PIP Insurance in Florida: Coverage, Limits, and Rules

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Personal injury protection, commonly called PIP insurance, is a first-party auto coverage. In Florida, it pays specified benefits for covered injuries without first requiring a decision about who caused the crash.

That basic definition is only the beginning. Florida law controls who must carry PIP, who may receive benefits, which losses are covered, when medical care must begin, and how PIP interacts with a later liability claim.

Florida PIP is part of the state’s no-fault system

Florida’s Motor Vehicle No-Fault Law appears in sections 627.730 through 627.7405 of the Florida Statutes. Section 627.733 generally requires an owner or registrant of a motor vehicle that must be registered and licensed in Florida to maintain the required security continuously during the registration period, subject to statutory exceptions.

“No-fault” describes the way PIP benefits are triggered, not a finding that no one caused the accident. Covered PIP benefits can be available without assigning liability, while property-damage, bodily-injury, uninsured-motorist, and tort claims may still depend on fault, coverage terms, and proof.

This distinction also explains why PIP is narrower than automobile insurance coverage as a whole. One policy can contain several coverages that answer different questions about the same crash.

Who Florida PIP can cover

Section 627.736 requires a compliant policy to provide PIP to the named insured and resident relatives unless properly excluded under the named-driver statute. It also identifies people operating the insured vehicle, passengers, and certain people struck by the vehicle while not occupying a self-propelled vehicle, subject to the statute’s exclusions and priority rules.

Coverage therefore does not turn only on whose name appears on a repair estimate or police report. The person’s relationship to the policy, household, vehicle, and other available PIP coverage can affect which insurer has priority.

Florida also permits a written named-driver exclusion under section 627.747 when statutory conditions are met. That exclusion can apply to the identified driver’s PIP injuries, lost wages, and death benefits resulting from that person’s operation of a motor vehicle.

What PIP pays

Florida’s required PIP benefits are divided into medical, disability, and death benefits. The overall statutory limit is $10,000 for medical and disability benefits, with a separate $5,000 death benefit, but a deductible and other limitations can change the amount payable.

Medical benefits

PIP pays 80 percent of reasonable expenses for medically necessary services listed in the statute. The covered categories include medical, surgical, X-ray, dental, rehabilitative, prosthetic, ambulance, hospital, and nursing services when the statutory requirements are satisfied.

The 80-percent rule does not mean that every billed charge is automatically covered. The service must fall within the statute, be medically necessary, be connected to the covered motor-vehicle injury, and comply with applicable provider, billing, timing, and policy requirements.

Disability benefits

PIP pays 60 percent of covered loss of gross income and loss of earning capacity caused by the injury. It also includes reasonable expenses for obtaining ordinary and necessary services that the injured person would have performed for the household but for the injury.

Income loss is not the same as medical expense, and both draw from the combined medical-and-disability limit. Records supporting the amount and cause of each claimed loss serve different functions.

Death benefits

Florida’s PIP statute provides a $5,000 death benefit per person. The statute treats this as additional to the medical and disability benefits provided under the policy.

The 14-day treatment rule and emergency medical condition limit

For PIP medical benefits, the injured person must receive initial services and care within 14 days after the motor vehicle accident. The statute specifies categories of authorized initial-care providers and facilities.

After timely initial care, the available medical-benefit amount depends in part on whether an authorized provider determines that the person had an emergency medical condition. The statute defines that term as an acute condition with sufficiently severe symptoms such that the absence of immediate medical attention could reasonably be expected to cause serious jeopardy to health, serious impairment of bodily functions, or serious dysfunction of a body part or organ.

When an authorized provider determines that an emergency medical condition existed, medical benefits can be available up to the $10,000 limit, subject to the policy and statute. Without that determination, medical benefits are limited to $2,500.

The 14-day rule concerns eligibility for PIP medical benefits. It is not a universal medical judgment about whether an injury exists, and it is not the same as a lawsuit filing deadline.

Deductibles and a lost-wage exclusion can change the result

Florida insurers must offer PIP deductibles of $250, $500, and $1,000. Section 627.739 applies the elected deductible to 100 percent of covered expenses and losses before benefits become payable, while preserving eligibility for up to $10,000 in benefits after the deductible is met.

The named insured may elect the deductible for the named insured alone or for the named insured and dependent resident relatives. The statute does not permit that election to be extended to every other person covered by the policy.

Florida law also allows the named insured to exclude benefits for loss of gross income and earning capacity for the people subject to that election. These options produce a premium reduction but also change which losses the policy will pay.

PIP is different from liability, medical payments, and uninsured-motorist coverage

PIP is first-party coverage for statutorily defined losses. Property damage liability pays for damage to another person’s property for which the insured is legally liable, while bodily injury liability addresses covered liability for injuries caused to others.

Medical payments coverage is a separate optional coverage that may address medical expenses according to its own terms. Uninsured or underinsured motorist coverage concerns bodily injury caused by a driver who has no bodily-injury liability coverage or insufficient limits.

Those coverages can overlap in subject matter without being interchangeable. The declarations page, endorsements, exclusions, limits, deductibles, and statutory priority rules identify which coverage responds and in what order.

No-fault does not eliminate tort claims

Florida section 627.737 limits tort liability to the extent specified PIP benefits are payable, but it does not abolish every claim against an at-fault party. Economic losses outside PIP and other covered damages may raise separate liability questions.

The statute restricts recovery for pain, suffering, mental anguish, and inconvenience to injuries meeting a threshold. Its categories include significant and permanent loss of an important bodily function, permanent injury within a reasonable degree of medical probability, significant and permanent scarring or disfigurement, or death.

The threshold concerns noneconomic damages in a qualifying tort action; it is distinct from the emergency-medical-condition determination used to set the PIP medical-benefit limit. Similar medical language can therefore serve different legal purposes.

A broader no-fault insurance overview can help place Florida’s system in context, but the operative rules come from Florida law. Rules in Michigan, New York, or another PIP state do not establish Florida coverage.

Records answer different PIP questions

A policy and declarations page identify the insured people, limits, deductible, exclusions, and endorsements. Medical records can document the timing, provider, diagnosis, services, and relationship to the crash, while wage records can document the amount of claimed income loss.

An accident report may record the circumstances of the collision, but it does not replace the insurance contract or medical evidence. Each record has a narrower evidentiary role.

Sources

• Florida Statutes section 627.736: required PIP benefits, exclusions, priority, and claims
• Florida Statutes section 627.733: required security
• Florida Statutes section 627.737: tort exemption and injury threshold
• Florida Statutes section 627.739: PIP deductibles and optional limitations
• Florida Statutes section 627.747: named-driver exclusions
• Florida Statutes section 627.7407: application of the no-fault law
• Florida Department of Financial Services personal automobile insurance overview