Understanding Florida No-Fault and PIP Insurance Coverage

If you were injured in an accident arising out of the use or operation of an automobile, you may be entitled to Personal Injury Protection (PIP) benefits if you require medical attention. Florida law requires every driver to have $10,000 in Personal Injury Protection coverage. If you are involved in a motor vehicle accident, your own insurance company pays for PIP benefits no matter who was at fault for the accident.

If you have no deductible, and have full Florida personal injury protection benefits, your personal injury protection will pay 60% of your gross (total) lost wages, and 80% of your medical bills (but limited by a Medicare type formula). If you have a deductible, you must of course first meet your deductible before your insurance company begins payment.

Insurance companies are now offering personal injury protection benefits without coverage for lost wages to the named insured. If you have this type of coverage, you and your spouse will not be entitled to lost wages.

If you do in fact have coverage for lost wages under your PIP, and your accident was not a worker's compensation accident, then you must have your employer complete the Wage and Salary Verification Form that our firm provides. This form should be completed immediately after you return to work. Even if you have some other type of disability or sick leave pay, you are still entitled to receive your lost wages from your personal injury protection coverage, unless you have signed an Assignment of Benefits for your physician, hospital, or other medical provider (and then it becomes more complicated). If you have signed such an assignment form assigning these benefits, which is very common, then it is possible that you have signed away all or most of your rights to receive lost wages, depending upon how your insurance company decides to treat the issue. We will do our best to obtain lost wages for you from your personal injury protection benefits, but we cannot guarantee that if you have signed an assignment form for a medical provider (which most medical providers do require for treatment), that we in fact will be able to get you the lost wages because the doctors may be entitled to be paid first.

Regarding your medical bills, if you have medical payments coverage, that will cover the 20% that your personal injury protection benefits (PIP) does not cover, after any PIP deductible has been met. If you have no medical payments coverage, any outstanding balances should be submitted to your private health insurance coverage. Your private health insurance may cover anything not paid for by your PIP coverage that is still owed to a medical provider.

If you have no personal injury protection or medical payments coverage, then your private health insurance coverage is primary. Please make certain that you instruct your doctors with regard to who to send their bills to. Your medical providers should be given all of your insurance information.

Contact our office toll free at 1-877-853-7466 to discuss your auto accident case or any questions you may have regarding personal injury protection coverage.