Personal Injury Protection (PIP) Info Series 1 of 3
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Personal Injury Protection (PIP) has been mandatory in Florida since 1971. Established under § 627.736 of the Florida Statutes, Florida’s PIP Statute has raised numerous questions regarding its effectiveness throughout the years. This blog is the first of a three-part blog that discusses a brief overview of some of the issues related to PIP in Florida.
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Florida’s PIP Statute requires automobile insureds to carry at least $10,000.00 in PIP coverage – although insureds can choose more than the required minimum coverage in return for higher premiums. In its latest incarnation, it requires those injured (i.e. the PIP claimant), such as insured drivers and their passengers who do not own motor vehicles, to obtain initial treatment for their injuries within fourteen (14) days of the motor vehicle accident that resulted in their injuries. Failure to obtain initial treatment within this time period results in an absolute harsh outcome because it allows the insurance company an easy out. That’s right. The insurance company can outright deny the claimant’s PIP benefits simply because the claimant did not obtain initial treatment within fourteen (14) days of the motor vehicle accident.
The PIP Statute also provides, albeit ambiguously, for the amount in which the PIP claimant is entitled by referring to an Emergency Medical Condition (EMC). It first states that the claimant is entitled to the minimum $10,000.00 in coverage to pay for lost wages and medical bills, if one of the claimant’s treating physicians opines that he/she has an EMC. But the ambiguity arises when it goes on to state that the claimant is only awarded a whopping $2,500.00 in coverage, if one of the claimant’s treating physicians opines that he/she does not have an EMC. What the PIP Statute fails to take into account is what happens when none of the claimant’s treating physicians has opined either way on whether he/she has an EMC. Can the insurance company still cap the claimant’s PIP benefits at the whopping $2,500.00, when none of the claimant’s treating physicians has provided an opinion either way? Some insurance companies believe so and have, in fact, denied further benefits despite the ambiguity in the PIP Statute.
Additionally, what constitutes an EMC is also an issue. While the Florida Legislature defined the term under § 627.732(16), the definition still leaves open the issues of what constitutes a “serious” jeopardy, impairment, or dysfunction to the claimant’s health and body.
To add to the issues, 50% of drivers on the road in Florida today only drive with the minimum required insurance. This means that an accident that requires immediate hospital attention quickly depletes the $10,000.00 provided under PIP.
Stay tuned to our upcoming blogs, which will further explore the issues involved with Florida’s PIP Statute and possible remedies.
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