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Personal Injury Protection Coverage

Vignette of a person using a calculator on top of financial documents

Personal Injury Protection, also known as PIP or no-fault coverage, is one of the two insurances that a person is required to have on his or her vehicle before they can get it registered. In order to go to the motor vehicle department and get his or her tag, the individual has to show proof that he or she has Personal Injury Protection, PIP, and property damages insurance.

Personal injury protection is insurance that an individual has that will pay a portion of the medical bills for injuries they sustained in a motor vehicle accident in Boca Raton whether it is their own fault or someone else’s fault.

Receiving Coverage

It does not matter whether the person gets rear-ended, fell asleep and ran up the road, or hit a tree, the person’s own insurer is the primary insurance for payment on those medical bills. Besides a person’s health insurance, Medicare, or Medicaid, no one else is going to pay for his or her medical bills prior to his or her personal injury protection coverage being exhausted.

It is necessary for a person be treated within 14 days of their accident to receive coverage by PIP. Typical Personal Injury Protection coverage is $10,000, paying up to 80 percent of their medical bills, leaving 20 percent unpaid.

Doctor reviewing brain scan MRI images in a hospital

Emergency Medical Condition

If the individual has not been treated within 14 days of the accident they will not be covered. If they do receive treatment in 14 days, that treatment is covered but it is limited to $2,500 out of the $10,000, unless a doctor has certified that he or she has an emergency medical condition.

The doctor does not have to certify the injury in the first 14 days, the individual just has to receive treatment in the first 14 days and then at some point a doctor has to render an opinion that he or she has an emergency medical condition. An emergency medical condition means that without medical care and attention, these injuries would be expected to last and would be pose an impact on the person’s life.

An insurance adjuster with a clipboard examining the scene of a car accident

Common Misconceptions

Some misconceptions surround how much PIP covers. It does not necessarily pay all of the bills. PIP coverage pays the reasonable customary charges for medical treatment for injuries causally related to the accident.

If an individual injured his or her neck in an accident and if it still hurts three days later and it is not related to the accident, his or her PIP coverage is not going to pay for it. It only pays for those symptoms of those injuries that were caused by the accident. Even for the injuries causally related to the accident, Personal Injury Protection will only pays 80 percent of the bills.

An empty courtroom facing the judge's bench

Impact on the Car Accident Case

Since a person is required to have PIP coverage in Florida, if he or she does not have it, the at-fault driver’s insurance company is entitled to a set off or what he or she should have had. So if the person has medical bills in the amount of $20,000 as a result of an accident, the other driver’s insurance company would be responsible for $10,000 of it because the injured party’s PIP should have paid the first $10,000. If an individual does not have PIP coverage it does not increase the amount of money the other insurance company is going to pay because he or she should have had that coverage.

If a person does not have personal injury protection coverage it is going to affect them and their ability to get treatment immediately because he or she does not have any insurance to pay for it. Ultimately, this will affect the amount of the person’s recovery from the car accident case because the injured party will still be responsible for the $10,000 expected coverage by PIP.

With the institution of the no-fault PIP statute some decades ago there was also an order that required the injured person has to have sustained a permanent injury or a permanent aggravation of a pre-existing condition in order to bring a claim against the at-fault party. In order to seek pain and suffering damages from the driver who caused the accident, the person has to have sustained a permanent injury.

Lawyer handing over compensation check

How Kogan & DiSalvo Can Help

A knowledgeable personal injury lawyer from Kogan & DiSalvo will be able to explain the types of PIP coverage and the thresholds necessary to bring about a suit. The attorney can explain how Personal Injury Protection works and how it can be best utilized in treatment of their injuries.

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