Florida Personal Injury Protection (PIP) Benefits – What am I Entitled to Under Florida’s Motor Vehicle No-Fault Law if I am Involved in an Automobile Accident?

Florida Personal Injury Protection Law_fightsforyou.netDriving on the roadways in South Florida is a treacherous task for which all owners of a motor vehicle are required to carry a minimum of $10,000 in property damage liability insurance (for when you are at fault and cause damage to another car or motor vehicle), as well as personal injury protection insurance (also known as PIP insurance).  You are not required to carry PIP insurance as the driver or rider of a motorcycle or moped given that a vehicle under the personal injury protection statutory framework is one with four wheels. It should also be noted that PIP is not required for drivers of taxi cabs, limousines and school buses.

WHAT IS PERSONAL INJURY PROTECTION NO FAULT INSURANCE:  Florida personal injury protection insurance coverage, also known as PIP benefits arising out of Florida’s Motor Vehicle No-Fault Law, are no fault benefits (can include a mix of lost wages and payments for medical bills) that your auto insurance carrier will provide whether you are at fault for the car accident or not.

WHAT IS ONE ENTITLED TO: If your vehicle is involved in a car accident, trucking accident (say with a UPS, FedEx or other semi/big rig on the highway),  motorcycle accident, you strike a pedestrian or bicycle, or you are struck by another motor vehicle while walking on a sidewalk or riding a bicycle, and you are injured in the accident, your insurance carrier is supposed to pay up to 80% of your medical bills (that are reasonable and necessary, including but not limited to doctor visits, hospital visits, X-ray’s, MRI’s, CAT scans, surgery, dental bills, emergency transport and ambulance bills, physical therapy and rehabilitation bills, home nursing care, prescriptions and pain medication, glasses, hearing aids and other medical appliances necessary for treatment) and 60% of your lost wages (PIP also reimburses you for your transportation costs for “reasonably medically necessary” medical treatment — will simply have to fill out the mileage form). Your PIP insurer will cover a maximum of $10,ooo in total personal injury protection benefits (your automobile insurer will require you to fill out a Personal Injury Protection Benefits “PIP” application, along with a wage loss form, in order to evaluate your PIP claim) assuming you meet the requirements of the new PIP law. For more information on the new PIP law and the statutory amendment in 2012, see my prior article on some of the relevant changes.  A majority of this amendment is effective starting January 1, 2013.

FLORIDA STATUTE 627.736(1) – REQUIRED BENEFITS:  An insurance policy complying with the security requirements of s. 627.733 must provide personal injury protection to the named insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in the motor vehicle, and other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle, subject to subsection (2) and paragraph (4)(e), to a limit of $10,000 in medical and disability benefits and $5,000 in death benefits resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle.

Subsection (2) states the following:  Authorized exclusions –Any insurer may exclude benefits:

(a) For injury sustained by the named insured and relatives residing in the same household while occupying another motor vehicle owned by the named insured and not insured under the policy or for injury sustained by any person operating the insured motor vehicle without the express or implied consent of the insured.

(b) To any injured person, if such person’s conduct contributed to his or her injury under any of the following circumstances:

1. Causing injury to himself or herself intentionally; or

2. Being injured while committing a felony.

Subsection (4)(e) states the following:  The insurer of the owner of a motor vehicle shall pay personal injury protection benefits for:

1. Accidental bodily injury sustained in this state by the owner while occupying a motor vehicle, or while not an occupant of a self-propelled vehicle if the injury is caused by physical contact with a motor vehicle.

2. Accidental bodily injury sustained outside this state, but within the United States of America or its territories or possessions or Canada, by the owner while occupying the owner’s motor vehicle.

3. Accidental bodily injury sustained by a relative of the owner residing in the same household, under the circumstances described in subparagraph 1. or subparagraph 2., if the relative at the time of the accident is domiciled in the owner’s household and is not the owner of a motor vehicle with respect to which security is required under ss. 627.730-627.7405.

