In the state of Florida, if you were injured in motor vehicle accident, whether it is the fault of another party or your own, your PIP coverage through your insurance company, must pay 80% of your medical expenses and up to 60% of your lost wages and replacement services (such as child care, home or yard cleaning, etc.). PIP insurance also pays up to $5,000.00 in death benefits.
Insurance claim disputes are not supposed to happen. The purpose of insurance is to help you when you are in need after an unfortunate event. In most cases the PIP insurance companies pay the money that is due under the insurance policy after you make your claim. However, there are occasions that the insurance company denies claims, pays less than what is due, delays payment, or makes unreasonable demands before making payment. This is when you need a lawyer to provide you with the advice and guidance on the different Florida PIP insurance claim disputes that arise.
Our law firm has significant experience in reviewing PIP insurance claims and advising claimants of their rights under their PIP policies. We also have extensive experience in litigating disputes involving PIP insurance, including actions for breach of contract and declaratory relief.
This type of coverage can, at times, be extremely troublesome for both the claimant as the statute regulating PIP insurance is often vague and open-ended. If you have any questions regarding your coverage, please do not hesitate to call.
Florida is a No-Fault Automobile Insurance State. What Does that Mean to a Florida Resident? What is PIP or Personal Injury Protection Insurance Coverage? Who is Covered Under a Personal Injury Protection Insurance Policy? What is a Deductible? A deductible is the amount of money a claimant must pay per accident before the insurance company will start paying your medical bills. If you do not choose a deductible your premium may be higher. Usually the higher the deductible in a policy, the lower the premium you pay. The insurance company is allowed to offer you PIP deductibles in the amounts of $250, $500, or $1,000, but you do not have to accept a deductible on your PIP coverage. The deductible may apply only to you and dependant family members who live with you. If you do choose a deductible, remember that a deductible can cause immediate out of pocket expenses as this amount will be subtracted from the available PIP benefits, which is the total amount you can collect in benefits. For example: The medical benefit of PIP is 80% of expenses for medical services. If you have $10,000 in medical bills, and you have a $1,000 deductible, you will have to pay the first $1,000 of those bills and the 20% of the remaining $9,000. Your PIP insurance would only be obligated to pay $7,200, and you would then owe $2,800. EXAMPLE: (WITH DEDUCTIBLE) $10,000.00 Submitted Medical Bills -$1,000.00 Deductible $9,000.00 Total before coverage applied X 80% Percent of PIP Coverage $7,200.00 The total amount PIP is obligated to pay. $10,000.00 Your total submitted bills. -$7,200.00 Total amount PIP would be obligated to pay. $2,800.00 Total amount YOU would be obligated to pay. EXAMPLE: (WITHOUT DEDUCTIBLE) $10,000.00 Submitted Medical Bills X 80% Percent of PIP Coverage $8,000.00 The total amount PIP is obligated to pay $10,000.00 Your total submitted bills -$8,000.00 Total amount PIP would be obligated to pay $2,000.00 Total amount YOU would be obligated to pay What is “Medical Payment Coverage? What is Extended or Additional Personal Injury Protection Coverage? What if an Accident Happens Outside of Florida? What is a Compulsory Medical Examination? It is important to know that if a claimant refuses to submit to the exam under PIP this may constitute as a breach of contract which may release the insurance company from their obligation to pay benefits.
Being a “No-Fault insurance” state means that drivers must carry insurance for their own protection, and it restricts their ability to sue the at-fault driver for damages. According to Florida law, if you own a motor vehicle with four or more wheels you must carry at least $10,000 of personal injury protection insurance (PIP) and a minimum of $10,000 of property damage insurance. If you fail to carry PIP and property damage coverage, the Department of Highway Safety and Motor Vehicles has the authority to suspend your driver’s license and vehicle registration. To get your license back, you will have to pay reinstatement fees of $150 up to $500.
If you are in an automobile accident, personal injury protection insurance (PIP) covers you whether you caused the accident or not, up to the limits of your policy. PIP pays: 80% of reasonable medical expenses. 60% of lost wages and replacement services such as child care, home or yard cleaning and up to $5,000 for death benefits.
For automobile accidents that happen in Florida, PIP covers you and dependant relatives who live in your home, passengers who do not have PIP coverage, certain licensed drivers who drive your car with your permission, and individuals who do not have PIP and were struck by the insured vehicle while (pedestrian, bicyclist, etc). If someone injured in your car has PIP, then that person’s own PIP insurance will cover him or her. However, if a person who was injured in your car and does not own a car or have any other access to PIP, your PIP insurance will cover him or her.
Medical Payment Coverage (Med Pay) is an optional insurance coverage you may elect to purchase and is separate from PIP benefits. Med Pay will pay the remaining 20% of your medical expenses when PIP only pays 80%, so that your medical expenses are fully covered. If you meet your maximum in PIP coverage and those PIP benefits are exhausted, Med Pay will pay medical expenses at 100% until it exhausted.
Extended PIP is an optional coverage offered by some insurance companies. For an additional premium the insurance company may increase the amount payable under your PIP coverage over the mandated $10,000. Usually the increase for medical coverage would be from 80% to 100% and the lost wage benefit from the mandated 60% to 80%.
For accidents that happen outside of Florida, but inside the United States or Canada, PIP covers only you and relatives who live in your home. In this case, you must be driving or riding in your own vehicle.
Florida law allows PIP insurance companies to require claimants to submit to compulsory medical examinations. A compulsory medical examination is when the PIP insurance company selects a physician of their choice to examine the claimant in order to evaluate any claims of injury. The insurance company will pay the cost of this examination.
