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Understanding PIP & What It Means To Be Exhausted

Auto Insurance

What Exactly Is PIP?

Florida is defined as a “no fault” state. Every driver in Florida is required to carry insurance that has Personal Injury Protection, commonly referred to as PIP. Personal Injury Protection is paid out by your insurance company even if you were not at fault for the accident. Florida statute 627.733, or the Florida PIP statute, states:

An insurance policy complying with the security requirements of 627.733 must provide personal injury protection to the named insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in the motor vehicle, and other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle, subject to subsection (2) and paragraph (4)(e), to a limit of $10,000 in medical and disability benefits and $5,000 in death benefits resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle.

What Can PIP Cover?

The above statute says that PIP insurance covers 80% of your first $10,000 in reasonable medical expenses. It can also cover reimbursement for gas and some lost wages. Your PIP insurer will pay the medical providers directly. Many people do not understand why their insurance is paying. The simple answer is because they are obligated to by law.

However, PIP only covers 80 percent of your first $10,000 in reasonable medical bills. After that your PIP benefits are exhausted. When a client receives that exhaustion letter, it only means that your insurance company has paid everything that they are required to pay under the PIP statute. This does not mean that you can no longer treat, though. Any bills that are not covered by PIP can be covered through the at-fault’s bodily injury policy when the case is settled.

Therefore, just because your PIP benefits have been exhausted does not mean that is the end of your case. In fact, many times it is just the beginning of the case.

What Do We Do When Your Patient Is Exhausted?

We will continue to bill the Auto Insurance so they are aware your patient is still treating and injured. (If they have health insurance, we are able to bill that as well). In the meantime, we will update the patient’s attorney with the outstanding balance every month to keep them posted on the patient’s balance. As well as following up with their current case status. (By doing this, it gives the attorney an idea of where all bills stand and keeps them in constant loop/communication with the patient’s case). By communicating with the attorney’s every month, we are able to keep track of their case status’s and make sure representation hasn’t dropped the patient (while the patient is still treating). We have found this to be tremendously helpful! By being in the “KNOW”, we can limit large outstanding balances for patients who have been dropped/no longer represented and start acting on solutions to get the bill paid vs. sitting in your accounts receivable.