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The Florida No Fault Law does two things

1) It establishes a limited exemption from liability for injuries caused to others in an automobile accident; and

2) It establishes personal injury protection (PIP) benefits to pay for certain losses resulting from an accident.

Legal Rights & Duties

Who is covered?

1) If you are a resident of Florida and own a motor vehicle, you are required to purchase PIP.  You are covered by PIP if you are the named insured.  You, the insured, are covered by PIP while driving your vehicle or when a passenger in another’s vehicle.  You are also covered while outside a motor vehicle if struck and injured by a motor vehicle.

2) Resident relatives who live with you, the insured, may be covered by your PIP benefits while they are driving your car, as passengers in your or another’s car, and while pedestrians if struck and injured by a motor vehicle.

3) Others who are injured while driving your insured motor vehicle or who are injured while a passenger in your insured motor vehicle or who are injured as a pedestrian when struck by your insured motor vehicle may be covered by your PIP.

4) If you or your insured relatives living with you are injured while outside Florida, and are in your insured motor vehicle, you and your insured relatives are covered under PIP as long as the injury occurs within the United States, its territories or possessions, or in Canada.

Exceptions

If your passengers or relatives living with you have a motor vehicle licensed in Florida or own a motor vehicle required to be licensed in Florida, they are not covered by your PIP coverage.  They must purchase PIP for themselves to have coverage.

Exclusons

An insurer may exclude no-fault benefits:

1) For injury sustained by any person operating the insured motor vehicle without your express or implied consent.

2) To any injured peson, if his or her conduct contributed to the injury under either of the following circumstancs:

a) causing injury to himself intentionally; or

b) being injured while committing a felony.

3) For injuries sustained by the named insured and relatives residing in the same household while occupying another motor vehicle owned by the named insured and not insured under the policy.

Benefits

The minimum limit for no fault personal injury protection benefits is $10,000 per person for loss sustained as a result of bodily injury, sickness, or disease ($5,000-death) arising out of the ownership, maintenance, or use of a motor vehicle.

Medical Payments

PIP pays 80% of medical benefits for all reasonable expenses for medically necessary medical, surgical,  xray, dental, and rehabilitative services, including prosthetic devices, wheelchairs, crutches, slings, neck braces and splints.  Medically necessary ambulance, hospital and nursing services are covered, and benefits also are paid for necessary remedial treatment and services recognized and permitted under the laws of the state for an injured eprson who relies solely upon spiritual means through prayer for healign because of religions belifes.

Note: if you have medical payments coverage through your auto insurance policy, the the medical payments coverage will be secondary to PIP coverage.  The excess medical expenses, the 20 percent not covered by PIP, and the decuteible may or may not be covered by the additional medical payments coverage depending on your particular policy.

Billing Requirements

Florida Statutes provide that with respect to any treatment or servies, other than certain hospital and emergency services, the statement of charges furnished to the insurer by the provider may not include, and the insurer and the injured party are not required to pay, charges for treatment or services rendered more than 35 days before the postmark date of the statement, except for past due amounts previously billed on a timely basis, and except that, if the provider submits to the insurer a notice of initiation of treatment within 21 days after its first examination or treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 75 days before the postmark date of the statement.  The insured has a responsibility to furnish the provider with the correct name and address of the personal injury protection insurer.  Failure to do so may result in delayed reimbursement to the provider.

Disability Benefits

PIP pays 60 percent of disability benefits for any loss of gross income and loss of earing capacity from inability to work because of an injury sustained in an accident.  Disability benefits also cover all expenses reasonably incurred for household services that, if not for the injury, the injured person would have performed.  Benefits must be paid not less than every two weeks.

Death Benefits

PIP pays up to $5,000 of available benefits per individual in death benefits.  The insurer may pay such benefits to the executor or administrator of the deceased, to any of the deceased’s relatives, including those related by marriage, or to any person appearing to the insurer to be equitably entitled to the payments.

Optional Deductibles and Limitations

1) PIP deductibles are available in the amounts of $250, $500, $1,000, and $2,000.  You may have elected a deductible to apply to you or to you and your dependent relatives who live with you, but that deductible will not apply to any other person covered under the policy.  Such an election may result in an adjustment of premium.  PIP deductibles are taken from the amount payable for medical and disability benefits.  For example, if you have a $10,000 medical expense, PIP pays 80 percent which is $8,000.  If your deductible is $2,000, the $2,000 is deducted from the $8,000 and your benefit is now $6,000.  Note, deductibles are typically not applied toward death benefits.

2) You may have elected that the benefits for loss of gross income and loss of earning capacity (disability benefits) be excluded from your PIP benefits.  Such an election will usually result in a reduction in your premium.

Coordination of Benefits

PIP benefits are primary over other insurance coverage, except that worker’s compensation benefits received will be credited against PIP benefits.  This means that your PIP insurer is ultimately responsible for payment of your claim.  How this works in a specific situation depends on the contract language in the other insurance policy.

Payment of Benefits

PIP benefits will be payable as loss accrues and reasonable proof of the loss and the expenses are provided.  Before PIP benefits are paid, an insurer may require written ntoice be given as soon as possible after an accident involving a mtor vehicle.  PIP benefits are overdue if not paid within 30 days after the insurer is provided written ntoice of a covered loss and of the total amount of the claim.  If a partial claim is made, that partial amount must be paid within 30 days after the insurer receives written notice.

Any part or all the remainder of the claim that is later supported by written notice is overdue if not paid within 30 days after such written notice is furnished to the insurer.  However, any payment shall not be deemed overdue when the insurer has reasonable proof shwoing that the insurer is not responsible for the payment even though written ntocie has been furnished to the insurer.

For the purpose of calculating ovedue paymetns, payment is considered as being made on the date it was postmarked or, if not posted, on the date of delivery.  All overdue payments will pay simple interest at the rate established in the policy, or pursuant to Florida Staute 55.03, whichever is greater.

What do I do to resolve disputes regarding PIP benefits?

1) In the event you are having a  dispute with the insurer for PIP benefits, you may demand mediation of the claim before resorting to the courts by filing a request with the Department of Financial Services on Form D14-510 provided by the Department.

2) Mediation is an informal process whereby a neutral mediator selected by the Department of Financial Services will work together with you and the insurer to resolve the dispute.

Note: This description of rights contains general statements and should not be construed as legal advice.  If you require specific advice regarding an automobile related accident that occured in the State of Florida, please contact the undersigned.