How are PIP Benefits Paid?

practice-bg1I am often asked by clients – do I automatically get a $10,000.00 PIP (personal injury protection) check made payable to me, following a car accident? In the typical scenario, unfortunately, the answer is no. This article will briefly explain the purpose of Florida PIP insurance and its applicability when you are in an accident. Please note that nothing in this article is to be construed as rendering legal advice but is for informational purposes only.

Florida is a no-fault state that requires every vehicle owner to carry $10,000 in PIP benefits pursuant to Fla. Stat. 627.7407. This means that when you are in an accident, whether it is your fault or not, you qualify to make a claim for PIP benefits (if available). But what is the purpose of this required coverage and who gets the money? Does the claimant automatically get a $10,000.00 check made payable to them, following an automobile accident? Unfortunately, the answer is no.

PIP is most commonly used to pay up to 80% of your medical bills which are incurred, following an accident. Examples of bills that are sometimes incurred following an accident include ambulance, hospital facility, emergency room physician, radiologist, chiropractor, etc. In the typical scenario, after an accident, if you are injured, you may seek medical treatment. The provider then submits their charges (i.e. the bill) to your PIP carrier for payment and the PIP carrier pays the provider up to 80% of allowable charges for qualified treatment.[1] In this circumstance, the PIP adjuster remits payment until PIP benefits are exhausted (i.e. a total of $10,000.00 has been paid), and the injured claimant does not directly receive a check of any kind. This is the most typical scenario, but there are other scenarios when you may directly receive a portion of PIP benefits, such as when you have lost wages. In the lost wage scenario, PIP pays up to 60% of your lost wages but you must submit documentation to substantiate your lost wages (by now you are realizing that everything in the personal world must be documented and substantiated!).

You may also be able to receive a check for mileage reimbursement related to driving to and from your doctor appointments; however, in my experience, this check is very nominal and likely will not amount of the full $10,000.00. You are also required to document your miles driven, the provider, date, etc., which often times is more trouble than it is worth, especially if you are receiving treatment several times a week. Regardless of your specific fact scenario, it is crucial to consult with a personal injury attorney that is familiar with the PIP statute and its requirements, BUT DO NOT WAIT! In a following article I will explain how your PIP benefits could be limited to a mere $2,500.00, if you do not follow the statutory requirements to qualify for the full $10,000.00 PIP benefits!

[1] NOTE: There are exceptions to this general rule, as the claimant must first qualify for PIP benefits and the treatment must be of the nature authorized by statute. Please consult with an attorney for a more in-depth explanation of Chapter 627, Fla. Stat., and to determine if you qualify for the maximum $10,000.00 PIP benefits. Each fact scenario is different and requires a careful analysis by a licensed attorney.

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