What Does PIP Stand For?
PIP stands for “Personal Injury Protection.” You may have heard the term “PIP” or perhaps you have seen it in the fine print of your insurance policy. Every auto insurance policy in the state of Florida includes PIP, it is mandatory, i.e., you have it on your policy no matter what, and it is something with which any FL driver should be familiar.
Personal injury protection is also known as no fault auto insurance. Its purpose is to provide injured drivers with up to $10,000 in immediate medical coverage in the event of an accident, regardless of fault. However, there are important criteria which must be met to access this coverage in full.
Whether you are an injured party or a medical provider looking into the mechanics of personal injury protection, if you are at the stage of seeking counsel be sure to find someone with experience. PIP is a complicated matter and can be tricky to navigate depending on the facts of your case.
Nevertheless, this article will seek to inform you on the various aspects of PIP including its main benefits and the important factors to look at when trying to maximize your access to its full coverage amounts.
Note: While it is possible in some cases to add additional PIP coverage to auto insurance policies, most drivers do not. Because most drivers do not opt for additional PIP coverage, the remainder of this article will assume an auto policy with $10,000 available in PIP, i.e., the required state minimum as set forth in 627.736, Fla. Stat. (2018). If you are interested in additional coverage for yourself in the event you are not at fault, look instead at adding underinsured motorist coverage. To the extent you are not at fault, UM insurance is more flexible and allows for pain and suffering damages to go directly into your pocket; PIP on the other hand serves only as a form of payment for incurred medical (and certain other) expenses—no money from PIP can go into a client’s pocket except in the form of disability benefits or incurred out-of-pocket expenses.
PIP is Comprised of 3 Types of Benefits
Personal injury protection insurance is comprised of 3 categories of benefits: Medical Benefits, Disability Benefits, and Death Benefits. Each category has an established dollar amount of coverage required at minimum by law, and each category has important stipulations as to what expenses qualify within those categories and what do not.
Medical Benefits and Disability Benefits Share the Same “Pool” of Coverage; Death Benefits Are Additional
The PIP Statue states that the medical- and disability-benefit components of PIP are together limited to $10,000. This means that as you use your $10,000 in coverage to pay for medical benefits, you are using the same source from which your disability benefits could come.
Death benefits, on the other hand, are in addition to the $10,000 afforded toward medical and disability benefits. Death benefits are at minimum $5,000 per individual, and are payable to the executor of the deceased (or potentially to family, etc.).
Medical Benefits: Payable at 80% Up to $10,000
Section (1)(a)1. of 627.736, Fla. Stat. (2018) stipulates that 80% of all reasonable expenses for medically necessary services are payable up to $10,000. There are important requirements that must be met for you to be afforded the full $10,000 to be used toward your medical (and certain other) expenses. This is one of the many areas in this process in which having a skilled personal injury attorney helps. With skilled counsel, you can be sure that your case will be managed in a way to get the full $10,000 to be used toward your medical bills (assuming all facts of your case genuinely meet the legal requirements for such coverage).
Requirement #1: The 14-Day Rule
To have access to any medical benefits AT ALL, you must receive treatment within 14 days after the motor vehicle accident. This is referred to as the “14-Day Rule.” It is easy to confuse this with the EMC requirement explained in Requirement #2 below, but make no mistake, this is a much more foundational requirement to which you should pay attention.
If you do not receive treatment for your bodily injuries within 14 days after the motor vehicle accident, you will be permanently precluded from having ANY access to the medical benefits component of your PIP insurance. This means that all $10,000 of your PIP insurance will be accessible only through the form of disability benefits, which as explained below, is not always the best use of that coverage.
Requirement #2: Emergency Medical Condition (EMC)
By default, medical benefits through PIP are actually limited to $2,500. Most people do not know this, and this can come as quite a shock at latter stages in a case if the client was not properly informed of this limitation. Medical expenses from an motor vehicle accident can be in the tens of thousands, if not hundreds of thousands, of dollars, and every bit of coverage helps. Given PIP’s ability to massively discount medical services before paying on them, the difference between $2,500 available in PIP medical coverage versus $10,000 available in PIP medical coverage can sometimes mean the difference between a $20,000+ bill sitting on your hands versus none at all.
So how do you access the full $10,000 in the form of medical benefits? Yet again, this is another area in which having skilled counsel is immensely useful. Section (1)(a)3. of 627.736, Fla. Stat. (2018) states that reimbursement for services can be provided up to $10,000 if and only if a physician, dentist, PA, or nurse practitioner determines that you had an “emergency medical condition” as a result of the accident. Also referred to as an “EMC,” this determination is critical to your ability to access the full $10,000 in the form of medical benefits. If you fail to get an EMC issued, you will be limited to $2,500 in medical benefits.