4. Accidental bodily injury sustained in this state by any other person while occupying the owner’s motor vehicle or, if a resident of this state, while not an occupant of a self-propelled vehicle if the injury is caused by physical contact with such motor vehicle, if the injured person is not:

a. The owner of a motor vehicle with respect to which security is required under ss. 627.730-627.7405; or

b. Entitled to personal injury benefits from the insurer of the owner of such a motor vehicle.

WHO PAYS THE PERSONAL INJURY PROTECTION NO FAULT INSURANCE BENEFITS: Assuming you are entitled to PIP benefits and meet one of the specifications referenced above, the next question one likely will have is who pays my PIP benefits. Typically when you own your own vehicle and are injured in an automobile accident (whether a driver or passenger in your own vehicle or someone else’s, or are struck by a car while riding your bicycle or walking down the street as a pedestrian), your own car insurance will be the party initially responsible for paying your personal injury protection benefits. However, if you do not own a motor vehicle, you would then look to the insurance company of a resident relative who resides with you to be responsible for PIP insurance benefits, regardless of whether they or their car was involved in the accident.  If a resident relative’s insurance is not applicable and you are injured as a passenger or driver of someone else’s car, you can look to have the PIP benefits paid by the insurance company of the owner of the car in which you were a driver or passenger.  If you are injured as a pedestrian (provided the injury results from the ownership, maintenance, or use of a motor vehicle), you can look to the at-fault party’s car insurance to pay PIP insurance benefits.

PERSONAL INJURY PROTECTION INSURANCE BENEFITS EXAMPLE WHEN IN A CAR ACCIDENT: Given the aforementioned, one would probably ask what the practical application of all this is assuming you are seriously injured in an automobile accident.  Your PIP insurance can have a deductible depending on what you selected when purchasing your policy. What this means is that if a person’s medical bills reach $15,000, the insurer is responsible to pay up to $10,000 of these bills (assuming they are reasonable and necessary)  if the person has no deductible on their policy, leaving you with $5,000 left over in medical bills. Assuming you have a $1,000 deductible, the insurer would apply their 80% starting at $14,000, to which they would pay up to $10,000, leaving you with outstanding bills amounting to $3,800.  You essentially must incur approximately $12,500 in medical bills for the insurance carrier to pay the maximum benefits of $10,000 (80% of $12,500 is $10,000).  Please keep in mind that the $10,000 maximum limit is all dependent on whether you meet the requirements of the new PIP law.  For more information on the PIP statutory amendment in 2012, see my prior article on some of the relevant changes.  A majority of this amendment is effective starting January 1, 2013.

Moral of the Story: whether you live in Miramar, Deerfield Beach, Coconut Creek, Doral, Lauderhill, Margate, Miami Lakes, Pembroke Pines or another area within Miami, Fort Lauderdale, Palm Beach or the Florida Keys (including Key Largo, Marathon, Islamorada, Tavernier or another Key down in Monroe County), and you are seriously injured in an automobile accident whether as a driver, passenger or pedestrian, know that you may be entitled to up to $10,000 in personal injury protection No Fault benefits from your own insurance carrier although your insurer will likely deny some of your medical providers’ claims, thus necessitating the retention of a Florida personal injury protection benefits (PIP) lawyer to assist you in getting the benefits you are entitled to under Florida’s Motor Vehicle No-Fault Law.

Personal Injury Protection Benefits (PIP): Can an Insurance Carrier Require You to Submit to an EUO to Secure PIP Benefits?

So you are seriously injured in a motor vehicle accident when your car or motorcycle is rear ended by a truck, and you put your car insurance carrier on notice.  Part of the benefits that you may be entitled to (assuming you have PIP insurance)  include your personal injury protection coverage (also known as PIP benefits), which are no fault benefits (can include a mix of lost wages and payments for medical bills) that your auto insurance carrier will provide whether you are at fault for the car accident or not.

