Personal injury protection (PIP) may cover a pedestrian who is hit by a motor vehicle in Florida. If so, PIP pays benefits for medical and other benefits.
This article focuses on medical payments and bills. I do not talk about disability benefits, death benefits, or pain or suffering claims for pedestrians here.
Every state has different laws in regards to pedestrians getting their medical bills paid in an auto accident. This article focuses on Florida pedestrian accidents.
What Medical Payments does PIP make if a motor vehicle hits a pedestrian in Florida who is covered by PIP?
The minimum limits for no-fault personal injury protection benefits for the medical are:
PIP Pays Up to $10,000 for Emergency Medical Condition
$10,000 per person for loss resulting from bodily injury, sickness, or disease arising out of the ownership, maintenance, or use of a motor vehicle if a physician, dentist, physician assistant, or advanced registered nurse practitioner has determined that the injured person had an emergency medical condition.
Example #1: Pedestrian gets medical treatment; Emergency medical condition
A motor vehicle driver’s negligence causes him to hit you while you are a pedestrian in Florida. Your hospital bill is $12,000.00.
Let’s assume that State Farm PIP covers you. If the hospital states that you have an emergency medical condition, State Farm PIP will pay the hospital $10,000 (80% of $12,500).
Formula To Determine How Much PIP Pays
The formula to determine the PIP payment is:
80% x total bill
You would then owe the hospital $2,500. This is because the total bill minus State Farm’s PIP payments is $2,500.
You Can Still Make a Claim for Medical Bills Against Liable Parties
You can still make a claim against any liable parties for the outstanding medical bills of $2,000. Most of the time this amount is paid from the careless driver or owner’s bodily injury insurance in their auto insurance policy.
You Also May Be Able To Get Other Compensation
You may also be entitled to other compensation. However, those damages are outside the scope of this article.
Pedestrian Hit By Car; Pedestrian Has Resident Relative Who Owns Uninsured Car
If a pedestrian is hit by a car driven by another, and the pedestrian did not own a car but lived with a relative who owned an uninsured car, then the at fault car insurer’s PIP must pay the pedestrian’s medical bills. State Farm Mut. Auto. Ins. Co. v. Pierce, 383 So. 2d 1184 – Fla: Dist. Court of Appeals, 5th Dist. 1980
When I use the word “car” in this article, it also includes a “truck”.
PIP Only Pays $2,500 for No “Emergency Medical Condition”
If a motor vehicle hits a pedestrian who is covered by PIP, and the pedestrian doesn’t have an emergency medical condition, then the minimum medical benefits are:
$2,500 per person for loss resulting from bodily injury, sickness, or disease arising out of the ownership, maintenance, or use of a motor vehicle if a physician, dentist, chiropractic physician, physician assistant, advanced registered nurse practitioner, physical therapist or person licensed to provide emergency transportation and treatment has determined that the injured person did not have an emergency medical condition.
Example #2: Same facts as above; No Emergency medical condition
Take the same facts from example #1 except assume the hospital does not state that you have an “emergency medical condition”. In this case, your car insurance will only pay the hospital $2,500.
You would owe the hospital $9,500. This is because $12,500 minus $2,500 is $10,000.
You can still make a claim against any liable parties for the outstanding medical bills of $9,500. You may also be entitled to other compensation.
As I’ve shown you above, PIP medical benefits pays 80 percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital and nursing services.
Need Treatment Within 14 Days of Car Accident
Medical benefits are only paid if the individual receives initial services and care within 14 days after the motor vehicle accident.
Example #3: Same facts as above except no treatment within 14 days
Take the same facts from Example #1 above, except assume that you don’t get medical treatment within 14 days after the motor vehicle accident. In this case, PIP does not pay any benefits.
You can still make a claim against any liable parties for the outstanding medical bills of $12,500. You may also be entitled to other compensation.
What are not considered Medical Benefits?
Medical benefits do not include massage or acupuncture, regardless of the person, entity, or licensee providing massage or acupuncture and a licensed massage therapist or licensed acupuncturist may not be reimbursed for medical benefits.
Note: If you have medical payments (Medpay) coverage through your auto insurance policy, then the medical payments coverage will be secondary to PIP coverage.
The excess medical expenses, the 20 percent not covered by PIP, and the deductible may or may not be covered by the additional medical payments coverage depending on the policy that covers you for PIP.
Will PIP pay a Bills Even if The Pedestrian Is Partially At Fault?
If you are covered by PIP, then yes. Even if you are cited for jaywalking and are 100% at fault, you may still be able to get your up to $10,000 of your medical bills by PIP.
Example – Pedestrian partially at fault
My client, a woman, was walking in a crosswalk while the “do not walk” sign was displayed. She was in Homestead, Miami-Dade County, Florida A driver of a car – that had a steady green light – hit her.
She received a ticket for walking across the street when she should not have been walking. (A ticket is inadmissible in a personal injury case in Florida).
My client’s injury was an orbital fracture (fractured bone below her eye). She had surgery whereupon a metal plate was put below her eye.
Progressive insured my client’s car with PIP. Progressive paid $10,000 of my client’s medical bills.
Imperial Fire & Casualty Insurance (RAC) insured the driver with $10,000 in BI liability coverage. Progressive insured my client’s car with $100,000 in uninsured motorist insurance.
Progressive paid us $100,000 to settle the case. The liability case settled for $110,000.
This settlement is before attorney’s fees, costs and medical bills were subtracted.
How to Make a PIP claim
In order to get your PIP claim set up, you would need to contact the proper PIP insurer that covers you.
Will the pedestrian’s health insurance pay the medical bills if a car hits him or her?
Even if you are able to get PIP, you should still use your health insurance, in addition to PIP, to pay your medical bills. Your health insurance may have a lien (claim) on the total settlement.
You should be very careful when paying back your health insurance company from the settlement.
So now that you know a lot about PIP, you may want to get money from the driver – and/or owner – of the car that hit you. In order to have the possibility of getting money from the other driver – and/or owner – you generally need to answer “Yes” to the following 3 questions:
- Was the driver was at fault?; and
- Were your injuries were caused by the accident?; and
- Is there an insurance policy that will pay for your injuries?
If you want to learn more about getting your bills paid after a car accident, check out this article on who pays your medical bills paid after a Florida auto accident.
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