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Bagen Law Blog

Can the PIP Insurance Company Exclude Certain Medical Expenses from My Claim?

Posted by Steven A. Bagen

Oct 28, 2021 11:45:00 AM

Bagen October Blog

In Florida, all car accident cases come under Florida's PIP or no-fault law. Dealing with medical expenses after being injured in a car accident can be stressful. When you are suffering from potentially serious or even life-threatening injuries, the last thing you want to worry about is the financial burden that follows a car accident. Even if your injuries are minor, they may still require expensive treatments that you can’t afford.

In these situations, it’s helpful to understand your rights and what will or will not be covered by insurance. In some states, if you are the victim, you can file a claim against the at-fault party’s insurance company for compensation to help cover costs related to the accident. However, in other states, like Florida, they have “no-fault” laws that require you to seek compensation through your own insurance company’s no-fault coverage, regardless of who was at fault for the accident. 


What is Personal Injury Protection Coverage?

No-fault insurance or Personal Injury Protection (PIP) is required in the state of Florida. PIP is the portion of your auto insurance policy that helps cover medical expenses and other damages for you and your passengers, no matter who was at fault in an accident. This coverage can even cover you if you are injured by another driver while you are outside of your car, such as while walking or riding your bike. 

Your PIP coverage is available right away, meaning you do not have to wait to fight against the guilty party’s insurance company to get the compensation you need. Your own insurance will automatically provide you with a certain amount to help cover your expenses depending on your state’s specific limits and policies. However, the downside to PIP coverage is that it might not cover all of your expenses, and states with mandatory PIP coverage make it difficult to pursue further compensation.


What is Covered Under PIP? 

In Florida, drivers are required to have a minimum of $10,000 PIP coverage on their auto insurance policy. PIP will cover 80% of any necessary medical expenses up to the $10,000 minimum. It can also cover 60% of any wages lost from being unable to work, as well as death benefits up to $5,000 per person. 

Things covered under PIP generally include:

  • Medical expenses 
  • Rehabilitative treatments
  • Lost wages
  • Replacement services (i.e. compensation for services or tasks you can no longer perform due to injuries, such as household cleaning and childcare)
  • Funeral expenses


What is Excluded from PIP?


With PIP coverage, your insurance policy will often have a deductible that you have to pay before your insurance will cover the rest of the expenses. PIP insurance will also not cover things unrelated to the car accident or severe injuries and treatments that go beyond the $10,000 limit. If this occurs, you may need to work with an attorney to review your options for pursuing additional compensation. 


What if My Medical Expenses Go Beyond What PIP Covers? 

If your injuries are severe and even life-threatening and require treatments that go beyond the limits of your PIP coverage, you may have a couple of options. In addition to basic PIP, you can also get what is called med pay or medical payments coverage to help cover medical expenses relating to an accident. However, med pay coverage is often less than PIP, but it may be able to help you cover your PIP deductible. 

In Florida, if you have sustained severe injuries, you may be able to pursue further medical and other compensation by filing a claim against the at-fault party’s insurance or by suing them. This can be tricky, though, as you will need to prove that your injuries are severe enough to warrant this and that your PIP coverage will not be enough. Many times your PIP insurance will send you for a second opinion medical exam, to cut off your PIP payments, In these situations, our law firm will fight for your PIP rights by filing a separate PIP lawsuit for you in court. 

You also have a personal injury claim or a lawsuit against the at-fault party if the following injuries occur:

  • Damage to your spinal cord
  • Traumatic brain injuries
  • Paralysis
  • Amputation
  • Disfigurement
  • Permanent limitation or use of an organ
  • Permanent limitation or use of a limb
  • Significant limitation or use of a bodily function
  • Substantial disability

Working With an Experienced Florida Personal Injury Attorney

If you live in Florida and are injured in a car accident, you may feel relief that your PIP insurance will automatically cover your expenses. However, if your injuries are severe and your expenses go beyond that which is covered by PIP, it can be frustrating and challenging to get the further compensation that you need and deserve. 

Working with an experienced personal injury attorney that knows the ins and outs of Florida state laws can make navigating the process of getting additional coverage and compensation less stressful. An attorney can walk you through your options and help you win your case to get you the full compensation that you need. 

If you or a loved one has been injured in a car accident, contact Steven A. Bagen & Associates today for a free case evaluation!

Contact Steven Bagen Gainesville Ocala personal injury lawyer


Topics: Car Accidents, Personal Injury Law