As a motorist in Florida, you know that you are required by law to carry personal injury protection (PIP) insurance.
Also referred to as “no-fault” insurance, PIP policies pay for your injuries after an accident, regardless if you or the other party was at fault. Ideally, the state wants to minimize the number of claims brought through the courts, and PIP insurance does so for the most part.
However, just because you have PIP does not mean you are barred from filing an injury claim after a severe accident. Instead, it requires that you understand the laws and limitations of PIP and your options when medical costs well exceed a PIP limit.
PIP Insurance and the No-Fault System Ft. Lauderdale Motorists Need to Know
PIP covers you in an accident, along with family and passengers in your vehicle at the time of an accident. If a party in your car has their own PIP policy, they can receive compensation for medical costs through that policy instead.
When you have PIP, you receive coverage for:
- 80 percent of all medical expenses related to the accident, including mileage for driving to those visits
- 60 percent of lost wages
- Up to $5,000 for funeral expenses
Your PIP limits are $2,500 unless you are classified as suffering an emergency medical condition. Once classified as an emergency medical condition, you can receive payments for up to the maximum policy, which is usually $10,000.
PIP Limits and Basics in Florida
The state requires that you carry at least $10,000 in PIP even if you can only unlock up to $2,500 after an accident. However, the law does not bar you from seeking higher coverage. Most consumers should buy more, especially if they have a single PIP policy for everyone in their family.
PIP will cover pedestrian injuries too, but will not cover motorcycle accident injuries.
Forcing consumers in the state to buy no-fault insurance means that, regardless of the party at fault, you would file a claim with your insurer for compensation first. These no-fault systems do have benefits, such as lowering insurance premiums and reducing litigation costs. However, some argue against the use of no-fault insurance, because it allows motorists to be more reckless knowing that they have coverage, regardless if they cause an accident.
To use your benefits, you must seek medical treatment before the 14-day anniversary of the accident. Also, PIP excludes non-traditional medical therapies, such as acupuncture therapy.
What Medical Expenses Are Covered by PIP?
Whether you can only use your $2,500 benefit or the full amount, PIP will cover most expenses (up to 80 percent) of the following:
- Immediate Medical Services
- Ambulance Costs
- Hospital Stays
- Surgical Procedures
- Diagnostic Services
- Laboratory Services
- Prescription Costs
- Medical Equipment Costs
Realize, that you still only receive 80 percent of these expenses. Therefore, if you have a $1,000 hospital bill, PIP only pays $800. The rest comes from your personal finances.
Lost wages are reimbursed up to 60 percent in value, subject to the maximum of $10,000. When your lost wages exceed this amount or you have exhausted the full benefit, you may seek loss of earning capacity from the other party’s insurance company.
When Your PIP Limits Are Exhausted, You Still Have Rights
While Florida is a no-fault state, they do recognize that accidents can and will exceed the policy limit. When your injuries exhaust your injury protection policy amounts, the law allows you to seek additional compensation from the at-fault party.
Typically, you must suffer serious enough injuries to file a claim against the other driver. Some examples of injuries can include:
- Traumatic Brain Injuries (TBI)
- Loss of a limb
- Permanent disfigurement
- Severe burns
- Broken bones
- Spinal cord injuries
The insurance company for the other driver might try to classify your injuries as non-serious, and they may even make claims that you are suffering from temporary injuries that disqualify you from filing a lawsuit. Realize, insurance companies are in the business of making money, which means they work toward paying out as little as possible on cases like these.
You will want to hire an attorney if you think your case is worth more than your PIP coverage. An attorney will then work to collect evidence that establishes the severity and permanence of your injuries; thus, qualifying you to seek further compensation.
The Insurer’s Right to an Independent Medical Examination (IME)
Florida law allows for insurance companies to request a victim undergo an IME. The insurer selects the IME physician, and they will do a physical examination and a review of your medical records – including those before the accident to make sure you are not claiming previous injuries.
It is imperative that you have an attorney. Your attorney will ensure you do not sign anything during the examination, which you are not required to do. Also, while you are undergoing your IME, you must remain honest and upfront with the insurance company’s physician, but you do not need to supply more information than necessary. Answer questions with brief responses, but do not elaborate. Likewise, do not exaggerate your symptoms, because this will make it look as though you have made up your claims.
Do You Need an Attorney for a Claim after PIP Is Exhausted?
Yes, you do.
You want an attorney to consult and tell you if you have a case after you have exhausted PIP benefits. The law is strict about which types of cases qualify for further compensation. Furthermore, while you are recovering from serious injuries, you want an advocate who will aggressively seek compensation on your behalf.
Insurance companies tend to take advantage of those who are negotiating a settlement without legal representation. Therefore, you want to protect your rights and ensure you get the settlement you deserve.