What is a No-Fault Car Accident Claim?

What is a No-Fault Car Accident Claim?

Dealing with the legal process can be overwhelming after you have been in a car accident. Understanding what a no-fault car accident claim entails can assist you with making informed decisions about your case so you can seek a maximum settlement for your injuries and damages.

Every state in the United States has different automobile insurance laws. Have you ever heard the term “Florida No Fault” before? This does not mean that the at-fault driver gets away with causing your injuries. Florida No Fault is also referred to as Personal Injury Protection (PIP) which is governed by F.S. 627.736. Every person who owns a motor vehicle is required to maintain PIP coverage. Regardless of who causes a motor vehicle crash, each injured person’s own automobile insurance carrier is responsible for paying a large portion of their respective medical bills. The goal of the no-fault system is to provide quick access to medical care and lost earnings benefits without lengthy disputes over liability.

When you file a no-fault claim, your insurance company typically pays 80% of your medically necessary and related treatment, 60% of your lost wages, capped at $10,000. Additionally, PIP will pay a $5,000 death benefit in the event someone passes away from injuries sustained in the crash. PIP only pays for medical expenses and lost wages; it does not cover pain and suffering or other non-economic damages. It also does not cover licensed massage therapy or acupuncture.

Understanding how these claims work is essential to knowing when you may need to pursue additional compensation. Cindy Goldstein has practiced PIP litigation for more than two decades. Schedule a free initial consultation with a Coral Springs car accident attorney at Cindy Goldstein Law by calling us today at (954)346-5420.

Key Takeaways - No-Fault Car Accident Claims

• Florida relies on a no-fault car insurance system, allowing your medical providers to seek prompt payment of your medical expenses from your auto insurance company. 
• This coverage only covers your medical expenses and lost wages. 
• If you successfully file a fault-based lawsuit against a potential defendant, you may receive compensation for your non-economic losses or any other economic losses not covered by PIP.
• You should speak to a car accident attorney to learn more about how you can receive payment for your injuries.

How Does No-Fault Insurance Work in a Car Accident Case?

No-fault car insurance is an auto insurance system that simplifies and speeds up the process of paying for your medical expenses after a car crash. Instead of determining who was at fault before covering medical expenses and certain financial losses, no-fault insurance requires drivers to turn to their own auto insurance provider for coverage. This system can reduce delays, limit lawsuits, and ensure injured drivers and passengers can access medical care quickly.

Personal Injury Protection (PIP) coverage provides no-fault insurance and pays for medical expenses, lost earnings, and certain related costs, regardless of who caused the crash. Typically, PIP covers 80 percent of reasonable medical bills and 60 percent of lost income, up to the policy limit—usually $10,000. Additionally, a claimant must also have an “EMC” evaluation where a medical professional of a certain classification evaluates and determines that the claimant sustained an “emergency medical condition,” otherwise, the PIP insurance company can terminate PIP benefits at $2500. The EMC determination must be done by an MD, DO, nurse practitioner, physician’s assistant, or a dentist. PIP coverage ensures that drivers and passengers have a baseline of financial protection immediately after an accident.

However, no-fault insurance has restrictions. It generally does not pay for pain and suffering, emotional distress, or other non-economic damages. It also does not pay for acupuncture or licensed massage therapy treatment. Importantly, all injured claimants who seek PIP coverage must seek medical treatment within 14 days, or they forfeit their PIP benefits.

How Do I File a No-Fault Claim?

Filing a no-fault car accident claim involves several essential steps to ensure you receive the benefits you have a legal right to under your Personal Injury Protection (PIP) coverage. The process begins immediately after the accident. First, you should seek medical treatment as soon as possible, since the law requires you to see a doctor within 14 days of the crash to qualify for PIP benefits. Delaying treatment can result in a denial of your claim.

Next, contact your personal injury attorney to assist you in making your PIP claim. Your attorney should notify your insurance company promptly about the accident. Most insurers require you to report the crash within a short time frame and cooperate fully with your insurance company. Your attorney can provide them with details such as the date, time, location of the accident, and any injuries sustained.

