What does “No-Fault State” Mean for Car Accidents and Why Does It Matter?

Florida is one of only 12 states that still deems itself a no-fault state in regards to car accidents. Drivers in no-fault states are legally required to purchase personal injury protection (PIP) as part of their car insurance policy. If you have PIP coverage under your insurance policy in a no-fault state, then PIP pays 80% of your accident-related medical expenses and 60% of your accident-related wage losses regardless of fault (hence the name “no-fault” coverage). Florida drivers must carry $10,000 of PIP insurance.

MYTH: In a no-fault state, you can’t go after the at-fault driver to recover for personal injuries or damages to your vehicle.
TRUTH: If you’re not at fault, you still have a claim against the other driver. “No-fault” does not mean “No claim.” It simply means you have coverage to pay for accident-related damages regardless of fault.

For context, let’s say you’re driving in Port Charlotte and cause a car accident. If you are injured and need accident-related medical treatment, your PIP will pay, even though you are at fault. Under Florida law, PIP is primary, which means your no-fault coverage MUST pay first, even if you have health insurance. Once the PIP limit of $10,000 is reached, this is when health insurance comes into play.

How do I know if I have PIP under my car insurance policy?

Simple: If you have an automobile insurance policy in Florida, you will have PIP, whether you know it or not. If you’re not sure about PIP because you are a part-time Florida resident, it’s important to verify the policy of the state in which your policy is registered. Coverages vary by state.

Who does PIP cover in a car accident?

PIP coverage under a particular policy covers everyone insured under that policy and it follows the insured(s). For example, if you are a passenger in a vehicle being driven by another Florida driver and are in an accident, your PIP coverage, NOT the driver’s PIP, pays for your accident-related treatment. By the same token, if you are in an accident while driving your own vehicle with passengers, then their PIP pays for their accident-related treatment.

There is one exception to both of these examples above. If a passenger does not have their own Florida insurance, the driver’s PIP can sometimes be used to cover the passenger(s).

As you can see, this gets confusing. It’s important to consult with a personal injury lawyer immediately after your accident to handle the myriad coverage issues that can arise.

Does PIP always have to pay for my accident-related treatment?

No. There are two main limitations to whether PIP must pay and, if so, how much. The first limitation is a time limitation. In order to be entitled to your PIP coverage, you must seek accident-related treatment within 14 days of the collision. If you seek treatment beyond that time frame, you forfeit your PIP by law. This is regardless of the extent or severity of your injuries.

The second limitation is based on a medical opinion. Assuming you get treatment within 14 days of the collision, then you must be diagnosed with an emergency medical condition (EMC) to be entitled to the full $10,000 of your PIP policy. If your condition is not deemed as such, your insurance can limit your PIP coverage to only $2,500.

Tip: Under the PIP statute, a chiropractor cannot render an EMC diagnosis. The best practice is to always go to the ER following a collision because, generally, a trip to the Emergency Room satisfies the EMC condition. From there you can treat without fear that your insurance company will not extend the full $10,000 in coverage for which you pay premiums.

If you do not have health insurance but have a Florida auto policy, you are still eligible for that $10,000 limit provided by PIP, so long as you seek medical treatment within 14 days of the accident and you have an EMC. With or without health insurance, PIP pays first.

The Role of Your Personal Injury Lawyer

Usually, PIP isn’t a contested issue. Drivers in the state of Florida are legally entitled to this protection and its allotted limits. On the other hand, insurance companies routinely play games when it comes to extending PIP coverage. If they can deny coverage altogether or lessen the amount of coverage to you, rest assured they will do so.

It’s important to get an attorney as a watchdog to make sure YOUR insurance company extends coverage that YOU paid for under your policy. Most importantly, your attorney can navigate problems with the insurance company while you prioritize seeking necessary medical treatment.

PIP is just the tip of the iceberg. There are more coverages available to compensate you for your injuries that the insurance companies may never tell you about. Getting a personal injury attorney involved on your behalf as soon as possible ensures that you collect these additional damages where warranted.

Still have questions regarding no-fault states and personal injury protection? Don’t hesitate to reach out, we’re happy to answer your questions. You can reach us at 941-979-5226.

It’s important to note that because the state legislature is constantly evolving, the information presented in this article is subject to change.

DISCLAIMER: Please note that the information provided in this blog is general in nature and should not be construed as legal advice nor as creating an attorney-client relationship. Every case is different and legal advice cannot be provided by Hancock Law unless/until we meet to discuss the particulars of your case. Whether an attorney-client relationship exists can differ on a case-by-case basis, but at Hancock Law we consider such a relationship to exist only upon a potential client’s request and our agreement to accept that representation.