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Delray Beach PIP Claims Lawyers

Delray Beach PIP Claims Lawyers

If you purchased PIP insurance coverage for your vehicle, you probably did so for the peace of mind.  This type of coverage, which is also known as “no-fault” insurance coverage is designed to make sure that, no matter who is at fault, your medical bills for an accident are covered.  Unfortunately, many people discover that the peace of mind they got with their PIP coverage was illusory and that their insurance companies may fight paying a PIP claim.  At Demand the Limits, our Delray Beach PIP claims lawyers will fight hard to make sure that you receive the benefits of the coverage that you expected when you bought your policy.

At Demand the Limits, we have noticed that many consumers are confused about automobile insurance policies and what type of coverage comes with each policy.  To help you understand PIP coverage, we have put together a primer that explains and defines PIP coverage, and also mentions some of the common issues that can occur when trying to file a PIP claim.

What is PIP?

PIP stands for Personal Injury Protection and is a type of coverage you can include on automobile and other motor vehicle insurance policies.  It is a type of no-fault coverage, which means that, if you are insured under PIP coverage, you can recover whether or not you were at fault in the accident.  PIP coverage is designed to cover medical expenses and other related expenses, such as transportation to and from doctor’s visits.

Does liability insurance include PIP coverage?

Liability insurance is a term used to describe the minimum amount of insurance that the state requires you to have to cover damages that you cause as a driver.  Different states require different amounts of liability coverage.  In Florida, you are required to carry $10,000 in property damage liability coverage.

Does Florida law require PIP insurance?

If you drive a vehicle with four or more wheels, Florida requires you to carry $10,000 in personal injury protection as well as $10,000 in property damage liability insurance.  In addition, your insurance requirements may be impacted by your driving record.  If you have been in a car accident or been convicted of certain crimes, the state may require you to purchase additional insurance coverage in order to register a vehicle.

Why is PIP insurance coverage important?

Because PIP is no-fault coverage, it provides coverage for medical expenses, regardless of who is at fault.  Though the required $10,000 amount is not enough to cover expenses for serious injuries, it is generally enough to fill-in-the-gap between health insurance coverage, by paying deductibles and out-of-pocket expenses.  In addition, because it can be used to pay for related expenses, such as transportation costs to appointments, PIP coverage can help you weather the unexpected expenses that can come with an automobile-accident related injury.

As a type of no-fault coverage, PIP helps you recover from injuries even if you were the driver at fault.  It also covers injuries in the event that the other motorist was an uninsured motorist.

Is PIP the same as full-coverage insurance?

No.  The term “full coverage” is used to describe a comprehensive insurance policy that pays for damages to your vehicle, even if you were at fault in the accident.  In addition, comprehensive insurance policies may include a larger amount of PIP protection.  However, standard PIP policies do not cover any damages to your own personal vehicle.

Who does PIP insurance cover?

PIP insurance covers the owner of the car, or the relative or spouse of the person who owns the car, provided that they live in the same household.  PIP insurance coverage applies even if you are the passenger in another car, as long as you either own a vehicle or live with someone who owns a vehicle.  PIP coverage also applies if you were a passenger in a vehicle that was involved in the accident.

What does PIP insurance cover?

Under Florida Statute 395.002(8), an emergency medical condition is a condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate attention could results in any of the following: serious jeopardy to the patient’s health; serious impairment to bodily function; and serious dysfunction to any bodily organ or part.

Why does Florida require PIP coverage?

Florida is one of 10 states that require PIP coverage.  The goal was to ensure that injured persons would have immediate access to medical care following an automobile accident, before having to establish fault.  Florida requires each driver to have $10,000 in PIP coverage before registering a vehicle.

What does PIP Cover? 

Under Florida Statutes § 627.736, PIP insurance is required to pay 80% of all reasonable and medically necessary treatments and services, lost wages, and even funeral expenses.

Is there extended PIP coverage?

Yes. While drivers in Florida are mandated to have $10,000 in PIP coverage, drivers can also contract for greater amounts of PIP coverage.  This is referred to as “extended PIP.”

Is PIP better than having to establish fault?

There is no single answer to this question.  Theoretically, requiring PIP coverage makes it easier for people to get immediate care for medical emergencies and provides a larger safety net of insurance coverage in the event of auto accidents.  However, by removing fault from the occasion, PIP coverage frequently places an injured party in the position of having to fight with his or her own insurance company in order to get coverage for injuries that were the result of an automobile accident.

Is PIP fraud really an issue?

The State of Florida has experienced a dramatic increase in PIP claims and payments over the last few years, despite a relatively stable number of drivers and car accidents.  Florida has some of the cities with the highest “questionable claims” rates in the nation.  Questionable claims cause insurance rates to rise.  As a result, in 2012, the State of Florida passed HB 119- Personal Injury Protection (PIP) for Auto Insurance Fraud to address PIP fraud.  While the goal of the bill, reducing the amount of PIP fraud, was great, an unintended side effect of the bill was that it made it harder for people with real injuries to collect under their PIP coverage.

I am a medical provider; can you help me understand PIP coverage?

