance policies, in an effort to reduce their insurance premiums. While this is completely understandable from a budgeting aspect, what many people don’t understand is how these deductibles will affect them in the long run. The following is an example of a deductible for PIP benefits and how it works: If someone has a $1,000 deductible for their PIP, this means they agree that the first $1,000 in medical bills that PIP would pay, is now going to be paid by you, out of pocket. Thus, for PIP purposes, a deductible essentially reduces the amount of bills that PIP would have normally paid, leaving you with more bills in the end. Therefore, avoid having an deductible if you can afford it.


Do I have to use my PIP within 14 days?


Essentially, yes you have to use your PIP benefits within 14 days, or you forfeit them for that accident. In order to use your benefits, you have to seek any sort of medical treatment for injuries that are related to the accident. Below is a list of medical providers that will “trigger” your PIP benefits:

  1. Urgent Care
  2. Hospital
  3. Primary Care Physician
  4. Dentist (if teeth issues due to accident)
  5. Chiropractor
  6. Orthopedic
  7. Medical Doctor

The above list is just some medical providers, mas you can tell, basically any kind of doctor or medical professional will qualify as long as they are treating you for medical issues related to the accident. One exception to the medical providers is a massage therapist. PIP will no longer provide coverage for treatment from a massage therapist even if the treatment is related to your accident.


Who takes care of the remaining 20% of PIP?


As stated previously, there is be 20% remaining in bills and other out of pockets due to PIP’s reimbursement rate. Additionally, if you use up all your PIP benefits and still have more bills that need to be paid, this will add to the out-of-pocket costs. So who is going to pay you for the remaining balances? Well, this answer depends on a lot of factors. If you have an auto accident, and the person who caused the accident has auto insurance, more specifically bodily injury coverage on their policy, their insurance will be responsible for providing you with a settlement that will pay for those amounts. Sometimes the at-fault party does not have the proper coverage to reimbursement your bills. If this happens, you may be able to receive a settlement from your own insurance company, if you purchased underinsured/uninsured motorist coverage prior to the accident. If none, of the above situations apply to you, then you are unfortunately stuck with the remaining out of pockets, unless of course you sue the opposing party personally.


PIP is a complicated benefit that is required by the state of Florida. There is a lot to know, and many different procedures involved. For more information, contact the Mantia Law Firm regarding PIP benefits in the state of Florida.


Main Office:

978 Douglas Ave.,
Suite 100
Altamonte Springs, FL 32714

Phone: 407-722-7727
Fax: 407-722-7728


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