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No-Fault Benefits Due to a Car Wreck

What Vehicles are Covered?

The owner of any motor vehicle in Florida, which must be licensed and registered, is required to purchase No-Fault insurance. The statute defines a “motor vehicle” for No-Fault purposes. It does not include taxicabs, limousines and school buses. Court decisions interpreting the law have decided motorcycles are not required to purchase this coverage. Mopeds are generally considered bicycles and are not covered. There are other exceptions as well.

What Coverage is required?

In addition to requiring the vehicle to have $10,000 in property damage coverage (to repair damage the vehicle causes to someone else’s property), the law makes it mandatory to have $10,000 in Personal Injury Protection benefits (PIP). Failure to have this coverage makes the person who should have purchased it self-insured for all the entire PIP benefits required under the statute.

Who Is Covered?

No-Fault policies provide PIP benefits for each covered person for bodily injury, sickness, disease, or death “arising out of the ownership, maintenance or use of a motor vehicle”. PIP benefits are available to the following people under every policy:

1. named insured,

2. relatives residing in the named insured’s household,

3. driver of the insured vehicle,

3. passengers in the vehicle, and

4. pedestrian struck by the insured vehicle and suffering bodily injury (the wording is actually broader but has further conditions).

Of course, the statute has a number of definitions and qualifiers. There is also a large body of case law interpreting how it applies in a wide variety of situations.

Is Fault Required?

No. Florida’s No-Fault system is not fault based. The PIP benefits are available for covered expenses causing injury as described even where the injured person is clearly at fault, including single car accidents, multiple vehicle accidents, or even being accidentally injured working on your car.

What Benefits Are Available?

1. Medical Benefits: PIP pays 80% of all reasonable expenses for medically necessary medical, surgical, x-ray, chiropractic, dental and rehabilitative services (subject to allowable deductible and fee schedule).

2. Disability Benefits: 60% of any loss of gross income and loss of ability to earn money (earning capacity).

3. Household Services: 100% of household services the injured person would have provided during the period of disability.

4. Transportation: Reasonable expenses to and from necessary medical treatment.

5. Death Benefits: Up to $5000.

Whose Policy Pays?

PIP benefits generally follow the owner. The insurer of the owner will pay PIP benefits for:

1. The owner while in Florida in their vehicle or while an occupant of someone else’s vehicle. The owner is also covered as a pedestrian struck by a vehicle causing bodily injury, but not if the owner was on a motorcycle, for instance, which did not have PIP coverage.

2. The owner while outside of Florida, but within the United States, its territories or possessions on in Canada, while occupying the owner’s vehicle.

3. A relative of the owner residing in the same household (under the circumstances in subparagraphs 1 and 2 above) if they are at the time of the accident domiciled in the owner’s household (certain exceptions apply).

4. Any other person while occupying the owner’s vehicle suffering accidental bodily injury in this state, or if a resident of this state, as a pedestrian (with some exceptions).

There are situations where two or more No-Fault insurers may be liable for the benefits. When that happens they pay the benefits on a pro-rata basis (for instance, a passenger injured in an accident who was a relative resident of someone with No-Fault benefits would be eligible for PIP from the car occupied in the accident and also from the policy of their relative.)

What Conditions the May the Insurance Company Require?

Some companies require a No-Fault Application to be completed in writing and sent to them. Many have policies which require a recorded statement of the person applying for the benefits. This is not the same as the adjuster of the at-fault party requesting a recorded statement of the victim injured in an accident caused by their insured.

When Must the Benefits be Paid?

Generally within 30 days of the insurance company receiving written notice of the fact of a covered loss and the amount owed. Therefore, if the injured person is using his or her own No-Fault insurance, they should promptly report the injury so a PIP claim is timely opened by the company. If relying on another person’s No-Fault insurer, do not assume the insurance company has been put on notice. Many people fail to notify their insurance company after an accident. The injured person should report the claim to be certain a claim file is promptly opened by the company. This will avoid delays in paying covered benefits.

DISCLAIMER

This information is provided as a public service to help Florida consumers gain a better understanding of the benefits available under No-Fault. This is only a general summary and is not to be considered as legal advice. The statute and applicable case law will determine rights and benefits in any particular case. The law is complex and contains specific definitions, exclusions and exceptions. We will gladly give anyone who is a client of our firm specific advice on their case after we have signed a retainer agreement with them.

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