Yes.  At the Demand the Limits, our PIP lawyers not only help people who have been injured, but can also help medical providers understand the role of PIP coverage.  Medical providers, or actually billing managers for medical providers, need to understand PIP coverage in order to maximize its effectiveness in helping injured people access immediate medical care and cover the gaps between no-coverage and the threshold established by many personal healthcare insurance plans.  It is important for medical providers to understand what PIP insurance covers in order for them to effectively process claims.

Are all injuries covered under PIP coverage?

No.  PIP coverage is designed to cover emergency medical situations.  The emergency requirement is not necessarily one of severity, but of timeliness.  Did the patient seek treatment within 14 days of the triggering automobile accident?  If the answer to this question is “no,” then PIP coverage automatically does not apply.  This 14-day triggering requirement is critical, not only for injured parties, but also for medical providers seeking compensation for treatment.

Does being treated by EMS at the scene of an accident count as seeking treatment within 14 days? 

Yes.  Under Florida Statute §627.736(1)(a)(a), the initial services and care provided by EMTs or others who provide emergency transportation and treatment count as establishing treatment within the 14-day window.

Who else can provide initial care and services?

Florida’s PIP laws are fairly inclusive.  You can seek treatment and services from providers who are: M.D.’s, D.O.’s, D.C.’s (chiropractors), dentists, hospitals, emergency medical personnel, and healthcare facilities that are owned by hospitals.  However, the PIP statute no longer allows PIP funds to pay for massage therapists or acupuncturists, even if they are prescribed by a medical doctor for treatment.

Does my treatment have to be completed within 14 days to be covered?

No.  As long as treatment is sought within the initial 14-day window, other follow-up treatment may be covered under PIP protection.  For the injured party, this means that you want to keep records of all treatment, follow-ups, and referrals.  For medical providers, it is important to keep records of referrals and prior treatment to show that the patient sought care within the 14-day window.

Who does PIP insurance cover?

PIP insurance covers the owner of the car, or the relative or spouse of the person who owns the car, provided that they live in the same household.

Can I collect under PIP coverage if I was walking or on a bicycle? 

Maybe.  If you own a vehicle or live with someone who owns a vehicle and you are injured by a vehicle while you are walking or riding a bike, your injuries may be covered by your PIP coverage. If you do not own a car or reside with a relative who owns a car, then the PIP coverage of the driver who owns the car will cover your injuries.

Do I have to be able to establish an Emergency Medical Condition (EMC) to get PIP coverage?

No.  As long as you sought treatment within the 14-day initial treatment window, you should have $2,500 in PIP insurance coverage.  Furthermore, you do not have to diagnosed with an EMC within the first 14 days to get greater coverage up to the $10,000 PIP treatment limit.

Does a provider have to diagnose an EMC in order to trigger the EMC coverage?

This is a gray area that makes things more difficult for both practitioners and medical providers.  The statute does not require the medical provider to use the term “emergency medical condition.”  However, it is not unusual for insurance adjusters to deny claims where obvious emergency medical conditions occurred, because of a medical provider’s failure to designate it as an EMC.  One way that the PIP Claims Lawyers at Demand the Limits help Delray Beach area clients is by helping them establish that an EMC exists and that claims over $2,500 should be covered by PIP coverage.

How can a PIP claim lawyer help me with my PIP claim?

The biggest problem with the PIP laws in Florida is that they are ambiguous.  They have big gaps in them that do not describe what should happen under certain frequently-occurring circumstances.  For example, the statutes outline the amount of coverage ($2,500) that should apply if the medical providers determine that there was no EMC, and the amount of coverage ($10,000) that should apply if there is a determination of an EMC; but fail to cover what should occur if no determination about an EMC is made.

In addition to the laws being ambiguous, many insurance contracts are also ambiguous.  There may be ambiguity in the contract about what coverage is due.  The result is that you may be entitled to greater coverage than your insurance company believes that it should provide.  While insurance companies may genuinely believe that they are interpreting the insurance contract correctly, contract law has a very specific interpretation rule that often works in favor of the insured.  Under contract law, any ambiguities in a contract are to be resolved in favor of the party who did not draft the contract.  Therefore, if you believe that you are entitled to greater coverage than your insurance provider is willing to extend, you should consult with an attorney to determine whether your interpretation of the policy is reasonable.

Conclusion

Are you finding the PIP process confusing?  It is not just you; not only Florida’s PIP laws frustratingly vague, insurance contracts can also be ambiguous, leaving you wondering what coverage you have.  All too often, these ambiguities work against the very people that insurance is supposed to protect.  At Demand the Limits, our Delray Beach PIP claims lawyers are familiar with every part of the claims process and the state’s ambiguous PIP laws.  We are committed to helping clients receive every bit of PIP coverage that they paid for, and will hold insurance companies to the promises that they made when the policies were purchased.  If you are having problems with a PIP claim or if you have been injured and want to know if you need to have an attorney to navigate PIP claims, we would be happy to speak with you about PIP coverage and injuries from automobile accidents.  You can contact us at our Delray Beach location to set up a free consultation.