FLORIDA MOTOR VEHICLE NO-FAULT LAW

Todd E. Copeland & Associates
Attorneys at 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.

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, injured by a motor vehicle.

(2) Children and 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 drive your insured motor vehicle or 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.

If your passengers or relatives living with you have a motor vehicle license in Florida or own a motor vehicle required to be licensed in Florida, they are not covered by your no-fault coverage. They must purchase PIP for themselves to have coverage.

An insurer may exclude no-fault benefits:

(a) for injury sustained by any person operating the insured motor vehicle without your express or implied consent.

(b) To any injured person, if his/her conduct contributed to the injury under either of the following circumstances:
     (1)  causing injury to himself intentionally;
                             or
     (2)  being injured while committing a felony.
                             or
(c)  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.

The limit for no-fault personal injury protection benefits is $10,000 per person for loss sustained as a result of bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle.

PIP pays 80 percent of medical benefits for all reasonable expenses for necessary medical, surgical, x-ray, dental, and rehabilitative services, including prosthetic devices, wheelchairs, crutches, slings, neck braces and splints. 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.

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.

PIP pays $5,000 per individual in death benefits. The insurer may pay such benefits to the executor or administrator of the deceased, to any of deceased's relatives, including those related by marriage, or to any person appearing to the insurer to be equitably entitled to the payment.

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, may be covered by the additional medical payments coverage. However, these benefits can not be used toward the PIP deductible.

(1) PIP deductibles are available in the amounts of $250, $500, $1,000, and $2,000. You may have elected a deductible to apply to you or to you and your dependent relatives who live with you, but that deductible will not apply to any other person covered under the policy. Such an election resulted in a reduction of premium. If you chose this option then you are not eligible for either of the other two options below [(2) and (3)].

PIP deductibles are taken from the amount payable for medical and disability benefits. For example, if you have a $10,000 medical expense, PIP pays 80 percent, which is $8,000. Your deductible is $2,000. The $2,000 is deducted from the $8,000. your benefit amount is now $6,000. Note, however deductibles are not applied to reduce the amount of death benefits.

(2) If you are an active or retired military person, you may have elected to coordinate your PIP benefits with military benefits for yourself and your dependent relatives. If you selected this option your premium was reduced.

(3) You may have elected that the benefits for loss of gross income and loss of earning capacity (disability benefits) be excluded from your PIP benefits. Such an election resulted in a reduction of your premium.

PIP benefits are primary over other insurance coverage, and 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, the 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 of 10 percent per year.

In the event you are having a dispute with the insurer for PIP benefits, you should contact a lawyer immediately who can assist you in enforcing your contractual rights under your policy of insurance.