Quick Answer: What does PIP cover after a Florida car accident?
PIP pays 80% of reasonable medical bills and 60% of lost income, up to a $10,000 limit, no matter who caused the crash. Initial care must come within 14 days, or PIP medical benefits do not apply.
Recovering from a car accident can be difficult, especially when your injuries keep you from working and your medical expenses exceed what your insurance will pay. Even with car insurance, you may find that your coverage falls short of what you need to recover. A car accident lawyer can help you understand your options for pursuing additional compensation.
Florida’s no-fault insurance law requires personal injury protection (PIP) coverage to help pay medical expenses and lost income, regardless of who caused the crash.
However, PIP benefits are limited, and you generally must receive initial medical care within 14 days to qualify for medical benefits.
If you were seriously injured in a crash, you may be able to pursue additional compensation from the at-fault driver.
Understanding what Florida PIP covers, when its benefits run out, and which injuries qualify for a claim beyond no-fault insurance can help you make informed decisions about your recovery.
Key Takeaways About Florida's No-Fault Law
- Florida requires owners of vehicles with four or more wheels to carry $10,000 in PIP coverage and $10,000 in property damage liability coverage.
- PIP pays 80% of reasonable, medically necessary expenses and 60% of lost gross income, up to a combined $10,000 per person.
- PIP medical benefits apply only if initial care is received within 14 days of the crash, and they drop to $2,500 without an emergency medical condition finding.
- An injured person can sue the at-fault driver for pain and suffering only after meeting Florida's serious injury threshold.
- Florida bars recovery for anyone found more than 50% at fault for their own harm in most negligence cases.
What Does PIP Cover in Florida?
PIP covers three categories of loss under section 627.736 of the Florida Statutes: medical expenses, lost income, and a death benefit. The medical and income benefits share one $10,000 limit per person, and the death benefit sits on top of it.
Medical Benefits at 80 Percent
PIP reimburses 80% of reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including ambulance, hospital, and nursing care.
You or another source, such as health insurance, are left with the remaining 20%. Massage therapy and acupuncture are excluded by statute, regardless of who provides them.
Lost Income at 60 Percent
The disability benefit pays 60% of lost gross income and lost earning capacity when the injury keeps you from working. It also covers reasonable expenses for household services you would have done yourself, such as paying someone to handle tasks you can no longer manage. A Melbourne personal injury lawyer can help you understand and pursue these available benefits.
The statute requires these benefits to be paid at least every two weeks.
The $5,000 Death Benefit
When a crash is fatal, PIP pays a separate $5,000 death benefit per person, in addition to any medical and disability benefits already paid. The insurer may pay it to the estate's executor or administrator or to certain relatives of the person who died.
The table below shows where PIP stops, which is often the first thing people discover after a serious crash.
| Loss after a crash | Does PIP pay it? | Where it may be pursued instead |
|---|---|---|
| Reasonable medical bills | Yes, 80%, within the $10,000 limit | Health insurance or an at-fault driver's liability coverage for the rest |
| Lost wages | Yes, 60%, within the $10,000 limit | A claim against the at-fault driver for the unpaid portion |
| Pain and suffering | No | A claim against the at-fault driver, only if the serious injury threshold is met |
| Medical bills above $10,000 | No | Health insurance, optional coverages on your policy, or the at-fault driver |
| Vehicle and property damage | No | The at-fault driver's property damage liability coverage or your own collision coverage |
| Massage therapy and acupuncture | No | Health insurance, depending on the plan |
The gap between what PIP pays and what a serious injury costs is where most of the legal questions in a Florida crash begin.
Who Does Florida PIP Insurance Protect?
Florida PIP insurance follows people more than vehicles. Under the statute, a qualifying policy provides PIP to several groups of people, subject to priority rules that decide which insurer pays first:
- The named insured on the policy
- Relatives who live in the same household, unless they are excluded or own a vehicle with their own required coverage
- Anyone operating the insured vehicle with permission
- Passengers in the insured vehicle
- Pedestrians and others struck by the insured vehicle while not riding in a self-propelled vehicle
Florida residents who do not own a car can still be covered, either through a household relative's policy or through the policy on the vehicle they were riding in or struck by. Motorcycles sit outside the PIP requirement because the statute defines a motor vehicle as one with four or more wheels, which is one reason motorcycle crash claims follow a different path.
How Does the Florida 14-Day Rule for PIP Work?