Your treating physicians must also submit medical documentation to your PIP carrier to support your claim, including medical records and bills. To support your lost wage claim, you will need to submit proof of lost earnings. Your insurance company will use this information to determine how much PIP will cover your expenses. While you are technically entitled to $10,000.00 in PIP benefits under Florida Law, your insurance company will likely unilaterally decide how much it wants to pay for your medical treatment. Any bills your insurance company refuses to pay may then be your financial responsibility. Having an experienced personal injury attorney on your claim can help prevent the insurance company from unlawfully or wrongly withholding PIP benefits that it should be paying to your medical providers for your medical care.

What Are the Limitations of the No-Fault System?

No-fault car accident claims in Florida offer quick access to medical and earnings-loss benefits through PIP coverage. Still, these coverages also have limitations that can undercompensate accident victims.

The most significant limitation is the cap on benefits. Florida requires drivers to carry only $10,000 in PIP coverage, which may not go far in a serious accident. Hospital stays, surgeries, or extended rehabilitation can easily exceed that limit, forcing victims to look beyond their own PIP insurance for help. Additionally, PIP typically covers only 80 percent of reasonable medical expenses and 60 percent of lost earnings, leaving victims responsible for some of their losses even within the coverage limit.

Another significant restriction is that PIP does not cover pain and suffering or other non-economic damages. In order to seek compensation for those damages, the accident victim must make a bodily injury claim with the at-fault party’s insurance company or the victim’s uninsured motorist carrier. Additionally, PIP does not cover acupuncture treatment or licensed massage therapy.

There are also strict deadlines and requirements. Injured parties must seek medical treatment within 14 days of the accident to qualify for PIP benefits. Failing to do so can result in a complete denial of coverage. Furthermore, insurers often challenge claims, questioning whether treatment is necessary or related to the accident.

Many medical providers will have the PIP patient sign an Assignment of Benefits (AOB) form allowing the PIP patient to transfer or assign the right to challenge the denial of PIP benefits to the medical provider. As such, when a PIP insurer wrongfully withholds payment of PIP benefits to the medical provider, the medical provider has standing to file a PIP suit against the PIP insurer through the AOB. Prior to March 2023, the law leveled the playing field between car crash victims and big insurance companies, and required PIP insurance companies to pay for the attorney’s fees and costs for the plaintiff’s attorney if the insurance carrier was deemed to have wrongfully withheld PIP benefits. This meant that if the medical provider through an AOB or the PIP patient won the PIP suit, or the PIP suit settled, the insurance company was required to pay for the Plaintiff’s reasonable attorney’s fees and costs. Unfortunately, HB837 was enacted in March of 2023, and it removes the PIP carrier’s legal requirement to pay fees and costs to the prevailing Plaintiff unless it pertains to a pure coverage issue. As such, PIP insurance companies can now play more games than ever in reducing or refusing to pay your PIP benefits. Attorney Cindy Goldstein practiced in the area of PIP litigation for more than 20 years and is well versed in the PIP laws to better assist you in your personal injury case.

Ultimately, while no-fault claims should provide fast relief, their limitations can leave victims without full compensation for their losses, especially when injuries are severe or long-term. Accordingly, you should do everything possible to file a fault-based claim against the at fault party’s bodily injury carrier or your uninsured motorist carrier because it can mean additional monetary compensation. An experienced attorney can guide you through complex legal procedures, negotiate with insurance companies, and advocate on your behalf to maximize your compensation.

What Happens When I Exhaust My No-Fault Coverage?

When you exhaust your no-fault coverage, you may still have options to cover your remaining losses. PIP only provides up to $10,000 in benefits. Once your expenses reach the $10,000 limit, any additional medical bills, lost earnings, or related expenses become your responsibility unless you have other insurance coverages such as Medpay or health insurance, or you seek compensation from the adverse driver or your uninsured motorist carrier.

Once PIP exhausts, you may use your health insurance to cover ongoing treatment, which may involve copays or deductibles. If another driver was at fault for the accident, you may also step outside the no-fault system and file a claim or lawsuit against their insurance company for the damages that exceed your PIP coverage. You can pursue compensation for economic damages, like unpaid medical expenses, and non-economic damages, such as pain and suffering, if you meet the “serious injury” threshold.

