A driver rear-ends you on I-95. You drive away feeling sore but otherwise fine. Three weeks later, the headaches start, an MRI shows a cervical disc injury, and the bills hit five figures. You call your insurer to open a PIP claim. The adjuster looks at the date of the accident and tells you the file is closed before it opened, because you missed the 14-day rule. That single sentence ends the case. It does not matter who hit you. It does not matter whether the injury is real. PIP pays nothing.
Personal Injury Protection is the heart of Florida's no-fault auto insurance system, and it is also the coverage most drivers misunderstand. This guide walks through what the $10,000 PIP limit actually pays, the two layers of medical coverage created by the Emergency Medical Condition rule, the 14-day deadline that decides every claim, who PIP covers besides the named insured, what is excluded, how to file the claim properly, and when an injury is serious enough to step outside no-fault and sue the at-fault driver directly.
Florida's PIP statute is Florida Statute § 627.736. The tort threshold that decides when you can sue outside no-fault is § 627.737. Both have survived several repeal attempts. As of the close of the 2026 regular session in March 2026, no PIP repeal bill has been signed into law. PIP remains mandatory in Florida.
How the $10,000 Splits Across Three Buckets
Florida requires every registered vehicle owner to carry at least $10,000 in Personal Injury Protection. Under § 627.736(1), that single limit funds three separate categories of benefit, all drawing from the same pool. Once the $10,000 is exhausted, the policy owes nothing more under PIP, no matter how many of these benefits have been claimed.
| Benefit | Reimbursement Rate | Notes |
|---|---|---|
| Medical and rehabilitative expenses | 80% of reasonable, necessary, and related costs | Covers ER visits, imaging, surgery, follow-up care, and prescriptions tied to the crash |
| Lost wages | 60% of gross income lost because of the injury | Income must be verifiable and the disability must be documented by the treating provider |
| Replacement services | Up to the policy limit | Pays for tasks the injured person can no longer perform: childcare, housekeeping, yard work |
| Death benefit | $5,000 | Separate from the $10,000 medical/wage limit, payable to the estate or to whoever paid burial expenses |
The death benefit is the one number that does not erode the $10,000 medical and wage pool. Every other benefit shares the same limit, which is why a serious injury exhausts PIP quickly. A single emergency-room visit, ambulance ride, and a few weeks of physical therapy can run through $10,000 before any meaningful lost-wage payment ever lands.
The Two Layers of Medical: $2,500 and $10,000
The full $10,000 of medical coverage is not automatic. Florida law splits PIP medical into two tiers, separated by whether a qualified provider diagnoses you with an Emergency Medical Condition (EMC). Without that diagnosis, your medical benefit is capped at $2,500. With it, you can access the full $10,000. The wage-loss and death-benefit pieces are not affected by the EMC distinction.
An Emergency Medical Condition is a specific legal term, not a clinical judgment call. It means acute symptoms of sufficient severity, including severe pain, where the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to health, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part. The treating provider has to document the EMC determination in the medical record for the insurer to honor the full $10,000.
Only a narrow group of providers can make the EMC call under § 627.736(1)(a). Medical doctors (MDs), doctors of osteopathic medicine (DOs), physician assistants, advanced registered nurse practitioners, dentists (for dental injuries), and hospital physicians qualify. A chiropractor does not, even though chiropractors are legitimate PIP providers for treatment. If your first stop is a chiropractor's office, you still need to see an MD, DO, PA, or ARNP within the 14-day window for the EMC finding to be on the record.
The $2,500 cap is the most expensive surprise in Florida auto insurance. A whiplash claim with two months of physical therapy and an MRI can easily exceed $2,500. If no qualified provider documented an EMC, the patient eats the difference even though the policy says "$10,000." Ask the first qualifying provider you see to put the EMC determination in writing.
The 14-Day Rule Decides Whether You Get Paid at All
Florida Statute § 627.736(1)(a) requires the injured person to receive initial services and care within 14 days of the motor vehicle accident. Miss the window by even one day and PIP medical benefits are forfeit for the entire claim. There is no exception for delayed-onset symptoms, no exception for not knowing the rule existed, and no exception for not being able to get an appointment.
