Florida’s no-fault insurance can help with medical expenses and certain income losses after a car accident. But “no fault” does not mean every expense is covered or that responsibility for the crash never matters.
In the video above, Scott Marshall of Marshall Injury Attorneys explains how personal injury protection, commonly called PIP, works and why you need to understand what happens when those benefits run out.
What does “no fault” mean?
PIP provides benefits for covered injuries regardless of who caused the crash, subject to the policy and applicable law. Florida generally requires $10,000 in PIP coverage for vehicles subject to its insurance requirements.
Scott explains that this coverage provides an initial source of payment after an accident. It does not necessarily cover all your losses.
How much of your medical care does PIP cover?
PIP generally pays 80% of reasonable, medically necessary covered expenses, subject to deductibles and available benefits. Qualifying initial care must occur within 14 days. Medical benefits up to $10,000 require an emergency medical condition determination by an authorized provider; a qualifying determination that no emergency medical condition existed limits medical benefits to $2,500.
Read the requirements in Florida Statutes section 627.736.
Understanding the unpaid 20%
Scott highlights that paying a percentage of medical expenses can still leave a balance.
For a simplified example, assume there is no deductible, all charges qualify and the full medical benefit is available. If eligible expenses total $12,500, an 80% payment would use $10,000 in PIP benefits, leaving $2,500 unpaid by PIP.
That is different from having $10,000 in eligible expenses, where an 80% payment would be $8,000. Actual patient balances depend on coverage, allowable charges and other applicable payment arrangements.
Can PIP help replace lost wages?
PIP generally covers 60% of qualifying accident-related income loss unless that coverage was excluded. Medical and disability benefits share the standard $10,000 limit; lost-wage benefits are not an additional $10,000.
Scott recommends telling your PIP adjuster promptly if an injury keeps you out of work. Ask what documentation is needed to support the request, and check your policy rather than assuming wage benefits are included.
Why the coverage limit matters
Scott cautions that a hospital admission or other substantial treatment can use available benefits quickly. If you are also unable to work, understanding the remaining coverage becomes particularly important.
Keep payment notices and ask your adjuster for an explanation of what has been paid and what benefits remain. Do not assume coverage is still available simply because treatment is continuing.
Give providers both sets of insurance information
Scott recommends giving medical providers your PIP claim information and your health insurance details, if you have health coverage.
Having those details available can help providers coordinate billing when PIP is exhausted. Confirm the arrangements with the provider and health insurer rather than assuming the switch will happen automatically.
Ask about applicable deductibles, copayments, network requirements and any information needed to process accident-related bills.
What about expenses PIP does not pay?
Scott explains that when another driver is responsible, eligible expenses left unpaid by PIP may be considered as part of a bodily injury claim.
Recovery is not automatic. Responsibility for the crash, available insurance and evidence supporting the claimed losses all affect the assessment. A pending claim also does not automatically put outstanding medical bills on hold.
If you do not have health insurance or cannot pay a balance, discuss the situation with your provider and attorney. Confirm any payment arrangement before relying on it.
Have questions about coverage after a Florida crash?
Marshall Injury Attorneys can discuss your accident, available insurance and expenses that may form part of your injury claim.
Request a free case review or call 727-772-5900.
This article summarises Scott Marshall’s video and includes additional general information about Florida PIP coverage. It is not legal or insurance advice and does not create an attorney-client relationship. Coverage and available benefits depend on the policy and circumstances. Every case is different.
