What PIP Covers in Florida (And What It Doesn’t)

Navigating the world of insurance can be tricky, especially when it comes to understanding Personal Injury Protection (PIP) coverage in Florida. As one of only twelve states with a no-fault insurance system, Florida mandates that all drivers carry PIP insurance. This means that, in the event of a car accident, your own insurance covers certain expenses, regardless of who was at fault. However, PIP coverage is not all-encompassing. It has specific benefits and limitations that are important to grasp in order to protect yourself financially.

What Does PIP Cover in Florida?

In Florida, Personal Injury Protection (PIP) is a mandated insurance coverage for all vehicle owners, and it plays a crucial role in the state's no-fault insurance system.

Medical Expenses

PIP offers coverage for medical expenses incurred due to injuries from a car accident. Specifically, it covers:

• Emergency medical care - Ambulance transport, emergency room visits, and necessary surgeries.

• Diagnostic tests - Including X-rays, CT scans, and MRIs for injury assessment and treatment planning.

• Hospital costs - Charges for inpatient care and related hospital services.

• Rehabilitation services - Like physical therapy, to aid in recovery.

• Prescriptions and medication - Costs for prescribed drugs needed post-accident.

PIP pays up to 80% of these medical expenses, subject to a $10,000 limit per person, provided they are deemed “medically necessary.”

Lost Wages

If injuries prevent you from working, PIP can help alleviate some financial pressure. It reimburses 60% of your lost income, up to the policy's limit. To receive this benefit, you'll need to provide proof of employment and medical documentation validating your inability to work.

Death Benefits

In the tragic event of a fatality resulting from a car accident, PIP provides a $5,000 death benefit. This amount is designated for funeral and burial expenses and is paid to the policyholder’s estate or family. This benefit is aside from the $10,000 PIP limit for medical and wage-related claims.

What Does PIP Not Cover in Florida?

While PIP offers several benefits, it has significant limitations that Florida drivers should note.

Pain and Suffering

PIP does not cover pain and suffering, or any non-economic damages like emotional distress or loss of enjoyment of life. Compensation for these types of losses must generally be pursued through a personal injury lawsuit, provided the injuries meet Florida's serious injury threshold.

Property Damage

PIP solely covers personal bodily injuries and does not extend to property damage. If your vehicle or another person's property is damaged in an accident, other types of insurance, like Property Damage Liability (PDL) or collision coverage, would be applicable.

Injuries to Others When You're at Fault

PIP only applies to the policyholder’s injuries. It does not cover medical expenses for other individuals injured in an accident where you are at fault. For such situations, Bodily Injury Liability (BIL) coverage is recommended, as it can pay for injuries sustained by others in accidents you cause.

Eligibility and Policy Limits

Who is Covered by PIP

Personal Injury Protection (PIP) in Florida extends its coverage beyond just the policyholder, thanks to its "no-fault" nature. This means it offers benefits regardless of who is responsible for the accident. Various parties may be protected under your PIP policy:

• The Policyholder - If you're injured in a car accident, whether as a driver or a passenger, PIP will cover your medical expenses and a portion of your lost wages.

• Passengers - Should passengers in your vehicle lack their own PIP insurance, your policy might cover their medical costs.

• Pedestrians or Cyclists - If your car strikes a pedestrian or cyclist, your PIP may help cover their injuries if they don’t have their own coverage.

• You as a Pedestrian or Cyclist - If you are hit by a car while walking or biking, your PIP policy can cover your injuries.

Policy Limits and Deductibles

Florida law mandates that drivers carry a minimum of $10,000 in PIP coverage. However, there are specific conditions under which these limits apply:

• Medical Expenses - PIP will cover 80% of necessary medical costs up to your policy limit.

• Lost Wages - The policy typically covers 60% of lost wages, again subject to the overall $10,000 limit.

• Death Benefits - In the event of a fatal accident, PIP provides a $5,000 death benefit for funeral expenses, beyond the $10,000 medical limit.

Policyholders are also required to pay a deductible before accessing the benefits, and high medical costs can quickly exhaust the policy limit, often prompting additional claims against other forms of insurance.

Emergency Medical Condition (EMC)

In Florida, to access full PIP benefits, your injury must be classified as an “emergency medical condition” (EMC). This refers to a condition requiring immediate treatment that could pose a serious health risk if left untreated. If your injuries don’t qualify as an EMC, benefits can be capped at $2,500, considerably less than the $10,000 available under other circumstances.

Supplemental Insurance Options

Medical Payments Coverage (MedPay)

Medical Payments Coverage, commonly known as MedPay, acts as a supplementary insurance to your PIP. It helps in covering the remaining 20% of your medical bills that PIP does not address. This optional coverage can be particularly beneficial if medical expenses exceed the limits of your PIP.

Uninsured/Underinsured Motorist (UM/UIM) Coverage

UM/UIM coverage is another supplemental policy that provides protection if you are injured by a driver who either lacks insurance or does not have sufficient coverage to pay for your damages. This ensures that you can receive compensation even if the at-fault driver’s insurance is inadequate.

Health Insurance Coordination

After your PIP benefits reach their limit, your health insurance may shoulder further expenses. However, it is essential to note that some health insurance plans may require a reimbursement from any personal injury settlements you receive. Coordinating between PIP and health insurance can help ensure you don’t pay for medical expenses out-of-pocket unnecessarily.