Your Insurance Coverage

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Your Insurance Coverage

You need to know about No-Fault Coverage.

Florida is a no-fault state, meaning that you can collect medical expenses from your insurance carrier regardless of who caused the accident and resulting injuries.

Personal Injury Protection (also known as PIP or No-Fault coverage) is not coverage for bodily injury to others, but rather coverage designed to provide partial payment of medical expenses for an injured occupant of an insured vehicle.

What Do No-fault Benefits Cover?

NOTHING if you don't have your first medical treatment/evaluation within fourteen (14) days of the date of the accident. Your first treatment must be by a hospital or outpatient facility owned by a hospital, a Medical Doctor (MD), Osteopath (DO), a Dentist or a Chiropractor (D.C.)

After your initial visit, PIP will pay:

  • 80% of reasonable and necessary medical expenses
  • 60% of lost wages and replacement services if there is a disability note from a doctor
  • mileage reimbursement to and from doctor's appointments related to the accident
  • prescription reimbursement
  • $5,000 in death benefits

with the following exceptions:

PIP will pay only for injuries evaluated at the first medical visit - if the complaint is not documented at the first visit, it will NOT be paid for. Be sure to note everything that hurts you at the first visit.

Coverage will be limited to $2,500.00, rather than the standard $10,000.00 available under most policies, unless your doctor diagnoses an 'Emergency Medical Condition'. Under the law, a chiropractor cannot diagnose an Emergency Medical Condition.

An 'Emergency Medical Condition' is currently 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 would reasonably be expected to result in any of the following:

a. Serious jeopardy to the patient's health

b. Serious impairment to bodily functions

c. Serious dysfunction of any bodily organ or part

It is important to note that not all treatment is covered and that Massage Therapy and Acupuncture are specifically excluded.

This coverage is primary over health insurance, Medicare and Medicaid. It may be subject to a deductible, dependent on the coverage you purchased.

Additional coverages are available through your insurance carrier or agent, for an additional premium, including bodily injury liability, medical payments, and underinsured or uninsured motorist coverage.

Medical payments coverage will cover the 20% of reasonable and necessary medical expenses not covered under the PIP or No-Fault coverage.

Bodily Injury Liability, which is coverage for liability that might arise from the operation of a motor vehicle, is NOT required under Florida law.

UM coverage (underinsured or uninsured motorist coverage) is one of the most important and valuable coverages you can buy. UM coverage is simply defined as liability insurance that YOU purchase to protect YOURSELF in the event that you are involved in an accident with an underinsured or uninsured motorist, who is at fault in the accident. This coverage will provide benefits for you, the members of your family and any other person in your vehicle at the time of the accident. Without this coverage, it is unlikely that you would be compensated for your injuries if the at-fault driver did not carry bodily injury liability. OUR OFFICE STRONGLY RECOMMENDS THE PURCHASE OF UM COVERAGE TO OUR CLIENTS, OUR FAMILIES, FRIENDS, AND STAFF.

Additionally, it is imperative that you fully understand what coverages you have purchased. 'Full coverage', a term frequently used, can refer only to the coverages required by law, PIP or No-Fault coverage and Property Damage, as described above.

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