What Does it Mean When People Refer to Florida as a No-Fault State?

In Florida, due to Financial Responsibility Laws, drivers are required to carry Personal Injury Protection Benefits (PIP) of at least $10,000.  Drivers also must carry Property Damage Coverage.  PIP benefits are often referred to as No-Fault benefits because PIP pays regardless of who was found at fault in the collision.  PIP will pay 80% of your medical bills and 60% of your lost wages.  In addition, there is also a $5,000 death benefit available under PIP.  Your PIP coverage is primary over health insurance.  Your medical provider must bill PIP if it is available.  As your Jacksonville PIP Attorney, we know how to maximize your PIP benefits to ensure you receive the most out of your coverage.  We keep track of your PIP benefits to ensure your medical providers are billing appropriately and to keep an eye on how much of your PIP benefits remain available.

What is the 14-day Rule?

Up until a few years ago, people injured in car accidents in Jacksonville did not have a time limit within which to submit their PIP claims.  The law has changed and now, Florida Statute 627.736(1)(a), requires a motorist to seek medical care within 14 days of the motor vehicle accident or they will not have access to their PIP benefits.  The medical providers eligible to provide the required medical care include:

• Medical Doctors and Osteopathic Doctors;
• Dentists;
• Chiropractors;
• Advanced Practice Registered Nurses; and 
• Hospital providers.

What is an Emergency Medical Condition (EMC)?

If you treat within the 14-day requirement, the amount of your PIP benefits is limited to $2,500 unless you are determined to have an Emergency Medical Condition (EMC).  Florida Statute 627.732(16) defines an EMC 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:

• Serious jeopardy to patient health.
• Serious impairment to bodily functions.
• Serious dysfunction of any bodily organ or part.”

It is important to note, you do not need to have an EMC determination within 14 days of the motor vehicle collision.  However, your PIP benefits will be limited until an EMC determination is made.  The medical professionals eligible to make an EMC determination include those listed above with the exception of Chiropractors.  Chiropractic physicians are not eligible to make an EMC determination.  

What if I do not own a car?  How do I get PIP Coverage?

You are only required to have PIP if you own an operational vehicle.  However, if you do not own a car, there are other avenues of PIP benefits available to you.  If you live with a resident relative, you may have PIP benefits available through your relative’s automobile insurance.  If you were in a friend’s car at the time of the accident, your friend or the car owner may have PIP insurance available for you.

If you file for PIP benefits with any insurance company other than your own, the first thing the insurance company will do is look to see if you have a car registered in your name.  If so, they will likely deny coverage claiming you should have PIP on your car and your PIP is primary over any other PIP coverage.  One successful way to defeat the denial is to prove your vehicle was not operable at the time of the loss.  For our clients injured in Jacksonville car accidents, we have allowed insurance adjusters to inspect our client’s vehicle to prove it was not operable and therefore was not required to be insured.

Can a Pedestrian Get PIP Benefits?

The answer is yes, with an exception we will go into below.  If you are walking or riding a bike and you are hit by a car, you are eligible for PIP benefits under your automobile coverage.  Courts have held a person struck by a vehicle while changing a tire on the side of the road was eligible for PIP benefits.  Florida Statute 627.736(1) states that the bodily injury, sickness, disease, or death must arise out of the ownership, maintenance, or use of a motor vehicle.  If you do not have an operable car and you do not live with a resident relative with a vehicle, you are entitled to the PIP benefits for the vehicle that struck you.  This only applies to you if you are a pedestrian or on a bicycle.  If you are a driver or passenger in a “self-propelled vehicle” (i.e. car), you can not obtain PIP from the other vehicle involved in the collision.  Additionally, if you are a pedestrian struck by a vehicle but you are not a resident of the State of Florida, you are not entitled to the other vehicle’s PIP benefits pursuant to Florida Statute 627.736(4)(e)(4). 

Florida’s PIP statute was supposed to be self-executing.  However, it has turned out to be one of the more complicated and fought-over pieces of legislation created.  There are so my twists and turns in the law, if you have filed a PIP claim in Jacksonville, we strongly suggest you speak with an attorney from Rosenberg & Calvin, P.A. to understand your rights and responsibilities.