Summary of Insurance Benefits
NOTIFICATION OF PERSONAL INJURY PROTECTION BENEFITS
YOUR PERSONAL INJURY PROTECTION RIGHTS AND BENEFITS UNDER
THE FLORIDA MOTOR VEHICLE NO-FAULT LAW
The Florida Motor Vehicle No-Fault Law does two things:
(1) It establishes a limited exemption from liability for injuries caused
to others in an automobile accident; and
(2) It establishes personal injury protection (PIP) benefits to pay for
certain losses resulting from an accident.
LEGAL RESPONSIBILITIES AND RIGHTS
Who is covered?
(1) If you are a resident of Florida and own a motor vehicle, you are required to purchase PIP. You are covered by PIP if you are the named insured. You, the insured, are covered by PIP while driving your vehicle or when a passenger in another’s vehicle. You are also covered while outside a motor vehicle if struck and injured by a motor vehicle.
(2) Resident relatives who live with you, the insured, may be covered by
your PIP benefits while they are driving your car, as passengers in your or
another’s car, and while pedestrians if struck and injured by a motor
vehicle.
(3) Others who are injured while driving your insured motor vehicle or who
are injured while a passenger in your insured motor vehicle or who are
injured as a pedestrian when struck by your insured motor vehicle may be
covered by your PIP.
(4) If you or your insured relatives living with you are injured while
outside Florida, and are in your insured motor vehicle, you and your insured
relatives are covered under PIP as long as the injury occurs within the
United States, its territories or possessions, or in Canada.
FRAUD ADVISORY NOTICE: Solicitation of a person
injured in a motor vehicle crash for purposes of filing personal injury
protection or tort claims could be a violation of Florida law or the rules
regulating The Florida Bar and should be immediately reported to the
Division of Insurance Fraud on-line at www.fldfs.com/fraud or by calling
1-800-378-0445 from within Florida or 850-413-3261 from outside of Florida.
EXCEPTIONS
If your passengers or relatives living with you have a motor vehicle
licensed in Florida or own a motor vehicle required to be licensed in
Florida, they are not covered by your PIP coverage. They must purchase PIP
for themselves to have coverage.
EXCLUSIONS
An insurer may exclude no-fault benefits:
(1) For injury sustained by any person operating the insured
motor vehicle without your express or implied consent.
(2) To any injured person, if his/her conduct contributed to
the injury under either of the following circumstances:
(a) causing injury to himself
intentionally; or
(b) being injured while committing a
felony.
(3) For injuries sustained by the named insured and relatives
residing in the same household while occupying another motor vehicle owned
by the named insured and not insured under the policy.
BENEFITS
The minimum limit for no-fault personal injury protection
benefits is $10,000 per person for loss sustained as a result of bodily
injury, sickness, or disease ($5,000-death) arising out of the ownership,
maintenance, or use of a motor vehicle.
MEDICAL PAYMENTS
PIP pays 80 percent of medical benefits for all reasonable
expenses for medically necessary medical, surgical, X-ray, dental, and
rehabilitative services, including prosthetic devices, wheelchairs,
crutches, slings, neck braces and splints. Medically necessary ambulance,
hospital and nursing services are covered, and benefits also are paid for
necessary remedial treatment and services recognized and permitted under the
laws of the state for an injured person who relies solely upon spiritual
means through prayer for healing because of religious beliefs.
Note: if you have medical payments coverage through your auto insurance
policy, then the medical payments coverage will be secondary to PIP
coverage. The excess medical expenses, the 20 percent not covered by PIP,
and the deductible may or may not be covered by the additional medical
payments coverage depending on your particular policy.
BILLING REQUIREMENTS
Florida Statutes provide that with respect to any treatment or services,
other than certain hospital and emergency services, the statement of charges
furnished to the insurer by the provider may not include, and the insurer
and the injured party are not required to pay, charges for treatment or
services rendered more than 35 days before the postmark date of the
statement, except for past due amounts previously billed on a timely basis,
and except that, if the provider submits to the insurer a notice of
initiation of treatment within 21 days after its first examination or
treatment of the claimant, the statement may include charges for treatment
or services rendered up to, but not more than, 75 days before the postmark
date of the statement. The insured has a responsibility to furnish the
provider with the correct name and address of the personal injury protection
insurer. Failure to do so may result in delayed reimbursements to the
provider.
At your initial treatment or service provided you will be required to sign a
disclosure and acknowledgement form stating that the services were actually
rendered, it is your right and duty to confirm that those services were
rendered, you were not solicited to seek services from the provider, the
provider explained the services, and if you notify the insurer of a billing
error you may be entitled to a share of the insurer’s savings.
