What Does Personal Injury Protection (PIP) Cover in Florida?

Personal Injury Protection (PIP) is a fundamental component of auto insurance designed to provide financial coverage for medical expenses and lost wages following a motor vehicle accident. This coverage applies regardless of who was at fault for the incident. PIP helps ensure that individuals injured in a crash can access necessary medical care and financial support for their recovery.

Understanding Florida’s No-Fault System

Florida operates under a “no-fault” auto insurance system, established to streamline compensation for injuries sustained in car accidents. This system mandates that each driver’s own insurance company pays for their initial medical expenses and a portion of lost wages, up to a specified limit.

PIP coverage is a cornerstone of this no-fault system in Florida. It ensures that accident victims can receive prompt medical attention and financial assistance directly from their own insurer, without the delay of determining fault.

Types of PIP Coverage

A Personal Injury Protection policy in Florida provides distinct categories of benefits to assist individuals after a motor vehicle accident. These benefits address various financial impacts from injuries sustained in a crash.

Medical benefits cover 80% of reasonable and necessary medical expenses incurred due to a covered accident. This includes a wide range of services such as doctor visits, hospital stays, ambulance transportation, diagnostic tests, and rehabilitation services. These payments help alleviate the financial burden of immediate and ongoing medical treatment.

Disability benefits, often referred to as lost wages, cover 60% of income lost when an injured person is unable to work because of accident-related injuries. This coverage also extends to the cost of household services if the injured individual can no longer perform daily tasks.

PIP policies also include death benefits, typically set at $5,000. This amount helps cover funeral expenses and other costs associated with the passing of an individual due to a covered accident.

Key Coverage Limitations and Requirements

Accessing PIP benefits in Florida involves adhering to specific conditions and understanding financial limits.

A significant limitation involves the “emergency medical condition” (EMC) requirement. If a medical provider certifies that an injured person has an EMC, the full $10,000 in PIP benefits for medical expenses may be available. An EMC is defined as a medical condition with acute symptoms, including severe pain, where the absence of immediate medical attention could reasonably result in serious jeopardy to health, impairment of bodily function, or dysfunction of any bodily organ or part.

If a medical professional determines that no EMC exists, the PIP medical benefits are typically limited to $2,500. This distinction highlights the importance of a proper medical evaluation after an accident.

Another critical requirement is the 14-day rule for initial medical treatment. For PIP benefits to be paid, an injured person must seek initial medical care from a qualified healthcare provider within 14 days of the accident. Failure to do so can result in the forfeiture of PIP benefits.

PIP policies also typically involve a deductible, the amount the insured pays out-of-pocket before coverage begins. Deductible options can range from $250 to $2,000.

After any applicable deductible is met, PIP covers 80% of medical expenses and 60% of lost wages, up to the policy limit of $10,000. Injured individuals are responsible for the remaining percentages of their costs.

Who is Covered by a PIP Policy

A single PIP policy in Florida provides coverage to a broader range of individuals than just the named policyholder. The scope of coverage extends to various parties who may be involved in a motor vehicle accident.

The named insured on the policy is always covered, whether they are driving their own vehicle, are a passenger in another vehicle, or are injured as a pedestrian or cyclist by a motor vehicle. Their PIP benefits apply across different accident scenarios.

Resident relatives living in the same household as the named insured are also covered under the policy. This includes family members related by blood, marriage, or adoption who reside at the same address. These relatives can receive PIP benefits if injured in an auto accident, even if they are not in the insured vehicle at the time.

Passengers in the insured’s vehicle at the time of the accident are typically covered by the policy. If a passenger does not have their own PIP coverage, the policy of the vehicle they are occupying may provide benefits for their injuries.

Pedestrians or cyclists who are struck by the insured’s vehicle are also eligible for coverage under the driver’s PIP policy, regardless of fault. This provision extends protection to vulnerable road users who may not have their own auto insurance.