The Florida 14-day rule means PIP medical benefits are available only if the injured person receives initial services and care within 14 days after the crash.
Treatment that starts on day 15 or later falls outside the medical benefit, even when the injury is real and later proves serious. This deadline runs from the date of the crash, not the date symptoms appear.
Which Providers Count for Initial Care
Not every type of visit satisfies the 14-day rule. The statute limits initial care to services provided, supervised, ordered, or prescribed by:
- A physician licensed under Florida's medical or osteopathic practice acts
- A dentist
- A chiropractic physician
- An advanced practice registered nurse registered under the statute
- A hospital, or a facility that owns or is wholly owned by a hospital
- Licensed emergency medical transportation and treatment providers, such as an ambulance service
Follow-up care must come on referral from one of those initial providers and stay consistent with the underlying diagnosis. Reviewing the steps to take right after a crash can help keep these timing requirements from becoming a problem later.
Emergency Medical Condition and the $2,500 Limit
PIP medical benefits reach the full $10,000 only when a physician, dentist, physician assistant, or advanced practice registered nurse determines the injured person had an emergency medical condition.
If a provider determines there was no emergency medical condition, medical benefits are capped at $2,500.
The statute defines an emergency medical condition as one with acute symptoms severe enough that going without immediate care could reasonably be expected to seriously jeopardize health, seriously impair bodily functions, or cause serious dysfunction of a body organ or part.
Policy Choices That Change What Your PIP Pays
Some PIP limits are set by elections made on your own policy, often years before a crash. Section 627.739 requires insurers to offer these options at the initial application and before each renewal:
- A PIP deductible of $250, $500, or $1,000, applied to 100% of covered expenses and losses
- An exclusion of the lost income benefit, which lowers the premium but removes wage replacement
- A combination of both, applied to the named insured alone or to the named insured and dependent relatives in the household
The statute's own required notice warns policyholders against electing the lost wage exclusion if anyone in the household is employed. Reading the declarations page after a crash shows which choices are in place and how much of the $10,000 is realistically available.
When Can You Sue Outside No-Fault in Florida?
You can step outside Florida's no-fault system in two ways: by pursuing economic losses PIP does not pay, and, if your injury meets the serious injury threshold, by seeking damages for pain, suffering, mental anguish, and inconvenience.
The tort exemption in section 627.737 protects an at-fault driver only to the extent PIP benefits are payable.
Economic Losses PIP Leaves Unpaid
Medical bills and lost wages that PIP does not pay, such as the 20% of medical costs and 40% of income outside its percentages or any amount above $10,000, can be pursued against the at-fault driver. The tort exemption does not cover those amounts.
Florida law also prevents a PIP insurer from placing a lien on a tort recovery, though you cannot recover the same losses PIP already paid or owes.
The Florida Serious Injury Threshold for Pain and Suffering
Damages for pain and suffering after a Florida car accident require an injury that fits at least one of four statutory categories. The injury only has to meet one of them, in whole or in part.
| Serious injury category under s. 627.737(2) | What it covers in plain terms |
|---|---|
| Significant and permanent loss of an important bodily function | A lasting loss of a major function of the body, such as use of a limb |
| Permanent injury within a reasonable degree of medical probability | An injury a physician expects to be permanent, other than scarring or disfigurement |
| Significant and permanent scarring or disfigurement | Lasting, significant visible changes to the body |
| Death | A fatal injury, which also opens a wrongful death claim |
Serious injuries, such as traumatic brain injuries or permanent spinal damage, may meet Florida's injury threshold and allow victims to pursue compensation for pain and suffering.
How Courts Test the Threshold Before Trial
A defendant who disputes the threshold may file a motion, and the court reviews the pleadings and evidence on a one-time basis 30 days before trial or the pretrial hearing, whichever comes first.
If the court finds the plaintiff cannot submit some evidence of a qualifying injury, it dismisses the claim without prejudice. Medical records that document permanency in clear terms carry significant weight at that stage.
Fault Still Matters Once You Step Outside
PIP ignores fault, but a lawsuit against the other driver does not. Under Florida's modified comparative negligence rule, a person found more than 50% at fault for their own harm recovers nothing, and anyone at 50% or less has damages reduced by their share of fault.
For example, a driver with $200,000 in damages found 20% at fault would recover $160,000; at 51% fault, the same driver would recover nothing.
Timing matters too. Most Florida negligence claims involving car accident injuries must be filed within two years under the statute of limitations, and exceptions can shorten or extend that
period depending on the facts and the parties involved.
