Florida is one of 12 no-fault auto insurance states in the nation. The law mandates that motorists carry at least $10,000 in personal injury protection (PIP) coverage instead of having liability insurance. When a person is injured in a car accident, regardless of who may be at fault, they are entitled to receive up to $10,000 in compensation for hospitalization, medical treatment, and lost wages.
No-fault insurance in Florida was designed to facilitate quick payouts to individuals and medical PIP providers, without forcing parties to establish liability in a court of law. However, medical PIP may not cover the full extent of treatment and hospitalization that injured parties face. When the damages exceed the allowable payment, injured parties may sue to recover additional damages. Motorists can also add Med Pay insurance to their policies in order to supplement their basic coverage.
What follows is a closer look at how PIP works in Florida, which medical services and providers are covered by PIP, and how the payment process works.
Medical Services Covered by PIP in Florida
Florida Statute 627.736 (1)(a) stipulates which medical services are covered by PIP. The insurance covers a broad range of initial and follow-up services, including:
- Prescription medication and pain management
- Orthopedic medicine
- Emergency dental treatment
- Chiropractic treatment
- Diagnostics and laboratory services
- Ambulatory services
- Rehabilitation and physical therapy
- Surgical intervention
Although PIP provides extensive coverage, it does have procedural stipulations. They are as follows:
- Treatment must occur within 14 days of the auto accident. The insurer will not accept a claim for treatment outside that window.
- Claims may be investigated for fraud. Insurers have 60 days to investigate an injured motorist’s claim. Nonetheless, they’re still required to pay the claim within 30 days—even if they do suspect fraud.
- Medical claims must be properly documented, coded, and signed. Florida Statute 627.736 (5)(d) provides explicit directions for doctors and facilities submitting PIP claim forms.
Unlike some types of liability insurance, PIP in Florida also covers payments of up to 60% for lost wages due to an accident. In order to get these benefits, injured motorists must submit a wage and salary verification form filled out by their employer.
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What Services Aren’t Covered by PIP?
Some alternative medical treatments aren’t covered by PIP. Statute 627.736 (1) (a) explicitly names massage and acupuncture as services that are not covered.
There are also some conduct exclusions noted in the statute. Medical services rendered to the injured motorists and household relatives are not eligible for PIP payments, if the person operating the vehicle failed to obtain the implied or spoken consent of the insured motorist.
Moreover, if the injured person harmed themselves intentionally or was injured while committing a felony, their medical treatment isn’t eligible for PIP compensation. In such cases, Florida Statute 627.736 reads that the 30-day payment provision “is held in abeyance, and the insurer shall withhold payment of any personal injury protection benefits pending the outcome of the case at the trial level.”
Details of PIP Payments to Medical Providers
As a medical provider, you can receive direct compensation from insurance companies if the patient countersigns the billing invoice. However, there are limits to the payout, and they are as follows:
- PIP only covers 80% of a patient’s medical costs. If an injured motorist suffered $6,000 worth of injuries, they are only eligible to receive $4,800.
- Benefits for non-emergency care are lower. The maximum amount for injuries that aren’t deemed emergencies is $2,500.
If you’re a medical provider operating in the Sunshine State, you have the right to sue for PIP compensation if an insurance company denies any part of your claim or fails to respond within the 30-day period. GED Lawyers is well versed in PIP legislation. In fact, 85% of our lawyers and support staff specialize in handling these cases. We know how insurance companies think and we consistently beat them at their game, recovering millions of dollars’ worth of damages for our clients.
How Does Med Pay Work With PIP?
Because PIP coverage is capped at $10,000, some motorists opt to supplement their coverage with Medical Payments, or Med Pay. Med Pay and PIP in Florida are both no-fault coverages, but only Med Pay is optional.
Unlike PIP insurance, Med Pay only covers medical bills and funeral expenses. It doesn’t compensate the insured for lost wages. Neither coverage compensates for pain and suffering; An injured motorist must sue to recover those damages.
When used in combination with PIP insurance, Med Pay provides supplemental benefits as follows:
- It pays for the 20% that PIP insurance does not cover.
- It may cover death and funeral benefits beyond the $5,000 that PIP insurance provides.
- It may provide health benefits coverage beyond the maximum $10,000.
Whether Floridians need Med Pay depends on their health insurance coverage. Because it’s considered a supplemental policy, Med Pay can’t take the place of an individual’s primary health insurance, and those insurance benefits will tap out first. However, Med Pay can pick up the tab for deductibles and co-pays that the injured motorist would otherwise have to pay.
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PIP in Florida covers a broad range of medical services. In fact, the law only excludes two common services—massage and acupuncture.
That said, insurance companies are on the lookout for fraud and will investigate and deny claims for a variety of reasons. Moreover, when an insurance company suspects foul play or the commission of a felony, they’re not required to pay claims within the usual 30-day period. Medical personnel must wait pending the outcome of a trial to receive compensation.
At GED Lawyers, we specialize in recovering damages for doctors who have been denied PIP insurance claims. If you’re a medical provider who believes you’re entitled to compensation for services rendered under the law, GED Lawyers would love to hear from you. Contact us toll-free at 844-443-3529 or locally at 561-995-1966 and let us know how we can help.