Initial care does not have to be the full course of treatment. A documented urgent-care visit, a hospital emergency-room evaluation, a primary-care appointment, or an osteopathic/orthopedic consult inside the 14 days is enough to keep the file open. The visit needs to be tied to the crash in the chart notes, and the provider needs to be one of the categories § 627.736(1)(a) recognizes (a licensed physician, an emergency-department physician, a physician assistant, an ARNP, a dentist for dental injuries, or a hospital).
Treat the rule as a hard deadline starting at the moment of impact. Even if you feel fine at the scene, soft-tissue injuries from low-speed crashes often surface days later. A documented visit within the first week protects the claim with margin to spare, and it usually does not cost anything out of pocket because the visit itself is a PIP-billable expense.
Who PIP Actually Covers
PIP follows people more than it follows vehicles. The coverage on your policy extends to a wider group than most drivers realize, and one PIP policy in the household often does the work of three. Under § 627.736(4), the people covered by a Florida PIP policy include:
- check_circleThe named insured and any relative residing in the same household, whether they were driving, riding as a passenger, or struck as a pedestrian or bicyclist.
- check_circleAny other person occupying the insured vehicle at the time of the accident, including non-household passengers who are themselves uninsured.
- check_circleAny pedestrian or bicyclist hit by the insured vehicle, if that person does not own a vehicle and therefore has no PIP of their own.
If you live in a household with one car and one PIP policy, that PIP follows your spouse on a bicycle, your teenager riding in a friend's car, and you when you are walking the dog and a car clips you. It does not follow your roommate, because roommates are not relatives under § 627.732. It does not follow you in a rental car if you have your own PIP policy, because your own PIP follows you. It does not follow a household member who owns their own car but did not buy PIP; that person was supposed to carry it themselves and the law does not bail them out.
A relative residing in the household must be related by blood, marriage, or adoption to qualify under § 627.732(3). Domestic partners, fiancés, and step-relatives only qualify if they fit the statutory definition. If a household includes adults who are not statutorily related, each one needs their own PIP policy on their own vehicle to be protected.
What PIP Does Not Cover
PIP is broad in who it covers and narrow in what it pays for. Several categories are excluded by statute, and several more are practical exclusions that show up in claim denials over and over.
- check_circleMassage therapy is excluded by name under § 627.736(1)(a)(5), as defined in § 480.033. A licensed massage therapist cannot be reimbursed under PIP, regardless of the referring provider.
- check_circleAcupuncture is excluded by the same provision, as defined in § 457.102. A licensed acupuncturist cannot be reimbursed.
- check_circleTreatment that begins after the 14-day window is excluded, no matter how clearly connected to the crash.
- check_circlePain and suffering, mental anguish, and inconvenience are not PIP benefits at all. PIP pays bills, not damages. Those non-economic categories only become available if you can step outside no-fault under § 627.737(2).
- check_circleInjuries from intentional acts, from operating a vehicle while committing a felony, and from racing or speed contests are excluded.
- check_circleDamage to the vehicle itself. PIP is medical coverage. Vehicle damage runs through collision (your damage) or property damage liability (someone else's damage).
PIP does cover chiropractic care delivered by a Florida-licensed chiropractor for crash-related injuries, despite the popular myth that it does not. The 2013 PIP overhaul kept chiropractic in the program. What it removed was the chiropractor's authority to make the EMC determination. Treatment is reimbursable. The EMC sign-off has to come from elsewhere.
How to File a PIP Claim, Step by Step
PIP claims are first-party claims, which means you file them with your own insurance company even if the other driver was at fault. The process is structured around documentation, deadlines, and the strict no-fault rules above.
- check_circleReport the accident to your insurer as soon as possible. Most policies require notice within a reasonable time, and delays give the carrier an argument that the injury is not crash-related.
- check_circleSee a qualifying provider within 14 days. Bring the crash report number, tell the provider the visit is for an auto accident, and ask them to document the connection to the crash and, if appropriate, the EMC determination.
- check_circleSign the Florida Standard Disclosure and Acknowledgment Form when the provider asks you to. Under § 627.736(5)(e), the form is required for treatment to be PIP-billable.
- check_circleAuthorize the provider to bill PIP directly. Most Florida medical offices that take PIP know how to bill the insurer. They will need your auto insurance information, the date and location of the accident, and the police report number.
