Basic Florida No-Fault
Florida is a No-Fault State. The No-Fault concept requires each of us to self insure for our own auto accident-related medical treatment. We do this through the purchase of Personal Injury Protection (PIP) insurance coverage.
We are constantly asked by clients why their insurance company has to pay their medical expenses when the other party was clearly at fault. The answer is simple; Florida law requires it to be done that way. The minimum required in Florida is $10,000.00 and it is paid at 80 percent toward your accident-related medical expenses and 60 percent of your lost wages resulting from your injuries. You can also contract for a deductible which cannot exceed $1,000.00 under the current law. However, if you do this then you will be responsible for the first $1,000.00 of your medical bills paid at 80 percent or lost wages at 60 percent.”
How Personal Injury Protection Coverage Works
Following an accident, you must seek medical treatment within 14 days. Generally, for the initial visit, PIP allows you to see any doctor of your choosing, unlike an HMO or managed care plan which may limit or dictate your choice. When you visit your treating doctor, you should advise them that you are there because of an automobile accident and provide them the information on your PIP policy. When your doctor submits your bill to PIP, they will be paid 80 percent of the “reasonable and customary” expenses related to your treatment. You will begin to accrue an unpaid balance of the 20 percent not covered by PIP.
After the initial visit, you should seek a medical opinion rendered by a medical doctor, doctor of osteopathic medicine, dentist, physician’s assistant or registered nurse practitioner stating whether the accident-related injuries constitute a need for immediate medical attention because of an “emergency medical condition”. This determination cannot be made by a chiropractic physician as per the statutory requirements. If this medical opinion is not rendered in accordance with the PIP statutory guidelines, then the insured will be limited to $2,500.00 in PIP benefits. However, if this requirement is properly met then the insured will be entitled to a maximum of the $10,000.00 in PIP coverage benefits that they purchased.
If treatment is not sought within the initial 14 days after the accident, then the insured will be prevented from obtaining any PIP benefits. Massage therapy and acupuncture treatment has been excluded from the PIP statute and thus they will not be covered treatment under the PIP coverage.