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08/22/13 It's The Law: PIP Law Explained

It's The Law

PIP Law Explained



I just moved to Florida and understand I am supposed to have PIP insurance for my car. Can you explain what that is?


Florida requires automobile owners maintain personal injury protection ("PIP") insurance coverage. The insurance is a type of "no-fault" insurance. As originally adopted, the insurance was a compromise between pure no-fault insurance under which an injured party obtains insurance benefits without regard to liability or fault and customary suit for damages. In a customary suit for damages, the person causing an accident would be responsible for damages incurred in the accident. The compromise was that one's own insurance would pay initial medical expenses, lost income and funeral expenses up to the amount of insurance coverage carried by that individual and the injured person was barred from suing the other party for pain, suffering and similar damages unless the injured party died or incurred a significant injury.

Over time, Florida's PIP law was amended as the Legislature tried to address shortcomings, most of which were raised by insurance carriers. The current law requires all licensed drivers to carry PIP insurance in the amount of $10,000.00. This insurance covers the driver's own injuries and lost wages caused by an auto accident, without regard to who is at fault. In 2012, Florida's Legislature adopted additional amendments to the PIP statutes reportedly to reduce insurance fraud. In amending the statutes, the Legislature adopted additional restrictions and limitations on PIP coverage.

The new law requires injured persons seek medical treatment within 14 days of an accident or PIP benefits will not be available. The injured person must be diagnosed to have an emergency medical condition ("E.M.C.") to be eligible for the full $10,000.00 in PIP benefits. If diagnosed with an E.M.C., PIP benefits are reduced to $2,500.00.

The emergency medical condition under the statute is a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:

a. serious jeopardy to patient health

b. serious impairment to bodily functions

c. serious dysfunction of any bodily organ or part

The diagnosis can only be made by a medical doctor, osteopathic physician, dentist or advanced registered nurse practitioner.

Assuming the injured person is diagnosed with an E.M.C., PIP insurance will pay 80% of all reasonable expenses for medically necessary medical, surgical, x-ray, dental and rehabilitative services, including prosthetic devices, and medically necessary ambulance, hospital and nursing services. The statute also limits what services can be paid.

Payment for medical services and care is limited to that provided, supervised, ordered or prescribed by a licensed medical doctor, licensed dentist, licensed chiropractic physician, or those provided in a hospital or facility that owns or is wholly owned by a hospital. Initial services may also be provided by a person or entity licensed to provide emergency transportation and treatment (EMS).

Follow-up treatment will be covered, but only if consistent with the underlying medical diagnosis by an authorized initial service provider and provided by either a person authorized to provide initial services and care, under the direction of such person, or a licensed physician's assistant or advanced registered licensed nurse practitioner. In addition, follow-up services and care can be provided by any of the following persons or entities:

a. Hospital or ambulatory surgical center

b. An entity wholly owned by one or more licensed physicians, chiropractors, or dentists, or jointly owned with the spouse, parent, child or sibling of such practitioners.

c. An entity that is owned or wholly owned by a hospital

d. A licensed physical therapist, based upon referable by a health care provider referenced in the statute, or

e. Qualifying health care clinics.

Medical benefits under the statute that may not be paid for include massage or acupuncture, regardless of the person, entity, or licensee providing or prescribing such service.

The recent amendment may make it even more difficult for injured persons to obtain recovery. It is not uncommon for an injured person to refuse medical treatment, because he or she does not think he or she is badly hurt. Others were on their way to work at time of the accident and cannot afford to miss employment. Many do not even know their own insurance will pay for their initial medical treatment. When they finally do go to the doctor because their injuries do not get better, it is after the new 14-day deadline.

The new statute wording may increase litigation claims for wrongful denial of PIP benefits. It should also encourage people injured in a car accident to consult with an attorney immediately.

By: William G. Morris, Esquire

William G. Morris is an attorney with offices at 247 North Collier Boulevard on Marco Island, Florida. His practice covers a broad range of subjects, including civil litigation, real estate, business and corporate law, estate planning and probate, domestic relations and contracts. He writes this column periodically with respect to legal matters that frequently affect non-lawyers. The information contained in this column is not intended as legal advice and, of necessity, is generalized. For questions about specific circumstances, the reader should consult a qualified attorney.

Questions for this column can be sent to: William G. Morris, e-mail: wgmorrislaw@embarqmail.com or by fax, (239) 642-0722 or

The Marco Island Eagle

Other articles of interest can be viewed at our website, www.wgmorrislaw.com.

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