- check_circleKeep a calendar of every visit, the time off work, and any out-of-pocket expense (prescriptions, mileage to medical appointments, replacement-service costs). These are the documents your insurer will need for the wage-loss and replacement-service portions of the claim.
- check_circleRequest your medical records and billing summaries as they are generated. You will want them if the claim is disputed, if your treatment crosses over into bodily injury territory, or if you need to step outside no-fault.
Under § 627.736(4)(b), the insurer has 30 days after receiving notice of a covered loss to pay the claim or notify the claimant in writing of the reason for non-payment. Overdue payments accrue interest at the rate provided in § 55.03 and may give rise to attorney's fees under § 627.428 in many circumstances. If your insurer is dragging beyond the 30-day window without a written explanation, that is a flag worth raising with your agent or with the Florida Department of Financial Services consumer helpline at 1-877-693-5236.
When You Can Step Outside No-Fault and Sue
No-fault is a trade. You give up the right to sue most at-fault drivers in exchange for a guaranteed first-party medical benefit that pays regardless of fault. For minor and moderate injuries, the trade ends at PIP. For serious injuries, Florida law lets you step outside no-fault and pursue the at-fault driver for the full range of damages, including pain and suffering, that PIP never pays.
Florida Statute § 627.737(2) sets the threshold. You can sue the at-fault driver in tort if the injury consists of, in whole or in part:
- check_circleSignificant and permanent loss of an important bodily function.
- check_circlePermanent injury within a reasonable degree of medical probability, other than scarring or disfigurement.
- check_circleSignificant and permanent scarring or disfigurement.
- check_circleDeath.
The threshold is about permanence and severity, not dollar value. A herniated disc that resolves completely with treatment usually does not meet it. A fracture that heals with a permanent limitation usually does. A scar across the cheek from a windshield strike often does. The treating physician's documentation, especially the language about permanence and the impairment rating, drives whether a case crosses the threshold.
If you cross the threshold, the at-fault driver's Bodily Injury Liability coverage is the primary source of recovery. If that driver has no BIL (which a Florida driver carrying only the state minimum legally does not), your own Uninsured/Underinsured Motorist coverage is the backstop. Florida insurers must offer UM coverage, and you can only reject it in writing under § 627.727. That rejection is one of the most consequential signatures a Florida driver ever puts on paper.
PIP vs Health Insurance: How They Coordinate
On a Florida auto-accident claim, PIP is the primary payer for crash-related medical care under § 627.736. Your health insurance plan is secondary, picking up the 20 percent PIP did not pay (and the balance above PIP's $10,000 cap, once exhausted). Some health plans will not even process a crash-related bill until they see a PIP exhaustion letter from your auto insurer. Keep the paperwork.
Two coordination notes are worth knowing. First, some auto policies offer a Medical Payments (MedPay) endorsement that stacks on top of PIP and picks up the 20 percent PIP did not pay, plus the wage-loss gap. MedPay is not required by Florida law, but it is inexpensive and one of the cleanest ways to plug the PIP coinsurance hole. Second, under federal law, Medicare is always the payer of last resort. A Medicare beneficiary's crash-related care runs through PIP first, then through any Medicare supplemental coverage, then through Medicare itself, and Medicare has a statutory right of recovery if it pays before PIP is exhausted.
The Bottom Line
Florida PIP is a thin but useful first line of defense after a car accident. The statute pays 80 percent of medical costs and 60 percent of lost wages from a single $10,000 pool, plus a separate $5,000 death benefit. The full $10,000 of medical coverage is only available with an Emergency Medical Condition diagnosis from an MD, DO, PA, ARNP, or dentist for dental injuries. Without that diagnosis, the medical benefit caps at $2,500. The 14-day rule is the hardest deadline in the policy: see a qualifying provider within two weeks of any crash, or the PIP file closes before it opens. Massage and acupuncture are excluded by statute. Pain and suffering is not a PIP benefit and only becomes available if the injury crosses the § 627.737(2) threshold for stepping outside no-fault. Carrying real Bodily Injury Liability and Uninsured/Underinsured Motorist limits is the only way to backstop the gap PIP leaves behind, and that gap is bigger than the headline $10,000 number suggests.