A.  Introduction

Personal Injury Protection, also known as PIP or Florida No-Fault, covers your medical bills, lost wages and other expenses regardless of who was at fault for the accident.  The bills are covered by PIP if they are reasonable, necessary and related to an accident. If you own a car and have PIP on your car, you must use your own PIP to pay your initial medical bills.  That is, even if you were not at fault for the accident, if you have your own PIP, you are not allowed to make a claim against the at-fault driver’s PIP.

If you do not have your own PIP and were operating someone else’s vehicle or were riding as a passenger in someone else’s vehicle at the time of the accident, you may qualify for PIP under the vehicle owner’s insurance policy.  There are many other scenarios under which you may qualify for PIP benefits.  Please contact our office if you have been in an accident and have questions about PIP coverage.

B.  PIP benefits that are available to you

In order for the PIP insurer to reimburse you, we must provide them with proof of your claim.  The following is a list of what is covered:

Medical Coverage

  • PIP will pay for 80% of your medical bills up to a total of $10,000.00 (If you have medical payments coverage  on your policy, they will pay 100% of your doctor’s bills up to the policy limit). Your doctors will send in bills directly to the insurance company.  The bills must be submitted to the insurance company within a certain time frame or the insurance company can deny payment.

Wage loss 

  • If you were working at the time of the accident, PIP will pay 60% of any wages that you have lost.  In order for them to pay, we first have to provide them with 2 things:
  1. A disability slip from your doctor stating the dates you are unable to work due to injuries from the accident.  You will need to continue to obtain a new disability slip from the doctor as long as they believe you are not able to work.  If the insurance company does not have an updated disability slip, they will not pay you until they receive one.
  2. Proof of what you were making from your employer.  Usually we will send a letter to your employer asking them to provide us with a statement of your wages over the past 13 weeks.  PIP will use that form to come up with an Average Weekly Wage which they will use to pay you.  If your employer does not provide us the information, we often use your pay stubs, W-2 tax forms or other items to prove the wages you were making.

Prescriptions 

  • PIP will reimburse you at 80% for any prescriptions that you pay for out of your pocket.  In order for them to reimburse you we have to provide 2 things:
    1. Receipt from the prescription showing what prescription was filled. Normally this is stapled to the bag at the pharmacy.
    2. Cash register receipt from the pharmacy showing that you paid and how much you paid.

Mileage & Tolls

  • PIP will pay you for mileage and tolls that you paid on the way to and the way back from your doctors appointments.  We provide our clients with a Mileage Voucher that can be used to document the mileage for these trips to the doctor so you can be reimbursed.PIP will pay mileage for doctors visits, hospital visits,  MRI or x-ray appointments, therapy appointments, or any other medical appointments. They will usually not pay for trips to the pharmacy to pick up medicine, or any other similar trips.

Household or Replacement Services

  • If you are unable to do any activity around the house like housecleaning, mowing the lawn, etc., due to your injury,  PIP will reimburse you for paying someone else to do this for you.  In order for them to pay we have to provide them 2 things:
    1. Receipt from person doing the services with amount you paid.
    2. Note from your doctor saying you need help with the service due to the injury you received in the auto accident. ( this is especially required if you are unable to do an activity for a long period of time, though it helps to have one for any household or replacement service that you are trying to get reimbursed for.)

Once we send the request for reimbursement to the insurance company, a check should be sent to you directly.  They officially have 30 days to pay all bills once they have been provided with reasonable proof that the bills are owed.

These benefits will continue to be paid as long as you still have PIP coverage and we continue to provide proof of the claim.  Once PIP has paid the limits of your coverage ( usually $10,000.00) they will no longer pay for these items.