PERSONAL INJURY PROTECTION (PIP) CLAIM DENIAL
Many Floridians are unaware that they may have as much as $10,000 of medical benefits, commonly referred to as Personal Injury Protection benefits or “PIP” benefits, if they were injured in a car accident within the State of Florida. PIP benefits are often available even if you do not own the motor vehicle involved in the accident and regardless of who was at fault. How does PIP work for me, you ask? Well I'll answer your questions of how PIP insurance applies, followed by the few instances where PIP does not apply.
I was in a car accident; do I have PIP benefits?
- First and foremost, regardless of fault or whose car you were in, if you were involved in a car accident and you own a vehicle that is insured in the State of Florida, the PIP benefits will go through your own car insurance. For example, you own a vehicle that is insured with GEICO. You are in your friend's car who is insured with Allstate and he backs into someone who has Progressive and you are injured. You will receive PIP benefits through your own insurance with GEICO. In addition, the not a fault party who had Progressive will get their PIP from Progressive. Your friend who has Allstate, even though he is at fault, will receive PIP benefits through his policy with Allstate.
- I don't own a vehicle; can I still get PIP benefits? If you don't own a vehicle you still can get PIP benefits if you live with a relative who has PIP insurance. A relative is defined as someone who is either blood related to you or related to you by marriage. Therefore, for example, if you live with a stepsister, step-cousin or third cousin you will be able to receive PIP benefits through your relative's insurance, provided that you live with him/her.
- Let's suppose that you're carless, you live alone or with a random roommate named Fred who never puts the dishes away and you were involved in a car accident; now what? You would still be eligible to receive PIP benefits from the insurance on the vehicle you were in when the accident occurred, regardless of fault. If for example, you lived alone, you did not own a car, and while you were a passenger in your girlfriend's car she was sideswiped by a drunk driver. You would get PIP benefits through your girlfriend's car insurance. If you do not have your own PIP through your own vehicle, or live with a resident relative, you are eligible to receive PIP benefits from the car you were in at the time of the accident. It does not matter who was at fault or whether you were driving the vehicle or were just a passenger.
- Finally, let say you were walking down the street, or on a bicycle, and you were hit by a car. You don't own a vehicle or live with any relatives who own a vehicle. Will you be able to get PIP benefits? Yes! You will receive PIP benefits from the insurance on the vehicle that hit you.
EXCLUSIONS, I.E. WHEN YOU NEVER GET PIP
- You were involved in an accident while riding a motorcycle. Motorcycles never get PIP.
- You were involved in an accident while a passenger in a bus, limousine or a taxi. Buses, limousines and taxis never have PIP. You might, however, have a potential claim and you should call an experienced attorney as soon as you can.
- You own a vehicle that is operable but is not insured. The key word here is operable, meaning you can drive it. So, if you have a car at home, that is uninsured but needs a new transmission or new battery, etc. you can still receive PIP benefits. However, if you have a car at home that is drivable, and you failed to insure it, you can never, under any circumstances, receive PIP benefits.
Some Final Things to know about PIP coverage in Florida.
- If you were involved in a car accident you have fourteen (14) days to receive medical treatment. If you fail to seek medical treatment within fourteen (14) days of the loss you waive your right to receive PIP benefits. It is crucial that if you are injured in an automobile accident that you do not “wait and see” if you start to feel better. We all have crazy schedules filled with work and family obligations, but if you do not make time to tend to your health you might be waiving your right to benefits. Those medical benefits are potentially worth $10,000. If your general practitioner or orthopedic physician cannot see you within fourteen days, it is imperative that you seek medical treatment elsewhere so you can get your full PIP benefits.
- I have health insurance; can't I just use that? In the State of Florida PIP benefits are primary. That means if you seek medical treatment as a result of an automobile accident, your PIP insurance should be paying your medical bills until your PIP insurance benefits are exhausted. It is always beneficial to provide both your automobile insurance and health insurance to your medical providers who are treating you as a result of an automobile accident. Your health insurance will “kick in” after your PIP benefits are exhausted.
- If, as a result of your automobile accident, you were injured and can no longer perform your job duties, you have the right to 60% of your lost wages under your PIP benefits. Let's take for example, a person who works in a supermarket stocking shelves and lifts boxes that are over 20 pounds. If you doctor directs that you not lift anything over 10 pounds for the next 60 days, you may have a claim for lost wages until you are cleared by the physician to work again.