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5 Things to Know about Personal Injury Protection or PIP Insurance

personal injury protection insurance
personal injury protection insurance

PIP or Personal Injury Protection is a type of motor vehicle insurance that provides for medical expenses and lost wages, or can provide a death benefit in fatal incidents. PIP is referred to as “no-fault” coverage, because PIP benefits are paid without regard to who is at “fault” for the automobile accident. All Florida drivers are required to carry PIP coverage for themselves.
Effective January 1, 2013, the Florida legislature changed the PIP laws. Failing to follow the new provisions could preclude you from receiving the full PIP benefits that you are entitled to pursuant to your PIP coverage. It is important to note some of the changes to the PIP laws below that are now effective.

1) You only have 14 days to seek treatment.

After an auto accident, you must seek medical treatment within 14 days. Failure to seek treatment within 14 days will most likely waive any right that you have to PIP benefits. Additionally, you will only be reimbursed by your PIP insurance if the treatment is “lawfully provided, supervised, ordered or prescribed by a licensed physician, licensed osteopathic physician, licensed chiropractic physician, licensed dentist, or must be rendered in a hospital, a facility that owns or is owned by a hospital, or a licensed emergency transportation and treatment provider. Follow up services and care requires a referral from such providers and must be consistent with the underlying medical diagnosis rendered when the individual received initial services and care.” It is imperative that you seek treatment within 14 days from a lawful provider or you could be precluded from receiving PIP benefits.

2) To receive the full $10,000 in PIP benefits, you must have an Emergency Medical Condition.

To receive the full $10,000 in PIP benefits, you must have an emergency medical condition. An emergency medical condition is defined as a “medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health, serious impairment to bodily functions, or serious dysfunction of a body organ or part.” A physician, osteopathic physician, dentist, physician’s assistant, or advanced registered nurse practitioner must make the determination that an individual has an emergency medical condition. Chiropractors are not permitted to make this determination.

3) If you do not have an emergency medical condition, you are limited to $2,500 in PIP benefits.

If you are not diagnosed with an emergency medical condition, you are entitled to $2,500 in Personal Injury Protection benefits. However, to receive additional benefits beyond the $2,500, you must be diagnosed with an emergency medical condition. Florida Auto accident victims may be forced to rely on their health insurance to receive treatment, if they are not diagnosed with an emergency medical condition.

4) Massage and acupuncture are not covered by PIP

Under the new PIP laws, massage therapists and acupuncturists are no longer covered by PIP benefits. If you seek treatment from these types of providers, you will most likely need to pay out of pocket or through your health insurance, if they allow for coverage.

5) Your Insurance Company may require you to give an examination under oath.

Your insurance company is permitted to require you to undergo a medical examination or an examination under oath. If you fail to comply with the request, the insurance company may deny your benefits under PIP. This means that if you fail to submit to a medical examination as requested by the insurance company, your insurance company may not be required to pay for any of your benefits.