Background
Florida is a No-Fault State. There are only eighteen states in the US that are no-fault. This makes Florida a member of the minority of states that practice such insurance policies. As of January 1, 2008, the current law took effect in Florida.
While Florida is a no-fault state, there is often confusion as to exactly what that means. It does not mean that an individual can seek compensation for injuries they have sustained even if they were 100% at fault.
The idea behind Florida’s No-Fault law according to the Florida legislature was to protect public health, safety, and welfare. This law requires that all individuals carry $10,000 in Personal Injury Protection (PIP) insurance. This insurance policy will pay for injuries sustained in a collision regardless of fault for the collision. The idea is to ensure that the general public has access to healthcare if they are injured in an accident even if they were at fault for the same.
Although Florida’s law has afforded this form of no-fault insurance there are some limitations. First and foremost, the policy pays 80% of the medical charges incurred up to a total of $10,000. It also can cover lost wages due to missed work at a rate of 60% and reimburse for mileage expenses in seeking medical attention.
Requirements
In order to qualify for PIP coverage, you must seek medical attention within fourteen (14) days after an automobile collision. If you do not seek medical attention within fourteen days, your PIP claim will be denied.
Additionally, in order to obtain the full $10,000 in benefits, your injury must be considered an emergency medical condition. This is defined as “a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following: (a) serious jeopardy to patient health. (b) serious impairment to bodily functions. (c) serious dysfunction of any bodily organ or part.” This diagnosis must be made by a medical doctor and cannot be made by a chiropractor. If your physician does not diagnose you with an emergency medical condition, you will be limited to $2,500 in PIP benefits.
Duties
As an insurance policyholder, you have a duty to cooperate with your insurance company. This may include a recorded statement with your insurance company. If you have been injured in an accident it is recommended that you retain a personal injury attorney to help you through this process. They will be able to help you walk through this process and ensure that the insurance company does not participate in impermissible or harmful questioning.
It is further important to ensure that your insurance policy is updated with all of your current information as soon as anything changes. Your coverage may be denied due to a material misrepresentation. This is a misrepresentation that is material to the acceptance of the risk and would have changed the rate at which insurance would have been provided or would have changed the insurer’s risk decision. To be careful, it is recommended to update any changes in address or living arrangement and any other information that has changed since you entered into the insurance contract as soon as possible.
Effects on Lawsuits
The No-Fault law has more overarching effects in addition to the medical coverage afforded to injured motorists. The legislature created alleged protection for individuals who adhere to the insurance requirements in Florida. As is discussed here, there are several components of damages that can be claimed in a personal injury lawsuit. A portion of these damages, known as noneconomic damages (i.e. pain and suffering) cannot be claimed unless the “tort threshold,” can be met. You may only be awarded damages for pain and suffering in the event the injury or disease consists in whole or in part of (a) Significant and permanent loss of an important bodily function; (b) permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement; (c) significant and permanent scarring or disfigurement or; (d) death.[1]
Oftentimes insurance companies will not even consider pain and suffering before a lawsuit is filed. Sometimes, they won’t even consider it after a lawsuit is filed. It will be up to a jury to make a determination that one of the four above-listed conditions is present. This is why a personal injury attorney is helpful to help navigate through these laws and procedures.
Conclusion
PIP is a safety net for injured persons. However, it may not compensate you fully for your injuries if they are severe. Make sure you maintain all necessary coverages, particularly Underinsured/Uninsured Motorist (UM/UIM) insurance discussed here.
[1] Fl. Stat. § 627.737