PIP and Healthcare

Who pays for your medical bills after a car accident?

One of the most common mistakes people make when involved in a motor vehicle collision is assuming the at-fault driver’s insurance will pay for their medical bills as they receive treatment. With that said a common question is “why should my insurance company pay for my medical bills when I’m not at fault?” Before answering this question, we need to take a step back and look at Personal Injury Protection or PIP.

What is PIP?

Personal injury protection (PIP), or “No-Fault” car insurance, is required by the state of Florida for all drivers to carry. PIP covers your medical bills and lost wages when you or your passengers are injured in a car accident, regardless of who was at-fault. Florida requires all vehicle owners to have a minimum of $10,000 in PIP coverage.

Just like other states that mandate PIP, however, Florida has its own set of special laws and regulations that may affect your lawsuit or legal action. This guide will help you navigate the PIP insurance process and ensure you receive all available PIP benefits.

What does PIP cover?

In Florida, PIP covers medical costs, lost wages, and death benefits, and you can decide whether you want your PIP to cover other household members or just you.

Medical costs

Most medical costs are covered by PIP; however, the state of Florida will only pay 80 percent of your PIP-covered medical expenses. If you have $10,000 worth of injuries, PIP is going to pay $8,000 of it. In addition, some practices, like acupuncture or massage therapy, are not covered under PIP insurance. Below are eligible PIP claims:

  • Ambulance services
  • Hospital stays
  • Doctors’ visits
  • Specialist appointments
  • Surgeries or medical procedures
  • Diagnostic tests, such as x-rays, MRIs, and CAT scans
  • Medication
  • Therapy
  • Rehabilitation

Note: You must seek treatment within 14 days of your accident, or you will forfeit your right to PIP benefits. Further, if your injury is not considered an emergency, you will actually only be entitled to $2,500 worth of PIP benefits. If you have an adequate health insurance policy, your health insurance should be able to take care of the rest of your costs.

Note: If a doctor deems your injury an emergency condition, then the $2,500 cap can be removed and you may be entitled to the full benefits of $10,000.

Learn more about when to use PIP and when to use health insurance here. [jumps to page section]

Lost wages

In Florida, PIP will cover up to 60% of your lost wages, subject to a $10,000 limit. Thus, if you are receiving medical treatment at the same time you are seeking lost wages, you may find the available amount of money for your lost wages will be lessened by the amount of your medical expenses. payment also includes services you would normally do, but now cannot because of the accident.

To receive your lost wages under your PIP benefits, you must complete a form to submit to the PIP adjuster. Florida law allots PIP adjusters 30 days to pay once the bill has been received by them. Therefore, it’s important for you or your attorney to submit these bills as soon as possible.

Death benefits

If the policyholder was killed, PIP covers funeral and burial expenses, in addition the benefits listed above. Your, or your next of kin, are entitled up to $5,000 for associated costs.

Which coverage comes first—health insurance, Medicare, or PIP-Medical?

For injuries related to a car accident, your PIP coverage is typically the primary coverage and comes before any other available insurance. Other insurers may reject bills that are sent to them until your PIP-Medical coverage is exhausted.

Can you use health insurance if you do not have PIP or Medicare?

Yes, if you do not have PIP or Medicare coverage on your car insurance, you may use your health insurance to pay for any medical bills resulting from a car accident. However, about 90 percent of all health insurance plans require you to reimburse the health insurance carrier for anything they pay toward the treatment of injuries sustained in a car accident.

The bottom line is you should use your health insurance to pay your medical bills once your PIP benefits have been exhausted. Your health insurance is secondary insurance. This allows you to get the treatment you need without being hassled by bill collectors for payment.

If you are having trouble understanding Florida PIP laws, make sure you are getting the right help you need. Darrigo & Diaz is able to help you get the PIP benefits you deserve, as well as help secure compensation to cover medical expenses, lost wages, and death benefits.

To learn more, contact Darrigo & Diaz by calling 813-774-3341 or contact us online.


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