Personal injury protection (PIP) is an add-on to car insurance that, when enacted, covers medical expenses and other costs. What makes this different than other forms of car insurance is that it is considered “no fault” coverage. That is, even if the person injured is at fault, they are still legally entitled to enact the PIP portion of their insurance policy. However, doing so as the at-fault driver can still cause premiums to increase.
In 2012, Florida Governor Rick Scott signed into law House Bill 119, outlined in Statute 627.736. This law mandates PIP as a part of every auto insurance policy. In addition, it lays out rather strict guidelines for what kinds of treatment qualify under PIP, and deadlines for enacting the policy. These were put in place to reduce PIP fraud, which was becoming a major issue in Florida. While there was initially some concern over the law and its ramifications on insurance and medical providers, it has since become an integral part of Florida drivers’ policies.
Florida’s PIP Law and Anti-Fraud Reforms
Under the PIP laws of Florida, drivers who are injured in an accident can receive up to $10,000 immediately to cover medical costs, instead of going through the court system to assign fault in the accident. That process could take months, causing a delay in payments for injured drivers, and puts heavy strain on the court system. PIP puts that responsibility on the driver instead.
The original issue with PIP was the number of claims being made. While the number of accidents and injuries remained relatively constant, PIP claims soared. In fact, some Florida cities were listed as having the highest numbers of “questionable claims” across the nation. About half of all insurance fraud claims in the state were a result of PIP. The cost of that fraud was being paid by taxpayers and insurance holders, causing rates to increase. That’s why Governor Scott signed into law the Personal Injury Protection (PIP) for Auto Insurance Fraud law in 2012.
What PIP Policies Cover
Florida Statute 627.736 lays out the specifics of what PIP coverage can be used for. First and foremost, it is used to cover a variety of medical benefits. After all deductibles are paid, PIP will pay 80 percent of the expenses for:
- Out-of-pocket prescriptions
- X-rays
- Dental work
- Rehabilitation
- Ambulance, hospital and nursing costs.
All of these expenses must be directly related to the auto accident. Unlike in some other states, Florida’s PIP laws do not cover acupuncture and massage therapy.
In addition, PIP insurance can be used to cover:
- 60% of lost wages
- Mileage reimbursement for doctor visits
- $5,000 in death benefits (in addition to medical and disability benefits).
Though the law states that PIP may cover up to $10,000 in medical costs, if you do not sustain an “emergency medical condition,” that payout is limited to just $2,500. An emergency medical condition is one in which immediate attention is needed, and not getting immediate treatment could seriously jeopardize your health.
Insurance Coverage Limits and the Emergency Medical Condition Rule
Although PIP offers a maximum of $10,000 in benefits, that full amount is only available if you are diagnosed with an emergency medical condition (EMC) — a condition that requires immediate attention and poses a serious threat to your health if untreated.
If your injuries are not considered an EMC, PIP benefits are capped at just $2,500.
Critical Deadline for PIP Claims
Perhaps the absolute most important clause in the Personal Injury Protection (PIP) for Auto Insurance Fraud law is the statute of limitations set for filing a claim. You must receive treatment for your injuries within 14 days of the accident in order to get your medical bills covered. If you do not, you will be responsible for your own expenses. These may be covered later on after a personal injury lawsuit, but that may take months to be completed.
Another important section to take note of is what continuing treatment is covered. If you sustained serious injury, like a traumatic brain injury or a spinal cord injury, only treatment related to those specific injuries can be covered by PIP. Finally, PIP will not be paid out if you intentionally tried to get yourself injured; you were injured while committing a felony; or if you were driving a car under whose insurance policy you are not covered, and you did not have express or implied permission to drive it.
Dealing with Delays & Letters of Protection
While PIP claims are often processed without issue, insurers sometimes delay payments — particularly if they suspect fraud. Florida law requires insurers to pay out PIP benefits within 30 days of receiving notice of a covered loss, though they have 60 days to investigate suspected fraud.
If payment delays prevent your doctors from getting paid, they may ask you to sign a Letter of Protection (LOP). This is a legal agreement stating that any unpaid medical bills will be covered from your future settlement.
A personal injury attorney can review any Letter of Protection before you sign, ensuring your interests are protected.
Why PIP Alone Often Isn’t Enough
Florida’s PIP system offers only limited financial relief. Even if you receive the full $10,000, that amount is rarely enough to cover serious injuries, especially if you require surgery, extended rehabilitation, or ongoing care.
- PIP covers only 80% of medical bills, leaving you to pay the remaining 20%.
- PIP covers only 60% of lost wages, meaning you lose 40% of your income.
If your injuries are serious — including broken bones, spinal cord injuries, or traumatic brain injuries — your expenses can easily exceed PIP limits. In such cases, you may need to pursue compensation beyond PIP through a third-party bodily injury liability (BIL) claim.
Third-Party Claims Against At-Fault Drivers
If your accident was caused by someone else, you may have another avenue. You can submit a third-party bodily injury liability (BIL) claim from any at-fault drivers or other parties involved to recover:
- Medical costs that exceed PIP limits
- 100% of your lost wages
- Pain and suffering damages (which PIP does not cover)
To file a successful third-party claim, you must prove:
- You sustained a serious injury, as defined under Florida Statutes § 627.737.
- The at-fault driver was negligent.
- Their negligence directly caused your injuries and losses.
Hiring an Attorney for PIP Claims
Often, PIP claims are easily handled by insurance companies with little to no conflict. However, there can be issues with payment to the medical provider if the insurance company drags their feet. Claims payouts are considered overdue 30 days after insurers are given written notice of the monetary amount of covered loss. The insurance company then has 60 days to investigate and ensure there is no fraud. In the meantime, your doctor may ask for a letter of protection, when is a contract ensuring all unpaid expenses will be covered by your PIP claim.
If you insurance company is taking too long to pay out your benefits, an attorney may be able to help. They can work to make sure your insurer pays you in a timely fashion. In addition, they can review any letter of protection to make sure it is sound before you sign it.
If you were not at fault for the accident, and PIP doesn’t cover all of your expenses after you sustain serious injuries, it may be prudent to hire a personal injury attorney to file a claim against the at-fault driver. They will make sure the serious injury you sustained is not downplayed by the defendant’s attorney. Even if you get a PIP payout, you may be entitled to further compensation under Florida law. Contact our Florida personal injury attorneys at Steinger, Greene & Feiner today for a free consultation and to learn more about your legal options.