Florida PIP: Is It Still Possible to Collect From the At-Fault Driver?

When answering calls from Fort Myers car accident victims, our attorneys have found that Florida PIP is one of the most misunderstood concepts.

“Why am I fighting with my own insurer?” “Can I still sue the person who hit me?” “What is the ‘no-fault’ system anyway? Someone is at-fault, right?”

Understandably, people are confused because Florida is one of just a few states that still uses this kind of system to handle auto accident claims, and there are all kinds of exceptions and caveats. PIP is not supposed to deny you the opportunity to have your damages covered, but many crash victims find navigating the system difficult and frustrating.  Our team at Garvin Injury Law can help you get answers and determine how to maximize your odds of receiving full and fair compensation for your injuries.

What is Florida PIP Coverage? 

As noted by the Florida Office of Insurance Regulation, the purpose of requiring personal injury protection (no-fault) auto insurance was to give drivers up to $10,000 in immediate medical coverage and lost wages instead of having to go to court and establish fault. The idea was to lower payment delays for those injured in crashes and cut down on the burden to the court system.

The statute indicates that PIP should pay for 80 percent of your medical bills for treatment associated with the crash (including prescriptions, dental expenses, and rehabilitation services) and 60 percent of your lost wages – up to $10,000. Unfortunately, the Florida legislature has recently allowed insurance companies to cap the amount that they are required to pay at $2,500.00 in the event that you are not diagnosed with an “Emergency Medical Condition” within the first 14 days following a car crash. <-More on this below

Everyone who operates a vehicle in Florida is required to have PIP coverage. PIP makes everyone responsible for covering their own injuries, no matter who was at fault. But as our Fort Myers car accident lawyers can explain, no-fault coverage does not necessarily translate to easy money.

Why You Might Fight With Your Own Insurer for PIP

First of all, you are not guaranteed $10,000 in coverage. In fact, under F.S. 627.736, PIP is limited to $2,500 if treatment occurs within two weeks, but “no emergency medical condition” exists. There is up to $10,000 available if treatment occurs within 14 days, and the patient is diagnosed with an emergency medical condition. An emergency medical condition is one that manifests by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention would result in serious danger to a patient’s health, serious impairment to bodily functions, or serious dysfunction of any body part or organ.

Sometimes, this is why people end up fighting with their own insurer: Over whether they had an emergency medical condition and were entitled to the full $10,000 in coverage. Other times, it is over what bills should be covered and whether their treatments were directly related to the crash (instead of, say, a preexisting condition).

Another reason people grapple with insurers over this payment is the question of whether they are insured, and if so under which insurance policy (in the event there are different policies in place). If you have your own coverage in your name, this typically is not an issue – even if you were on a bicycle or walking and were struck by a car. However, if you do not, it will often come down to whether you were covered as a resident family member of someone who does. Even if you don’t have this coverage personally you may be able to find coverage under a policy issued for the vehicle.

When there is a dispute with your PIP insurer about coverage, it is a good idea to consult with an attorney, just to be sure you are not getting the short end of the stick. If your injuries are serious, then you definitely need to talk to a lawyer.

Can I Still Sue, Even With Florida’s No-Fault System?

The short answer is yes. You can step outside the no-fault system, file a claim, and collect more than Florida PIP benefits, presuming a few things:

• The other driver was at-fault (or at least partly at-fault).
• You suffered injuries that required more than the $10,000 in benefits available under your policy for out-of-pocket losses.
• You have reached the serious injury threshold (aka the tort threshold), as outlined in F.S. 627.737, which involves significant/permanent loss of important bodily function, permanent injury, significant disfigurement/scarring, or death.

You may not necessarily need to file a formal lawsuit. An experienced injury lawyer may be successful at filing and negotiating a fair claim direct with the other driver’s insurer (and/or your own uninsured/underinsured motorist coverage carrier). It is only when those negotiations are not successful that the need to file a lawsuit arises. Most car accident injury claims are settled prior to trial.

PIP is supposed to cut down on our reliance on the court system and offer a chance at immediate compensation for medical bills or lost wages. It is not supposed to deny you the opportunity to be fairly compensated for serious injuries caused by someone else’s negligence. If you have questions about the process or your legal options after a crash, we can help.

If you are injured in a car accident in Fort Myers, Naples or Key West, contact our injury attorneys at Garvin Injury Law at 800.977.7017 for a free initial consultation.

Additional Resources:

F.S. 627.736, Required personal injury protection benefits; exclusions; priority; claims

More Blog Entries:

Understanding the Basics of Catastrophic Injury Claims in Florida Injury Lawsuits, Sept. 9, 2020, Fort Myers Car Accident Lawyer Blog