Commercial Trucks and Delivery Vans Under Florida's No-Fault Law
Florida's no-fault rules also apply to crashes involving commercial trucks and delivery vehicles, including Amazon and Walmart delivery truck accidents. However, these accidents may involve additional insurance coverage and potentially liable parties.
For PIP purposes, Florida defines any motor vehicle that is not a private passenger vehicle as a commercial motor vehicle, a category that covers many delivery and freight vehicles.
Your PIP Insurer's Right to Reimbursement
When an insurer on a private passenger vehicle pays PIP benefits because you were riding in, or struck by, a commercial motor vehicle, section 627.7405 gives that insurer a right of reimbursement against the commercial vehicle's owner or its insurer.
Your benefits still come from your own policy first, and the reimbursement dispute happens between the companies.
Why Truck Crashes Rarely Stay Inside PIP
Crashes involving heavy trucks and commercial delivery vehicles often produce injuries that cross the serious injury threshold.
Once a claim moves outside PIP, the questions shift to who employed or contracted the driver, which commercial policy applies, and how much coverage it carries. Those are the claims our Melbourne truck accident lawyers handle against national carriers and delivery networks.
Protecting a PIP Claim While You Recover
Most PIP disputes turn on paperwork and timing rather than on the crash itself. A few habits in the weeks after a collision make PIP disputes easier to resolve:
- Keeping every bill, explanation of benefits, and denial letter from the PIP insurer in one place
- Asking treating providers whether an emergency medical condition determination is in the records
- Noting work days missed and keeping pay stubs that show income before the crash
- Writing down the claim number and the adjuster's contact information from the first call
- Avoiding recorded statements to the other driver's insurer before understanding how the claim may be used
If a PIP insurer does not pay, Florida requires a specific pre-suit process before anyone can sue for those benefits:
- The claim must first be overdue, meaning unpaid 30 days after the insurer received written notice of the loss and its amount.
- A written notice then goes to the insurer, identified as a demand letter under section 627.736, with the insured's name, the claim or policy number, and an itemized statement of amounts claimed.
- The notice travels by certified or registered mail, return receipt requested, to the person the insurer designated for these notices.
- The insurer has 30 days to pay the overdue amount with interest and a 10% penalty, capped at $250, before a lawsuit may be filed.
Mailing the demand letter tolls the limitations period for a PIP benefits action for 30 business days. Because these steps are technical, small errors can delay payment for months.
FAQs About No-Fault Law in Melbourne, Florida
Is PIP still required in Florida?
PIP is still required in Florida, where the statutes require owners of vehicles with four or more wheels to maintain PIP and property damage liability coverage, and the Florida Department of Highway Safety and Motor Vehicles requires proof of both before registration.
Do I have to use PIP if I have health insurance?
Insurance claims get complicated when multiple types of coverage overlap. Florida law makes PIP benefits primary even when you have health insurance, with workers' compensation benefits credited against them when they apply.
Health insurance may then help with the 20% PIP does not pay and with costs above the PIP limit, depending on the plan's terms.
Does PIP cover me if I was hit while walking or riding a bicycle in Florida?
PIP often covers a pedestrian or bicyclist hit in Florida after a car accident, since it extends to people struck by an insured vehicle while not riding in a self-propelled vehicle, and a Florida resident without a car may receive benefits through the striking vehicle's policy if no household policy applies.
Which insurer pays first depends on the statute's priority rules.
How long does a PIP insurer have to pay a claim in Florida?
PIP benefits become overdue if not paid within 30 days after the insurer receives written notice of a covered loss and its amount. An insurer that pays only part of a claim must provide an itemized explanation of what it reduced or denied.
Does bodily injury liability coverage come with Florida PIP?
Bodily injury liability coverage does not come with Florida PIP, because the basic registration requirement covers PIP and $10,000 in property damage liability, so many drivers carry no bodily injury liability coverage unless they choose it or another law requires it. When PIP falls short of covering your losses, you may have additional options for pursuing compensation.
Get Legal Help When Florida PIP Coverage Isn’t Enough
Florida’s PIP benefits may fall far short of covering the cost of a serious injury. If you are facing a long recovery or permanent limitations, you may be able to pursue additional compensation from the at-fault driver.
No Client Left Behind helps injured people throughout Melbourne and Brevard County understand their options beyond PIP. Call (786) 733-9509 to speak with a Melbourne car accident lawyer about your rights and potential claim.
