No-Fault Benefits: Understanding PIP and Medpay Coverage (Florida)

In Florida, every driver is required by law to carry certain minimum insurance coverages, including personal injury protection (PIP). Regardless of whose fault an accident was, your own PIP insurance pays benefits to you. These benefits include eighty percent of reasonable and necessary medical expenses and sixty percent of lost wages. Florida's PIP laws are designed to ensure that each driver can obtain needed medical attention following an accident without suffering financial hardship.

Every driver can also purchase optional medical payments coverage (Medpay) from their insurance company. Medpay benefits pay the twenty percent of medical bills not payable by PIP, and typically one hundred percent of bills after PIP coverage has been completely used.

The statutes and regulations governing PIP are numerous and confusing. PIP laws govern who is entitled to PIP, including certain passengers and pedestrians, which doctors are eligible to receive payments from PIP, how much doctors can charge and be paid, and what you can do if you are in a dispute with your insurance company. These regulations can have major impacts on your treatment and your wallet. Some doctors may stop treating you if your insurance company fails to pay properly. In some situations, if your doctor fails to bill properly, not only won't your insurance pay – but you do not owe the bill either.

Many people believe that when they "purchase" PIP and Medpay coverages in certain amounts that they should be able to use all of it following a car accident. Realistically, you are covered "up to" the limits of the policy amounts subject to many terms and conditions of the statute and the policy itself. Most significantly, the medical treatment must be necessary and related to the car accident.

Often, an insurance company will have you examined by a doctor who will say the treatment is not necessary or not related to the accident. In that case, the insurance company will stop paying and you are responsible for any future bills – unless you take the appropriate steps to challenge the insurance company.

If you have been in an accident, you should speak to an experienced attorney with knowledge of PIP laws. Having a lawyer will place you on equal footing with your insurance company and ensure that you will get the benefits you paid for.

Stephen Lawler, Esq.
http://www.thelawlerfirm.com