Florida No-Fault (PIP) Insurance: Complete Client Guide for Daytona Beach, DeLand, and Sanford
Florida is one of only a few “no-fault” states, meaning your own auto insurance pays certain expenses after a crash through Personal Injury Protection (PIP), regardless of fault. The system is supposed to provide quick, nearly automatic payments for medical care and lost wages. In practice, it is one of the most heavily litigated areas of Florida law.
This guide explains what PIP is, what it covers, how disputes arise, and what changed with the 2023 tort reform. It also answers the questions real clients ask, so you understand how PIP works in Daytona Beach, DeLand, Sanford, and across Central Florida.
What Does “No-Fault” Mean in Florida?
Under Florida Statutes § 627.736, every owner of a motor vehicle registered in Florida must carry at least $10,000 in Personal Injury Protection (PIP) coverage.
“No-fault” means that if you are injured in an accident, your own insurer pays certain benefits regardless of who caused the crash. Only if you meet the permanent injury threshold in § 627.737 may you pursue pain and suffering damages against the at-fault driver.
What PIP Covers
- Medical Expenses – 80% of reasonable and necessary treatment
- Lost Wages – 60% of lost income and household services
- Death Benefits – $5,000
- Other Costs – mileage to and from medical providers
Because PIP pays only 80% of medical expenses, there is a 20% co-pay.
The 14-Day Rule and EMC Requirement
Why You Must Seek Treatment Within 14 Days
Florida law requires you to seek initial treatment within 14 days of the accident. If you miss this window, the insurer can deny your PIP medical benefits entirely.
Who Can Provide the First Evaluation
The initial visit must be with:
- MD/DO (physician)
- Chiropractic physician
- Dentist
- Hospital facility
- Emergency medical personnel
EMC and Your Coverage Limit
Without an Emergency Medical Condition (EMC), you are capped at $2,500. With an EMC determination, you can access up to $10,000 in benefits. Only an MD/DO, dentist, PA, or APRN may make the EMC finding. Chiropractors cannot.
Automobile Accident Is Broader Than Driving
PIP applies to injuries “arising out of the ownership, maintenance, or use” of a motor vehicle. Courts have found coverage in scenarios such as:
- Crush injuries while repairing a car
- Carjackings or assaults inside a vehicle
- Loading or unloading activities
Motorcycles are generally excluded from PIP, so riders must obtain other coverage.
Who Pays First: The Coverage-Priority Chain
Florida law sets a clear order:
- Your own policy
- Resident relative’s policy
- Policy on the occupied vehicle
- Striking vehicle’s PIP
Whether someone qualifies as a “resident relative” is a frequent litigation issue, often turning on household facts like address, mail, and intent to reside.
Assignment of Benefits: A Case May Already Exist in Your Name
Medical providers often require an Assignment of Benefits (AOB), allowing them to bill your insurer directly and even file suit in your name.
- Many Floridians are unaware a PIP lawsuit was filed until months later.
- After the 2023 reforms, providers can no longer recover one-way attorney’s fees, but assignments still matter.
- Always ask what you are signing when seeking treatment.
Underwriting Challenges and Misrepresentation
Insurers often invoke § 627.409 to rescind coverage if you allegedly misrepresented facts in your application, such as garaging, prior losses, or household drivers. When in doubt, list all individuals aged 14 or older on your insurance policy as a household relative, driver, or excluded driver, and keep copies of emails to insurance agents disclosing such information.
- In Independent Fire Ins. Co. v. Arvidson, 604 So. 2d 854 (Fla. 4th DCA 1992), the court stressed insurers must prove reliance and true materiality.
- In St. Paul Fire & Marine Ins. Co. v. Thomas, 273 So. 2d 117 (Fla. 4th DCA 1973), ambiguities in applications were construed against the insurer.
Most insureds prevail unless the insurer proves intentional, material misrepresentation that truly changed its underwriting decision.
Tort Reform 2023: The End of Automatic Attorney’s Fees
For decades, insureds who won against their insurers recovered fees under § 627.428. That statute was repealed in House Bill 837 (2023).
Now:
- No more one-way attorney’s fees in PIP.
- Fees are available only in declaratory judgment actions after a total coverage denial, under § 86.121.
- Fee rights apply only to named or omnibus insureds—not assignees like providers.
This change has dramatically reduced the number of small-value provider suits.
Timing: When Must Insurers Pay?
Under § 627.736(4)(b), PIP benefits are overdue if not paid within 30 days after written notice of a covered loss. Interest accrues on overdue benefits.
Florida PIP FAQ
What is no-fault insurance?
It means your own PIP coverage pays medical bills and wage loss first, regardless of fault.
Do I need to be driving or riding in a car or truck for PIP to apply?
No. The definition of "use" of an automobile has been heavily litigated. If an automobile is in anyway
involved in your injury, you should consult with a Florida PIP attorney.
Why do I need to seek treatment within 14 days?
Because the law requires it. Miss the window and you may lose PIP benefits.
Do I need to file the claim within 14 days?
No, the deadline is for treatment, not the claim. Still, report promptly.
Who can do the first evaluation?
Physicians (MD/DO), chiropractors, dentists, hospitals, or EMS.
Who can make an EMC finding?
Only MD/DOs, dentists, PAs, or APRNs. Chiropractors cannot.
How much does PIP pay?
80% of medical expenses, 60% of lost wages, plus $5,000 death benefits.
What if I don’t have an EMC?
You are capped at $2,500. With an EMC, up to $10,000 is available.
Can my provider sue my insurer without telling me?
Yes, if you signed an AOB. Many patients learn later that a lawsuit was filed in their name.
Can my insurer rescind my policy for errors in the application?
Only if the misrepresentation was material and relied upon. Many such arguments fail.
Are motorcycles covered by PIP?
No. Motorcycles are excluded from Florida’s no-fault law. However, depending on the CCs of the engine,
some mopeds will qualify for PIP.
How long does my insurer have to pay?
30 days from written notice, or benefits are overdue and interest accrues.
Does PIP apply if I am in an automobile accident out of state?
Maybe. Generally, PIP coverage is available if
you
are driving
your
insured vehicle at the time of the accident.
Can I sue the at-fault driver for pain and suffering?
Yes, but you may recover from the at-fault driver only if you meet the
permanent injury threshold in § 627.737.
Get Help with Florida PIP and No-Fault Insurance Disputes
Florida’s no-fault system is complex. Between the 14-day rule, EMC determinations, assignments of benefits, underwriting disputes, and the 2023 changes to attorney’s fees, most people do not realize how quickly benefits can be reduced or denied. Insurance companies often use these technicalities to their advantage.
At My Affordable Attorney, we help clients throughout Daytona Beach, DeLand, Sanford, and across Central Florida enforce their rights under Florida’s PIP laws. Whether your claim was delayed, denied, underpaid, or you just want to understand your benefits, we can help.
Call 866-466-5925 today for a free consultation, or explore myaffordableattorney.com to learn more. We are available 24/7 and offer same-day appointments.