Florida PIP and No-Fault, Explained

How PIP works

Florida is a no-fault state. Every Florida-registered car must carry $10,000 of PIP coverage. After a crash, the injured person's own PIP coverage pays first, regardless of who was at fault. PIP pays 80 percent of reasonable medical expenses and 60 percent of lost wages, up to the $10,000 cap. Death benefits add another $5,000.

The 14-day rule

This is where most PIP cases go sideways. Section 627.736(1)(a) limits medical reimbursement to "initial services and care" rendered within 14 days of the accident. If the injured person does not see a qualifying provider within that window, PIP pays nothing for medical care, even after the deadline.

Two weeks sounds like plenty. It is not. People with soft-tissue injuries often wait, hoping pain will resolve. Some seek care only when symptoms persist. Some never connect the symptom to the crash. By the fifteenth day, PIP medical coverage is gone.

Tell every client: see a doctor in the first 72 hours. Not the fourteenth day, the third. Document the visit. Get an exam, even if the visit is brief.

The $10,000 vs. $2,500 distinction

The PIP medical cap is $10,000 only if a qualified provider certifies that the patient suffered an "emergency medical condition." Without that certification, the cap drops to $2,500. The certification must come from a physician, dentist, physician assistant, or advanced practice registered nurse. It must be in the chart.

The statutory definition of EMC tracks federal EMTALA: a condition manifesting itself by acute symptoms such that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part.

The determination is medical, not legal. But the lawyer's job is to make sure the treating provider documents the determination explicitly. A clean note saves $7,500 in coverage.

What PIP covers

• Medical care: 80 percent of reasonable expenses for medically necessary services from qualifying providers.
• Lost wages: 60 percent of any loss of gross income and loss of earning capacity.
• Replacement services: cost of services performed by others that the injured person would have performed (housework, childcare).
• Death benefits: $5,000 for funeral and related expenses.

What PIP excludes

• Massage therapy and acupuncture (excluded by the 2012 amendments).
• Treatment outside the 14-day window (no coverage at all).
• Treatment beyond the $10,000 / $2,500 cap (PIP is exhausted).
• Pain and suffering (PIP is medical and wage only; pain and suffering require a third-party claim).
• Motorcycle riders (PIP does not cover motorcycle injuries).

What happens after PIP exhausts

The case becomes a third-party liability case in earnest. The injured person pursues the at-fault driver's bodily injury liability coverage. If that coverage is insufficient, the injured person turns to their own UM/UIM coverage under section 627.727. Health insurance may pay continuing medical bills, subject to subrogation against any third-party recovery.

PIP demand letters and bad faith

If the carrier denies PIP benefits or pays less than the statutory minimum, section 627.736(10) requires a pre-suit demand letter. The carrier has 30 days to cure or face suit. Bad-faith claims under section 624.155 add another layer; they require a Civil Remedy Notice and a 60-day cure window before suit.