How does PIP insurance work after a car accident in Florida?

By: David W. Lipcon, Esq.

Florida is a no-fault state, so after a car accident you turn to your own Personal Injury Protection, or PIP, coverage first. PIP pays 80% of your medical bills and 60% of your lost wages up to a $10,000 limit, no matter who caused the crash, as long as you follow the rules.

Those rules are strict, and missing one can cost you the entire benefit. Understanding how PIP works, and when you can step outside it, is the key to protecting yourself after a Florida crash.

Contact the Miami car accident attorneys at Lipcon & Lipcon, P.A. for a free consultation, or call (305) 670-6144. We can explain how PIP applies to your crash and whether you can pursue the at-fault driver.

What is PIP and how does no-fault work?

Under § 627.736, every owner of a vehicle registered in Florida must carry at least $10,000 in PIP and $10,000 in property damage liability. PIP is first-party coverage, which means your own insurer pays your medical bills and lost wages after a crash regardless of fault. The system was built to get injured people paid quickly without waiting for a fault fight.

Notably, Florida does not require bodily injury liability coverage, so the driver who hurt you may have no policy to pay for a serious injury. That gap is why uninsured and underinsured motorist coverage matters so much in this state. In practice, the no-fault rules shape almost everything after a crash, from what care is covered right away to when you can hold the other driver responsible.

What is the difference between PIP and bodily injury coverage?

PIP and bodily injury liability do different jobs. PIP is first-party coverage that pays your own bills after a crash, quickly and regardless of fault, up to $10,000. Bodily injury liability is third-party coverage that pays for the harm you cause to someone else. Florida requires PIP but does not require bodily injury liability, which is why so many at-fault drivers cannot fully pay for a serious injury. When that happens, your own uninsured or underinsured motorist coverage can step in to fill the gap.

What does PIP cover?

All PIP benefits are paid from the same $10,000 limit. The coverage includes:

Because medical care and lost wages share one $10,000 pool, serious injuries can exhaust PIP quickly. A single emergency room visit and a few follow-up appointments can absorb most of the limit.

What is the 14-day rule?

This is the trap that catches the most people. Under § 627.736(1)(a), you must receive initial medical services and care within 14 days of the accident. If you do not see a qualifying provider within that window, your insurer can deny PIP medical benefits entirely, even for a real injury. There are no exceptions for delayed symptoms, and the clock includes weekends and holidays.

The practical lesson is simple: see a doctor right away, even if you feel fine, because injuries like whiplash and concussions often surface days later.

What is the emergency medical condition rule?

The provider you see within those 14 days matters. To unlock the full $10,000 in medical benefits, a qualified provider must determine that you have an emergency medical condition. If no such determination is made, your PIP medical benefit is capped at $2,500. That single medical decision can be the difference between $2,500 and $10,000 in coverage. Because the determination often has to be made early, getting to a provider who can properly evaluate an emergency medical condition quickly can protect thousands of dollars in benefits.

Does PIP pay if the crash was not your fault?

Yes. That is the point of no-fault. Whether or not you caused the crash, you file first with your own PIP insurer, which pays up to the limit. PIP is generally the primary payer for accident-related medical bills, though some policies let you elect health insurance as primary to lower the premium. Knowing which coverage pays first affects your out-of-pocket costs. It is worth checking your declarations page before a crash ever happens so you know which coverage leads.

How do you use your PIP benefits after a crash?

Using PIP is a process with deadlines. Report the crash to your own insurer promptly, usually within the time your policy requires. Get initial medical care within the 14-day window and ask the provider about an emergency medical condition determination. Keep every bill, referral, and record, and track any missed work for the wage benefit. Your insurer can also require you to attend an independent medical examination, and skipping it can jeopardize your benefits, so it helps to stay organized and responsive.

What does PIP not cover?

PIP is limited by design. It does not pay for:

These gaps are exactly why serious injuries often require a claim against the at-fault driver.

When can you step outside no-fault and sue the at-fault driver?

You can leave the no-fault system and pursue the at-fault driver for full damages, including pain and suffering, only if your injury meets the serious injury threshold in § 627.737. That threshold requires one of the following:

The key word is permanent. Temporary aches will not clear the threshold, but a herniated disc, a surgery, or nerve damage often will. Proving permanency takes medical evidence, and it is exactly where insurers dig in.

Does PIP cover passengers, pedestrians, and motorcyclists?

PIP reaches more than just the driver. Passengers in your vehicle and pedestrians or bicyclists you strike can generally access PIP benefits. Motorcyclists are the major exception. Because motorcycles are excluded from PIP under § 627.736, injured riders receive no PIP benefits and must rely on the at-fault driver’s coverage, their own uninsured motorist coverage, and health insurance.

What if your medical bills exceed $10,000?

A $10,000 limit does not go far after a serious crash. Once PIP is exhausted, you typically turn to your own health insurance, any medical-payments coverage, and a claim against the at-fault driver if your injury meets the threshold. Sorting out which source pays, and in what order, is one of the most useful things a lawyer can map out early so bills do not pile up while the claim is pending. Because serious injuries routinely blow past $10,000, this planning is often the difference between manageable bills and a pile of collections notices.

What are common PIP disputes?

Even a valid PIP claim can turn into a fight. Insurers frequently challenge whether treatment was reasonable and necessary, or whether a charge was reasonable, and they may accept that physical therapy was appropriate while arguing you had too many sessions. PIP reimbursement is also tied to a statutory fee schedule, so a provider may bill more than PIP pays, leaving a balance the patient can be asked to cover. An insurer can require an independent medical examination and use it to cut off future benefits. These disputes are common, and they are one reason people turn to a lawyer even within the no-fault system.

How long do you have to file a claim in Florida?

For a claim against the at-fault driver, the deadline is generally two years. Under § 95.11(4)(a), negligence claims arising on or after March 24, 2023, must be filed within two years. A dispute with your own PIP insurer is a contract matter with its own separate deadline, so it helps to calendar both early.

Talk to a Miami car accident lawyer

Lipcon & Lipcon, P.A. has represented injured people across Miami and South Florida since 1993. Founding partner David W. Lipcon has practiced law in Florida since 1992 and handles car accident claims throughout Miami-Dade, including cases where PIP falls short of the harm done. If you were hurt in a crash, contact our Miami office for a free consultation or call (305) 670-6144.

Frequently Asked Questions

How does PIP insurance work in Florida?

PIP pays 80% of your medical bills and 60% of lost wages up to a $10,000 limit after a crash, regardless of who was at fault, under § 627.736.

What is the 14-day rule for PIP in Florida?

You must receive initial medical care within 14 days of the crash under § 627.736(1)(a), or you forfeit your PIP medical benefits entirely.

Does PIP cover pain and suffering in Florida?

No. PIP covers only medical bills and lost wages. To recover pain and suffering, you must step outside no-fault and meet Florida’s serious injury threshold.

When can you sue outside of PIP in Florida?

You can sue the at-fault driver when your injury meets the threshold in § 627.737: a permanent injury, significant loss of a bodily function, significant scarring, or death.

Does PIP cover motorcycle accidents in Florida?

No. Motorcycles are excluded from PIP under § 627.736, so riders rely on the at-fault driver’s coverage, their own UM coverage, and health insurance.

For more on these claims, visit our Miami car accident lawyer page.