FAQ #1: Does my EMC have to happen within 14 days of the MVA (Motor Vehicle Accident)?
Technically, no. Though it is best practice to have this determination made during the course of whatever treatment you seek within the first 14 days. That said, if for whatever reason your medical records from the first 14 days do not reflect an emergency medical condition, this determination can actually be made after the fact.
Need help getting an EMC to unlock your full $10,000 in PIP medical benefits? Contact Attorney Mangal today at MANGAL, PLLC for a FREE case evaluation.
FAQ #2: Can My Chiropractor Issue an EMC?
The short answer: “no.” The long answer: “no, but he/she can possibly arrange it for you.”
If you have been injured in a motor vehicle accident and are currently treating with a chiropractor, to the extent you do not already have an EMC in your medical records, be aware that your chiropractor is legally ineligible to issue an EMC for your injuries. This has nothing to do with the skill of your chiropractor; instead, it has everything to do with the wording of Section (1)(a)3. of 627.736, Fla. Stat. (2018). Per the statute itself, chiropractors are specifically excluded from being able to issue an EMC.
However, as per the “long answer” two paragraphs above, it is possible that your chiropractor may be able to arrange an appointment for you with a provider that can issue an EMC. Just as it is critical to seek skilled counsel when involved in an MVA, it is also just as important to seek medical care from providers experienced in this industry. Chiropractors who frequently deal with auto accidents usually have medical contacts established to whom they can send their patients for simple one-off evaluations like EMC evaluations.
If you have been involved in an auto accident and are currently treating, talk to your attorney or provider today to confirm that an EMC was issued in your medical records. Otherwise you may be limited to only $2,500 in PIP medical benefits.
Disability Benefits: Payable at 60% Up to $10,000
PIP disability benefits, unlike their medical-benefits counterpart, are much more straightforward. If you have been involved and injured in an auto accident, regardless of the 14-Day Rule or whether you have an EMC in your medical records, you are eligible to seek disability benefits from your PIP insurance policy. Here, PIP will pay directly to you 60% of any loss of income and/or earning capacity due to your injuries from the MVA. Though you are limited to only $10,000, if you are injured in a way that requires minimal treatment but still genuinely prevents you from being able to work, PIP disability benefits may be a good way to recoup some of your losses.
Unlike PIP medical benefits which are typically paid out directly to your medical providers, PIP disability benefits are paid directly to you. This means that seeking disability benefits for lost income/loss of earning capacity is one of the limited ways in which you can put money in your pocket directly from your own PIP insurance. However, as will be discussed in a future article on The Official Blog of MANGAL, PLLC, this is not always strategically to your benefit. If you have medical bills outstanding, strategically it is more often than not better to channel your PIP benefits toward your medical bills as opposed to lost wages/earning capacity. Having a skilled attorney by your side helps in making these choices.
It is also worth noting that PIP disability benefits will also extend to reimburse you, in full (not just at 60%), for any reasonable expenses incurred in seeking ordinary and necessary services from third-parties to help you/your household while you are injured. This reimbursement, however, is for expenses actually paid out-of-pocket (as opposed to reimbursement for loss of income/earning capacity where you are being “reimbursed” for, in an academic sense, opportunity cost).
Death Benefits: Payable at $5,000 In Addition to Medical/Disability Benefits Coverage
The third and final categorical benefit of PIP is that of death benefits. As discussed before, this coverage is in addition to the $10,000 afforded toward combined medical and disability benefits. For example, if someone were to have suffered injuries that used up the entire $10,000 in medical/disability benefits and said person were to have also passed away, there would still be $5,000 available in PIP death benefits to that person (or rather, his/her estate). This benefit of PIP is also fairly straightforward, and usually is not a major source of issues or complications in personal injury cases. If your loved one passed away in a motor vehicle accident, be sure to inquire about PIP death benefits from your insurance company.
Conclusion: Final Thoughts on Personal Injury Protection Insurance
The information above is only the tip of the iceberg when dealing with PIP insurance. While it may seem straightforward to meet PIP’s requirements for accessing its medical benefits, disability benefits, and death benefits, in practice it is an entirely different ballgame to ensure that auto insurance companies actually comply with the rules. Insurance companies deny PIP claims routinely, and claimants are often left with no PIP money despite having factual scnearios which warrant the full $10,000 and then some. Having a skilled attorney by your side can be the difference between being upside down in medical bills and loss of income versus walking away with all your bills paid and having sizable sums of money in your pocket. Seek counsel from Attorney Mangal today at MANGAL, PLLC so you can have peace of mind of knowing you have full access to all $10,000 of your PIP benefits.
