What is No-Fault Insurance in Florida?

Florida operates under a no-fault insurance system sometimes called "personal injury protection" or "PIP" for shorthand. Almost all personal car insurance policies in the State of Florida include this benefit.  This does not mean that it doesn't matter who was at fault for the crash - it does matter!  What this means is that after an accident, your insurance company will cover a portion of your medical expenses and lost wages, regardless of who was at fault.  You may have noticed an important word in that last sentence, "portion".  Even though you will typically have a $10,000.00 no-fault benefit after a motor vehicle crash, you will still likely incur uncovered damages that your insurance does not pay.  Your medical bills will often still be subject to a 20% co-payment provision in your no-fault insurance, a separate deductible that can be as high as $1,000.00, and additional medical bill amounts that exceed the $10,000.00 benefit threshold.  It is not uncommon for the entire $10,000.00 benefit to not even be sufficient cover the initial emergency room hospital bill! 

No-Fault Insurance Doesn't Cover All of Your Damages

Your no-fault insurance will not pay anything towards future estimated medical expenses or pain and suffering damages.  Our office pursues these additional damages against the at fault party on your behalf as part of the liability claim which is separate from the no-fault claim.  Our office will also help you navigate the claim process with your no-fault insurer to help you increase your net recovery by maximizing these benefits.  We can also help you review your insurance policy to make sure you are entitled to these benefits, as they do not always apply.  Some examples where no-fault insurance does not apply include the following situations:

1. Your car insurance is an out-of-state policy where no-fault benefits are not required and you did not purchase no-fault coverage
2. Your car insurance is a commercial insurance policy, in the event you were driving for business purposes
3. At the time of the crash you were driving for a ride-sharing platform such as Uber or Lyft.  A modified no-fault benefit scheme will sometimes apply in these instances.
4. Your car insurance contains a exclusion stating you won't qualify for no-fault benefits under a special circumstance or otherwise claims that your policy is not in force for the subject accident.

This topic can cause a lot of confusion when injured victims report the crash to the at fault driver's insurance company.  A common tactic that we see a lot is the at fault driver's insurance company will advise an injured victim that their own insurance company is supposed to pay for the injured person's medical bills through the no-fault system.  While it is true that often times an injured victim will have some no-fault benefits available to pay a portion of their medical expenses, what these insurance representatives often don't mention is that they are responsible for covering other damages such as the co-pay amounts, expenses over the $10,000.00 benefit and other damages like pain and suffering.  They are hoping you will simply accept their partial explanation and never pursue a liability claim against their insured.  Do not fall for this tactic!

How to Qualify for No Fault Benefits

In theory, obtaining your No-Fault benefits should be a very simple process.  Florida legal decisions discussing this topic repeatedly state No-Fault benefits are intended to be "swift" and "automatic".  However, it is not always so simple.  In order to determine your eligibility for No-Fault benefits you have to follow a formula and order of priority to identify the correct No-Fault insurer that generally applies as follows:

1. If you own a vehicle that is insured, that insurer will be your No-Fault insurer regardless of what vehicle you were in.  Many people are surprised to find out that their insurance company is involved in situations where they were riding in another person's vehicle.
2. If you do not own a vehicle but you live with a relative that owns an insured vehicle, that insurer will be your No-Fault insurer.  Again, people are often surprised to find out an insurer that seemingly has no connection with the crash (and in this case isn't even the injured person's insurance company) is responsible for payment of the No-Fault benefits, but its true.
3. If you do not own a vehicle and you don't like with a relative who owns an insured vehicle, your No-Fault insurer is the insurer of the vehicle you were occupying at the time of the crash, even if you aren't related to the owner of that vehicle.
4. If none of the above apply and you were injured as a pedestrian struck by a vehicle, you will be entitled to No-Fault benefits from the insurer of the vehicle that struck you.

It's not a simple as it might seem at first, but an experienced injury attorney can help you navigate this process.  Contact our office if you have any questions relating to your No-Fault benefits, even if you're not planning on pursuing an injury claim against the other driver.

The No-Fault Claim Process - What You Need to Know

Your No-Fault insurer will typically send you an application form and ask that you cooperate with their investigation into the crash.  Sometimes, they will request a "recorded statement" which is essentially a chance for their representative to ask you a series of questions on a recorded phone line.  These statements can include questions about how the accident happened to determine who was at fault, as well as questions designed to inquire into the nature of your injuries and medical treatment.

A No Fault insurer can generally require your cooperation in accordance with terms and conditions found in their insurance policy.  This is because you are obtaining benefits from this insurer that are governed by the policy, which is an enforceable contract under Florida law.  Additionally, most policies will also permit the insurance company to demand that you submit to an "Examination Under Oath" sometimes abbreviated as "EUO", which is similar to the recorded statement but where you are placed under oath prior to the statement taking place, and/or require that you submit to a "Independent Medical Exam" sometimes abbreviated as "IME".  The IME is a physical exam performed by a doctor hired by the insurance company at the insurance company's request and expense.  In reality these examinations are anything but "independent" and are utilized by an insurer to justify their refusal to pay for additional benefits.  Both of these exams are generally adversarial, meaning they are generally requested by the insurance company to find a basis to avoid payment of your claim.  Injured victims should also be aware that if they do not reasonably comply with these demands from their No-Fault insurer, their No-Fault claim may be denied as a result.

Why its Important that You Pursue Your No-Fault Claim

A question we get all the time is, "Do I have to File a No-Fault Claim"?  It is understandable that people will be reluctant to file a claim with their own insurance company when they did not cause the accident or their injuries.  We have written separately regarding questions people ask about whether their premiums will go up in "Will My Insurer Punish Me If I File a Claim".  However, you would be foolish to skip this important part of the claim process when you're injured in a motor vehicle accident.

The No-Fault law, found under Fla. Stat. § 627.736, contains important features that impact your injury claim against the at fault driver.  Specifically, the No-Fault law provides that the at fault driver is entitled to a setoff against your medical damages in the amount of $10,000.00, which generally applies to the amount of No-Fault benefits you are entitled to.  This setoff will apply in situations where you voluntarily refuse to submit your No-Fault claim or in situations where you were required to purchase car insurance but did not do so.  What this means is that your claim will start off being discounted by $10,000.00 for its valuation purposes, but you will not receive the corresponding $10,000.00 No Fault benefit, if you refuse to submit this claim.

Furthermore, the $10,000.00 benefit plays an important role in maximizing your net recovery for your liability claim presented against the other driver.  By using that benefit to satisfy your medical expenses after an accident, we are able to put more money in your pocket once the claim is settled in its entirety because the doctors who treated you will be already compensated, sometimes in part, for their treatment.

Conclusion

No Fault benefits and coverage are a lot more complicated than they may initially seem, but are an important part of the claim process when you are pursuing a claim against an at fault driver.  Contact our office if you have any questions whatsoever about your No Fault claim and how it can impact your claim, your medical bills, or your insurance.