The legislature recently amended the PIP statute in 2012, ie., section 627.736, and included a provision to include the requirement that insureds seeking benefits under the Florida Motor Vehicle No–Fault Law “comply with the terms of the policy, which include, but are not limited to, submitting to an examination under oath.” 627.736(6)(g).  For more information on the PIP statutory amendment in 2012, see my prior article on some of the relevant changes.  A majority of this amendment is effective starting January 1, 2013.

So the question becomes, what happens if your accident occurred prior to the effective date of the new statute.  Prior to this amendment, while an insurance policy may have stated that in order to secure coverage under the policy, the insured may have been required to submit to an EUO (examination under oath – an examination akin to a deposition where the carrier investigates the accident, the extent of your injuries, etc.),  the PIP statute did not have this provision requiring them to comply with the terms of their policy.  As such, prior to this amendment, if your policy required you to possibly submit to an EUO in order to secure benefit sunder your policy, did that mean that if you failed to submit to a requested EUO, that the insurance carrier could simply deny you PIP benefits under your auto policy.  According to the Florida Supreme Court, an injured person’s failure to submit to an EUO did not cancel his or hers PIP coverage under their policy in order to secure no-fault benefits.

In the case of Nunez v. Geico Gen. Ins. Co., — So.3d —-, 2013 WL 3214401 (Fla. 2013), the Florida Supreme Court answered the above question in the negative. In Nunez, an insured of Geico was injured in a car accident in September of 2008, to which she made a claim for personal injury protection benefits.  When Geico denied her claim after failing to submit to an EUO, Nunez filed suit for declaratory relief, seeking a judgment that Geico violated the 2008 version of 627.736, Florida’s PIP statute.  The Florida Supreme Court held that because Nunez’s policy with Geico was issued in 2008, her accident was in 2008, and she filed her class action complaint in 2009, and because the amendment did not take effect until 2013 and that the purpose of the no-fault statutory scheme is to provide swift and virtually automatic payment, the Florida Supreme Court ruled that EUO conditions in Nunez’s insurance policy were invalid as contrary to the terms of section 627.736 (2008).

Moral of the Story: whether you live in Miami, Fort Lauderdale, Palm Beach or any other area of Florida, should you sustain injuries in a motor vehicle accident, car accident, trucking accident, motorcycle accident, or are even walking or on a bicycle and struck by a car (ie, a pedestrian accident), and your accident occurred prior to the PIP amendment that was effective in January of 2013, you may wish to secure a PIP or injury lawyer to assist you with a potential claim for improper denial of your car insurance benefits if you have been denied personal injury protection benefits given your failure to attend an examination under oath (EUO).

Florida’s New PIP Insurance Law- Florida Legislature Passes Amendment to Section 627.736, the Personal Injury Protection (PIP) Law

Primarily effective January 1, 2013 (some parts are effective earlier), Florida’s new PIP insurance law, section 627.736, will change due to amendment.  The old law allowed up to $10,000 in personal injury protection benefits, including the payment of up to 80% of medical bills (that were reasonable, related and necessary) and 60% of lost wages.  Florida’s new PIP insurance law now provides that in order to get up to the $10,000 in PIP benefits, there must be a determination by a medical physician, osteopathic physician, dentist,  physician’s assistant or registered nurse practitioner, depicting an “emergency medical condition.”  An emergency medical condition is defined under section 627.732(16) as 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.

Of note, Florida’s new PIP insurance law requires a finding of an emergency medical condition within fourteen days of the date of accident, or else the PIP benefits are restricted to $2,500. Moreover, if no treatment is received within fourteen days, it appears that personal injury protection benefits are not required to be paid.

Finally, massage therapists and acupuncturists are no longer covered by PIP.

It will be interesting to see how courts will interpret Florida’s new PIP insurance law and the litigation Florida PIP lawyers will be required to bring over differences in interpretation.