Tell Me About PIP

by Matt Romanik
01/18/19 (Updated: 02/04/19)

What is PIP?

Personal injury protection (PIP) is Florida’s no-fault insurance, which is designed to streamline and ease access to medical care for those involved in motor vehicle collisions.

Do I need personal injury protection?

Most individual driver policies in Florida are required to have PIP for personal vehicles. There are substantially different rules for other types of vehicles, including commercially owned vehicles, motorcycles, and some vehicles which, technically, don’t meet the definition of motor vehicles, like certain mopeds under a certain displacement. The lawyers at Delgado & Romanik can help you determine whether you should legally have PIP to be driving in the State of Florida.

What does PIP insurance typically pay?

Most insurance policies default to $10,000 of personal injury protection, which is the minimum limit in Florida. However, there are numerous variables in determining how much PIP insurance is right for you, including:

  • Potential deductibles
  • Increased coverage limits
  • Owning multiple cars and wanting to be sure all of them are covered

Be sure to talk to a knowledgeable lawyer about these potential options and engage accordingly with your insurance agent to be sure that you have coverage appropriate for you and your family.

If I’ve been hurt and I think I’m covered by PIP, what should I do next?

In circumstances where there is no medical care provided within the 14 days immediately after a motor vehicle accident, the potential payment of PIP benefits may be limited. In addition, personal injury protection may provide some benefits, at a smaller level, if doctors do not ultimately state that an emergency medical condition resulted from the injury. It’s important to get to a physician with the right qualifications within the right time frame to make sure you don’t exclude yourself from benefits that would otherwise be available. The lawyers at Delgado & Romanik can certainly help explain the process and timing regarding any specific scenarios.

What if I don’t have a car?

Many variables can factor into potential personal injury protection recoveries, including:

  • Whether you’re licensed as a driver
  • Whether you have an operable vehicle that should have PIP
  • Whether other vehicles you own would be required to have PIP
  • Whether you live with relatives who do have PIP
  • Whether you’re not actually occupying a vehicle, but are struck by a vehicle which is covered by PIP

The inquiry in this regard is very fact-specific and can be assessed on a case by case basis to brainstorm potential of coverage(s) for immediate medical care, regardless of fault for an accident.

Does PIP insurance cover my lost wages?

PIP can cover lost wages up to 60% of a person’s traditional pre-accident earnings.  While there is no absolute rule on how that should be calculated, many carriers will default to looking at the quarterly earnings an injury victim had prior to the accident. Many times, it’s prudent to ask the carrier to reserve a certain amount towards lost wages, for fear that it would otherwise be utilized by medical providers before the injured party even knows that has happened.

What if I have health insurance and PIP?

Benefits can be coordinated based on the plan languages but, in many instances, it’s in the injured party’s best interest to utilize PIP first, because PIP need not be paid back, ever, once it’s paid by a carrier. On the other hand, if recoveries are made against certain other parties, your health insurance may have a right of subrogation, meaning a right to repayment, against any proceeds you receive, even if you are not at fault for the accident and are provided limited compensation based on the at-fault party’s amount of coverage available. Strategizing the long term outcomes and the potential effects on net recovery is an important thing that attorneys at Delgado & Romanik can help you investigate.

Why is utilizing PIP helpful for my potential injury claim?

PIP provides immediate access to care, without the right to reimbursement, as discussed above. It enables you to get the care that you need without incurring medical bills that need to be reimbursed or that otherwise would not be paid by other insurance.

What do I do with the pile of forms my PIP carrier just sent me?

While certainly we recognize that many people are perfectly competent and able to fill out legally specific forms that may impact their claim, it’s extremely important to know that carriers commonly look for very technical and minor errors in insurance documents to allege fraud or misrepresentation to deny benefits. If you have any question whatsoever about appropriate answers in a PIP application or associated paperwork, we would be glad to help you sift through and be sure the answers are complete, accurate, and won’t lead to the potential denial of benefits.

Some of the documents use acronyms which are not familiar to many and might include some of the following:

  • PIP, as explained above, is the personal injury protection law.
  • EMC is an emergency medical condition, diagnosed by a medical doctor, relating to the injury for which PIP treatment is sought.
  • MMI is maximum medical improvement, which otherwise means a point at which a person is not expected to further heal, or in other words, a medical plateau.
  • EOB is an explanation of benefits. It’s common that your carrier will send documentation of bills that have been received, how they were processed, what amount the PIP paid, and what deductible, if any, remains the responsibility of the patient.
  • EUO is an examination under oath, which many policies require, in which a carrier will ask many detailed questions about the potential claim to assess the validity.

The lawyers at Delgado & Romanik advise you to be extraordinarily cautious of examinations under oath. Most reputable carriers will only request one if they truly perceive there has been some misrepresentation or lack of information that may affect the coverage and the claim, but unfortunately, some carriers set them almost as a matter of course just to see if they can find a land mine for the unwary.

Once a client has committed, under oath, certain positions to an insurance carrier, it is typically very difficult to change the answer or un-ring the bell. Should your carrier request an examination under oath of you, as always, our firm would be willing and able to represent your interests to be sure adequate consideration is given into the preparation for and performance of the examination under oath.

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