Common Issues in No-Fault Car Accident Claims

Insurance companies may raise several issues with your claim, including the following:

• Insurance companies may dispute whether specific medical treatments are reasonable, necessary, or related to the accident. Insurers may deny or limit coverage for chiropractic care, physical therapy, or ongoing treatment, leaving injured drivers struggling to receive compensation for their medical bills. However, this care may be exactly what you need after a car accident.
• Insurance companies may demand that you attend an independent medical exam (IME) with one of their doctors, who they pay for. This paid-for doctor will likely reach a different conclusion from the medical professional you received treatment from, and render an opinion to your PIP insurance company that medical treatment is no longer reasonable, related, or necessary. This is referred to as an “IME cut off.”
• Your insurance company may conduct a “peer review” where the insurance company pays an expert to review your medical treatment and PIP bills to determine that the treatment or billing was not reasonable, related, or necessary. 
• Serious injuries can quickly exceed the cap on PIP, forcing accident victims to seek compensation outside the no-fault system. Even relatively moderate injuries, like broken bones or extended hospital stays, can exhaust PIP benefits almost immediately.
• The insurance company may have a different view of your lost earnings, including whether you were even unable to work in the first place.
• The insurance company may delay in paying your PIP claim, making it difficult to pay medical providers on time. In the meantime, the providers may bill you personally for their services. 
• The insurance company may claim that you did not seek medical care in enough time to qualify for PIP coverage. The law requires you to seek treatment within 14 days of the accident to be eligible for PIP coverage.
• The insurance company may challenge your PIP coverage, and/or attempt to void your policy for material misrepresentations made at the time of policy inception. 
• Your insurance company may deny coverage or payment of PIP benefits claiming you failed to cooperate with them in their investigation, and cooperation is a condition precedent to coverage. Having an experienced personal injury attorney well versed in PIP laws can help determine the degree of your required cooperation and guide you through the claims process. 

When Can You Step Outside the No-Fault System in a Car Accident Case?

You can step outside the no-fault based system and make a bodily injury claim seeking compensation for pain and suffering damages when you have sustained a severe injury as defined pursuant to Florida Law.

A severe injury can be one of the following:

• Significant and permanent loss of an important bodily function
• Permanent injury within a reasonable degree of medical probability (other than scarring or disfigurement)
• Significant and permanent scarring or disfigurement
• Death

You can also file a fault-based claim if your damages exceeds $10,000.00, and your PIP will no longer cover your damages. When you exhaust your PIP, you can file a claim for your economic damages, including lost earnings and medical expenses under the bodily injury coverage of the adverse driver’s automobile policy. You can file a claim under these circumstances even when you have not suffered a serious injury.

Many car accidents resulting in injuries will incur medical expenses greater than $10,000. Given how expensive medical care is, one trip to the hospital where the hospital orders diagnostic testing can easily exhaust your PIP benefits.

Why You Need a Lawyer for a No-Fault Car Accident Claim

As outlined above, PIP insurance carriers are no longer liable for Plaintiff attorney’s fees when they wrongfully deny PIP benefits, unless it’s a pure coverage issue. As such, insurance companies will look for any reason to withhold PIP benefits to maximize their profit. Moreover, any documents you submit to your PIP carrier can be used against you in your claim against the adverse driver’s bodily injury insurance, or your uninsured motorist carrier when presenting your personal injury claim. If PIP denies payment of medical bills, those bills become your financial responsibility.

Any time you deal with insurance companies, you must counteract their tactics to underpay your claim. The size of the claim does not matter; regardless of the value of your personal injury claim, the insurance companies will always try to save money to increase profit. A car accident attorney fights for you to receive full compensation for your injuries, no matter how much your case is worth. Your car accident claim is a significant event in your life, and your attorney should treat it with the utmost seriousness.

Call a Local Car Accident Attorney Today

While no-fault car accident claims should simplify the process, dealing with insurance companies and understanding your rights can still be challenging. Retaining an attorney well-versed in PIP and personal injury law can protect your interests and ensure you receive the compensation you deserve. If you have suffered an injury in a car accident, consulting with a lawyer can provide the guidance and support you need to handle the legal system and secure a favorable outcome. To get aggressive legal help with your no-fault car accident claim, speak to an experienced Coral Springs personal injury attorney at Cindy Goldstein Law (954)346-5420.

No-Fault Car Accident Claim FAQs