If you've been injured in a Florida automobile or personal injury accident, you may have to rely on your personal injury protection (PIP) benefits to cover your medical bills until insurance details are sorted out. Unfortunately, medical bills can accumulate quickly in the days following a car crash. This is especially true when injuries are more severe, such as a traumatic brain injury or fractured bones.
If you are still in need of treatment after your coverage runs out, don't allow the fear of growing debt stop you from getting the care you need. Learn how to pay your medical bills when your PIP benefits run out. Florida requires every driver to carry at least $10,000 in personal injury protection under Florida Statute 627.736, and that limit goes quickly after a serious crash.
How Do PIP Benefits Work?
Florida is a no-fault state. Under Florida Statute 627.736, personal injury protection (PIP) pays your medical bills first, whoever caused the crash. This means that in Florida, the default option for covering costs following an auto accident is for your doctors to receive payment directly from your own insurance company, no matter which driver was at fault.
Florida minimum auto insurance law requires all drivers to carry a minimum of $10,000 of personal injury protection (PIP), though you may carry a larger policy if you wish. In the case of an accident, PIP claims are made against your insurer for payment of medical bills and lost earnings. Under Florida Statute 627.736(1)(a) and (1)(b), your insurer pays 80 percent of reasonable and medically necessary expenses and 60 percent of lost gross income, up to the $10,000 combined limit. Whatever fees or damages remain after PIP coverage will need to be recovered otherwise.
How Do I Claim PIP Benefits?
Call the police as soon as possible to complete and receive a long-form accident report. This report will include insurance and personal information for each driver as well as the circumstances surrounding the accident. Then, notify your insurance company. Using the phone number listed on your insurance policy will get you in contact with a claims adjuster who can begin a formal claims process for you.
Step 1. Medical Attention
To begin claiming PIP benefits, first seek medical attention from any PIP medical provider. Florida Statute 627.736(1)(a)1. lists who may provide that initial care: a physician licensed under chapter 458 or 459, a chiropractic physician, a dentist, an advanced practice registered nurse, a hospital or a hospital-owned facility, or emergency transportation and treatment personnel licensed under part III of chapter 401.
You must receive initial services and care within 14 days of the crash. Florida Statute 627.736(1)(a) makes that a condition of PIP medical benefits, so missing the 14 days means the insurer owes nothing even if you were badly hurt. The deadline runs to the first treatment, not to when symptoms appear, and follow-up care stays covered once that first visit is on the record.
Step 2. Filing a Claim
Once you've received a diagnosis from a PIP medical provider, you can file a claim with your PIP insurance provider. This can be done by calling your insurance adjuster and providing them with your doctor's diagnosis. You can also begin the claims process online, typically found under tabs like "Claims" or "Report a Claim" on your insurance provider's website. Your personal injury attorney typically assists in handling this process for you.
How Much Are PIP Benefits?
Florida Statute 627.736(1) sets the PIP limit at $10,000 in medical and disability benefits plus $5,000 in death benefits. That $10,000 is the statutory floor, and some insurers sell optional medical payments coverage on top of it. How much of the $10,000 you can reach depends on your medical diagnosis.
For a PIP claim, your medical professional must determine if the accident resulted in an emergency medical condition (EMC). An EMC is a condition that, without treatment, could result in serious jeopardy to the patient's health, bodily function, or dysfunction of any bodily organ or part. If a doctor diagnoses you with an EMC, you will be eligible for the maximum payout available from your PIP coverage.
If you do not have an evaluation by your doctor that determines you suffered from an EMC, you will only be eligible for benefits up to $2,500. In serious cases, these limits can be exhausted rapidly.
How Often Are PIP Payments Paid?
PIP benefits can be paid by your insurance company each time you are involved in an auto accident. For instance, if you were involved in a serious auto accident twice in one year, your auto insurance would provide your limit of $10,000 or more once for each claim. This is because insurance companies view each accident as a completely new and separate claim.
Under Florida Statute 627.736(4)(b), a PIP benefit is overdue if the insurer does not pay it within 30 days after written notice of the covered loss and its amount. Overdue payments carry simple interest running from the date the insurer received that notice.
Paying Medical Bills After PIP
Which pays first, PIP, health insurance or Medicare? For car crash and pedestrian injuries, PIP is primary. In fact, health insurance or Medicare may even reject medical bills that are sent to them until PIP coverage has been fully exhausted.
Once you have used your entire PIP coverage, your health insurance takes over. Unfortunately, this means that you will likely have to take on out-of-pocket expenses, such as co-pays and deductibles in order to continue treatment.
Florida Law Also Gives You a Right to Sue
Florida's no-fault law does not set a dollar threshold for suing the at-fault driver. Under Florida Statute 627.737(2), you can recover pain and suffering, mental anguish and inconvenience only if the injury involves a significant and permanent loss of an important bodily function, a permanent injury within a reasonable degree of medical probability other than scarring, significant and permanent scarring or disfigurement, or death. Economic losses work differently: medical bills and lost wages above what PIP paid can be claimed from the at-fault driver without meeting that threshold. A negligence claim in Florida must be filed within two years under Florida Statute 95.11(5)(a).
Working alongside a Florida PIP attorney can help ensure that you've fully exhausted every option before moving forward with a lawsuit. For example, many Floridian drivers carry Bodily Injury Liability (BI) coverage on their policy. In the case that your PIP benefits failed to cover all of your medical expenses, you could sue against a driver's BI insurance rather than the individual directly.
A knowledgeable attorney can negotiate a settlement with the at-fault insurance company to speed along the process and save you the trouble of needing to file a formal lawsuit. In the case that the insurance company denies your claim, or offers you an amount far below what you deserve, a personal injury attorney can move ahead with a lawsuit in order to secure the compensation you're owed.
Contacting a Trusted Personal Injury Attorney
As soon as you've been involved in an accident, contact a trusted Personal Injury attorney. A trusted Florida PIP attorney will be very familiar with PIP claims and what to do when those benefits run out. They will also be more likely to get a claim made against the at-fault driver's insurance company settled more quickly and more efficiently than if you tried to go at it alone.
After you've been injured by an at-fault driver, your medical bills should not be your responsibility. Time is of the essence, especially when serious injuries quickly drain your limited PIP coverage. If you've been injured in an auto accident and are rapidly depleting, or have depleted, your PIP benefits, do not hesitate to contact the trusted attorneys at Weinstein Legal Team today for a free case review.
