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The 80/60 Answer, and the Fine Print That Eats It
Florida PIP pays 80 percent of your reasonable medical bills and 60 percent of your lost income after a crash, regardless of who caused it.
It adds a $5,000 death benefit and covers household services you can no longer perform.
All of it lives inside one $10,000 limit, and the exceptions decide more claims than the benefits do.
Miss the 14-day treatment window and PIP pays nothing.
Get classified below an emergency medical condition and the $10,000 becomes $2,500.
Here is what your PIP actually pays, what it never will, and what takes over when it runs out.
At-a-Glance: Florida PIP Benefits
- 80% of reasonable and necessary medical expenses, up to the $10,000 limit
- 60% of lost gross income, plus replacement household services
- $5,000 death benefit, paid on top of medical and disability benefits
- Treatment must begin within 14 days of the crash or benefits are forfeited
- Without an emergency medical condition determination, the cap drops to $2,500
- PIP never pays pain and suffering or vehicle damage
The Four Benefits Inside a Florida PIP Policy
Section 627.736 builds PIP from four benefit types, all drawing on the same $10,000 pool.[1]
Medical benefits: 80 percent. Ambulance, emergency care, hospital charges, physician visits, diagnostic imaging, physical therapy, chiropractic care, and prescriptions, paid at 80 cents on the dollar for reasonable and necessary charges. Massage and acupuncture are excluded by statute, a detail that surprises patients mid-treatment.
Disability benefits: 60 percent of lost income. If injuries keep you off work, PIP replaces 60 percent of your lost gross income. It also pays for replacement services: the childcare, cleaning, and household work you can document paying someone else to do while you cannot.
The death benefit: $5,000. Paid to survivors or the estate after a fatal crash, on top of any medical and disability benefits already consumed.
The deductible caveat. Policies can carry PIP deductibles up to $1,000. A deductible you forgot choosing shrinks every number above, which is worth checking on your declarations page before a claim, not during one.
What the Math Looks Like on a Real Claim
A Typical Moderate-Injury PIP Claim
An ER visit with imaging bills $9,000. PIP pays 80 percent: $7,200, leaving $1,800 of the pool. Six weeks of therapy bills $3,000; PIP covers the remaining $1,800 and stops. You missed three weeks of work at $1,200 per week: that $3,600 loss would pay at 60 percent, $2,160, except the pool is empty.
Total crash costs so far: roughly $15,600. Total PIP paid: $9,000, with a $10,000 policy. The remaining $6,600, and every dollar after it, belongs to the at-fault claim, your health insurance, or you.
That worked example is the honest answer to what PIP covers: the opening weeks of a real injury, and not much more. It is also why the 20 and 40 percent gaps PIP leaves are recoverable from the at-fault driver, and why the claims that matter run through the fault system.
The Two Traps: 14 Days and $2,500
The 14-day rule forfeits everything. No initial treatment within 14 days of the crash means no PIP benefits at all, on a policy you paid for. Soreness that "should pass" is the classic way this deadline gets missed. The full mechanics live on our 14-day PIP rule page.
The emergency medical condition determination sets your cap. Unless a physician, dentist, PA, or advanced practice nurse determines you had an emergency medical condition, benefits stop at $2,500 instead of $10,000. The determination is a documentation event, made in the records by qualified providers, and its absence quietly costs claimants $7,500 at a time. Chiropractors cannot make it, which shapes where crash treatment should start.
Both traps reward the same behavior: prompt evaluation by the right provider, with symptoms fully described. Our Florida no-fault overview shows how these pieces fit the larger system.
Who Your PIP Policy Covers
PIP follows people more than vehicles. Your policy covers you as a driver, a passenger in any car, a pedestrian, or a bicyclist struck by a vehicle. It extends to resident relatives in your household, children riding school transportation, and in defined situations passengers and permitted drivers without their own coverage.
The coverage questions get genuinely tricky in multi-vehicle households, for out-of-state residents crashed in Florida, and for rideshare situations where personal and commercial coverage intersect. Whose PIP pays is a real question with real sequencing rules, and getting it wrong delays the medical payments the system exists to speed up.
What PIP Never Covers, and What Pays After It
PIP excludes the two largest categories of crash loss entirely. Pain and suffering is never a PIP benefit; it belongs to the claim against the at-fault driver, gated by the serious-injury threshold. Vehicle damage is not PIP either; the at-fault driver's property damage coverage owes for your car.
When the $10,000 exhausts, the sequence matters: health insurance takes over treatment, MedPay fills the 20 percent gap if you bought it, and the liability claim, or your own UM coverage when the at-fault driver is underinsured, absorbs the rest. Coordinating those layers, and keeping the liability claim's value intact while PIP and health insurers assert their reimbursement rights, is quiet work that changes net recoveries by real percentages.
Florida PIP Coverage FAQ
- What does PIP cover in Florida?
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Four things, all within a $10,000 limit: 80 percent of reasonable and necessary medical expenses, 60 percent of lost gross income, replacement household services you must pay others to perform, and a $5,000 death benefit. It pays regardless of fault, but only if initial treatment begins within 14 days of the crash, and only up to $2,500 unless an emergency medical condition is documented by a qualified provider.
- Does PIP cover lost wages in Florida?
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Yes, at 60 percent of lost gross income while crash injuries keep you from working, drawn from the same $10,000 pool as medical benefits. Documentation drives payment: employer wage statements and physician disability notes make the claim, and self-employed claimants need tax and income records ready. The 40 percent PIP does not replace remains claimable from the at-fault driver.
- Does PIP pay for pain and suffering?
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Never. PIP is economic-loss coverage only. Pain and suffering compensation comes from the liability claim against the at-fault driver, and only after your injury meets Florida's serious-injury threshold: permanent injury, significant permanent scarring, significant loss of an important bodily function, or death. That distinction is why serious injuries become lawsuits while minor ones stay PIP claims.
- What happens when my $10,000 in PIP runs out?
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Health insurance takes over ongoing treatment, MedPay coverage fills the copay gap if you purchased it, and the remaining losses join your claim against the at-fault driver or your own UM coverage. PIP and health insurers typically assert reimbursement rights against your eventual settlement, which makes lien management part of protecting your net recovery.
- Can my PIP claim be denied or cut off?
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Yes, and routinely: for missing the 14-day window, for lacking an emergency medical condition determination, after an insurer-scheduled medical exam concludes further treatment is unnecessary, or through disputes over whether charges were reasonable and related. Cutoffs are contestable, and pattern denials by PIP insurers are their own species of fight. If benefits stop while treatment continues, that is a problem worth a phone call.
PIP Pays First. Make Sure It Is Not the Only Thing That Pays.
PIP was designed to cover the first weeks of a minor injury, and that is exactly what it does. Everything larger belongs to the claim most crash victims never fully make.
Injured Floridians deserve their PIP benefits paid without games, the gaps recovered from the driver who caused them, and a clear map of how the layers fit together. The attorneys at Lawsuit Legal handle the PIP fight and the liability case as one coordinated recovery.
We help crash victims with cut-off benefits, families sorting coverage after a serious wreck, and workers losing income PIP only fractionally replaces, across Florida. Call (888) 713-6653 for a free case evaluation.
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