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PIP Law Covered Individuals

One of the most common reasons insurance companies give when denying a medical provider’s PIP claim is that the patient was not covered under a PIP policy. Here we explain who is covered under PIP law and who isn’t, including some of the more complicated areas of this lengthy and complex law. The good news for you is that our law firm is thoroughly knowledgeable and steeped in Florida PIP law and capable of tackling any type of issue that arises. If the insurance company denies your claim because they say the patient wasn’t covered under a valid PIP policy, we’ll take a close look and see if they are right or not. If not, we’ll take your claim through the appropriate processes and help you get paid for the full value of your claim. You spent your valuable time and expertise providing medical treatment. Let Shuster Saben Estevez see to it that you get paid for the services you provided.

Who Is Covered Under a PIP Insurance Policy?

An auto insurance policy is taken out by an individual. This person is the policyholder and the “named insured” under the policy. In many types of insurance policies, the named insured is the only one who is covered. When it comes to Florida PIP policies, however, other people are covered as well. For instance, PIP coverage extends to relatives residing in the policyholder’s household (subject to the named driver exclusion discussed below). If any household member related to the policyholder is injured in an auto accident, they can receive medical treatment with expenses covered by the policyholder’s PIP policy. If you treat any such person, you have a right to claim reimbursement from the insurer.

A policyholder or related household member is covered under the policyholder’s PIP policy if they were injured in a Florida motor vehicle accident. This coverage extends to people injured in a crash as a

  • Driver/operator of the vehicle
  • Passenger
  • Bicyclist
  • Pedestrian
  • Another person struck by a motor vehicle while not an occupant of a self-propelled vehicle

For example, if your patient was walking down the street and got hit by a car, they are covered under their PIP policy or the policy of a family member whom they live with.

Who Is NOT Covered Under a PIP Insurance Policy?

Motorcyclists. PIP insures motor vehicles, and a motor vehicle is defined in Florida PIP law as any self-propelled vehicle with four or more wheels designed and licensed for use on Florida roads. It includes any type of private passenger motor vehicle and commercial motor vehicles as well, but it does not include motorcycles. A person injured in a crash while operating or riding on a motorcycle cannot get PIP benefits, even if they otherwise hold a valid PIP policy or live with a relative who does.

Excluded named drivers. Florida PIP law includes a “named driver exclusion” statute. This law allows the policy to exclude coverage for injuries sustained while operating a motor vehicle by an “identified individual who is not a named insured, provided the identified individual is named on the declarations page or by endorsement and the named insured consents in writing to such exclusion.” Note that this exclusion only applies to drivers, not passengers, bicyclists or pedestrians. Also, the person must be identified in the policy, and the named insured must consent in writing to the exclusion. The law further defines what coverages can be excluded and when a policy cannot exclude coverage for certain reasons. If the insurance company is denying your claim on this basis, let us take a close look at the facts and make sure they are not improperly excluding your patient from coverage.

Other Vehicle. The insurer can exclude benefits to a named insured and household members who are injured while occupying another motor vehicle owned by the named insured that is not insured under the policy.

No Consent to Operate. The insurer can exclude benefits for an injury sustained by any person operating the insured vehicle without the express or implied consent of the insured.

Intentional Injury or Felony. The insurer can exclude benefits to any injured person whose conduct contributed to their injury either by intentionally causing their injury or if they are injured while committing a felony.

Shuster Saben Estevez Is Here to Help With Your Florida PIP Law Claim

Additionally, numerous other conditions apply regarding whether an individual is eligible for benefits or not. For instance, they must seek treatment within 14 days, and they must have had an appropriately documented emergency medical condition to receive the full $10,000 in benefits. Insurers find many ways to turn down claims, but we know the law and won’t let them treat you unfairly.

If your Florida PIP claim is being unreasonably delayed, denied or underpaid for any reason, the attorneys at Shuster Saben Estevez can help. We are Florida’s leading PIP law firm for doctors and maintain offices throughout the state. Call 877-511-7829 to talk to a lawyer today.

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