ADVISORY NOTICE: You may be entitled to a
certain percentage of a reduction in the amount paid by the motor vehicle
insurer if you notify that insurer of a billing error.
DISABILITY BENEFITS
PIP pays 60 percent of disability benefits for any loss of gross income and
loss of earning capacity from inability to work because of an injury
sustained in an accident. Disability benefits also cover all expenses
reasonably incurred for household services that, if not for injury, the
injured person would have performed. Benefits must be paid not less than
every two weeks.
DEATH BENEFITS
PIP pays up to $5,000 of available benefits per individual in death
benefits. The insurer may pay such benefits to the executor or administrator
of the deceased, to any of the deceased’s relatives, including those related
by marriage, or to any person appearing to the insurer to be equitably
entitled to the payment.
OPTIONAL DEDUCTIBLES AND LIMITATIONS
1. Persons subject to deductibles may be able to recover the amount of the deductible from a tortfeasor otherwise exempt from liability under Section 627.737, F.S.
2. Deductibles must be applied to the entire amount of any
expenses and losses described under required personal injury protection
benefits. After the deductible is met, each insured is eligible to receive
up to $10,000 in benefits. Thus, for instance, an insured with a $1,000
deductible would have to incur $13,500 in medical expenses (assuming no
disability or death benefits) in order to receive the entire $10,000 in
benefits [($13,500-$1,000) x 80%].
3. Deductibles of $250, $500 and $1,000 must be offered but may not be
required.
4. You may have elected that the benefits from loss of gross income and loss
of earning capacity (disability benefits) be excluded from your PIP
benefits.
COORDINATION OF BENEFITS
PIP benefits are primary over other insurance coverage, except that workers’
compensation benefits received will be credited against PIP benefits. This
means that your PIP insurer is ultimately responsible for payment of your
claim. How this works in a specific situation depends upon the contract
language in the other insurance policy.
PAYMENT OF BENEFITS
PIP benefits will be payable as loss accrues and reasonable proof of the
loss and the expenses are provided. Before PIP benefits are paid, an insurer
may require written notice be given as soon as possible after an accident
involving a motor vehicle.
PIP benefits are overdue if not paid within 30 days after the insurer is
provided written notice of a covered loss and of the total amount of the
claim. If a partial claim is made, that partial amount must be paid within
30 days after the insurer receives written notice.
Any part, or all of the remainder, of the claim that is later supported by
written notice is overdue if not paid within 30 days after such written
notice is furnished to the insurer. However, any payment shall not be deemed
overdue when the insurer has reasonable proof showing that the insurer is
not responsible for the payment even though written notice has been
furnished to the insurer.
For the purpose of calculating overdue payments, payment is considered as
being made on the date it was postmarked or, if not posted, on the date of
delivery. All overdue payments will pay simple interest at the rate
established in your policy, or pursuant to s. 55.03, F.S., whichever is
greater.
WHAT DO I DO TO RESOLVE DISPUTES REGARDING PIP BENEFITS?
(1) In the event you are having a dispute with the insurer
for PIP benefits, you may demand mediation of the claim before resorting to
the courts by filing a request with the Department of Financial Services
“Department” on Form DFS-H2-510 provided by the Department.
(2) Mediation is an informal process whereby a neutral
mediator selected by the Office will work together with you and the insurer
to resolve the dispute.
You may reach the Department at a local service office or call
1-800-342-2762.
PLEASE NOTE: This description of your rights contains general
statements and should not be construed to enhance, alter, or amend your
rights under your policy and Florida law.
FRAUD ADVISORY NOTICE: The Department of
Financial Services may pay rewards of up to $25,000 to persons providing
information leading to the arrest and conviction of persons committing
crimes investigated by the Division of Insurance Fraud arising from
violations of certain Florida Statutes. You may report such fraud on-line at
www.fldfs.com/fraud or by calling 1-800-378-0445 from within Florida or
850-413-3261 from outside of Florida.
"NO FEES OR COSTS UNLESS WE WIN YOUR CASE"
You might wonder what areas we practice as a personal injury attorney. Cities serviced: St. Petersburg FL, Largo FL, Clearwater FL, Palm Harbor FL, Tarpon Springs FL, New Port Richey FL, Port Richey FL, Tampa FL, Brandon FL, Bradenton FL, Sarasota FL, Ft Myers FL, Naples FL, Miami FL, Ft. Lauderdale FL, Daytona FL, Orlando FL, Jacksonville FL, Pensacola FL, Tallahassee FL and Florida.
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