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01/10/2014
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Who is covered by PIP?

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Personal Injury

The Gainesville Automobile Collision Attorneys, of the Law Office of Alba & Yochim P.A., recognize that Florida policyholders often have difficulty determining precisely which persons may be entitled to Personal Injury Protection (PIP) benefits in the event that a car accident occurs — whether under their own auto insurance policy, or the auto policy held by another individual.

In accordance with the provisions set forth under Florida Statutes, section 627.736(1), PIP provides coverage to five main categories of individuals, each of which are discussed below.

Named Insured. The most obvious category of individuals that PIP provides coverage for are the persons named in the insurance policy, or as stated in the statute, the ‘named insured.’ Some auto policies have more than one person listed on the policy, and absent an exclusion to the contrary, each person named in the insurance policy will qualify for PIP coverage.

Resident Relatives. The second category of individuals that PIP benefits cover are persons that reside in the same household as named insured, or ‘resident relatives.’ Unless an auto policy specifically excludes a resident relative, or another restriction applies, a resident relative will qualify for PIP benefits under the named insured’s policy, even if the victim was injured while in a vehicle other than the named insured’s.

Person Operating Insured Vehicle. The third category of individuals that may be entitled to PIP benefits is a person that is injured while operating a vehicle that is insured under the policy. It is important to note that entitlement to PIP benefits is subject to any authorized exclusions included within the policy.

Passengers. The fourth category of individuals that qualify for PIP coverage under Florida law are passengers that are injured while riding in a motor vehicle that is covered under the auto policy. As with other categories of persons, entitlement to PIP benefits is subject to any authorized exclusions included within the policy.

Other Persons Struck by Insured Motor Vehicle. The fifth category of individuals that PIP provides benefits for, are persons struck by an insured motor vehicle while NOT an occupant of a self-propelled motor vehicle. Because Florida law does not specifically define “self-propelled” vehicle, assessing entitlement to PIP benefits depends heavily on case law to interpret the manner in which the court will classify the terms ‘self-propelled,’ and/or ‘vehicle,’ and in some cases even ‘occupant.’

As stated within the classifications described above, it is also necessary to take into considerations any policy exclusions that limit coverage to a particular person and/or in specific scenario. Consider the following two categorizations: (1) Statutory Exclusions that are generally automatic; (2) Contractual Provisions that are authorized by statute. While the two are actually interrelated, in the sense that contractual provisions must be authorized by statute, and statutory provisions will be included within the auto policy (contract), it can be helpful to distinguish between the two in order to better understand basic principles of PIP.

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Statutory Exclusions, which can result in the automatic denial of PIP benefits, refer to a victim’s failure to meet the medical treatment prerequisites, as required by state law. Under Florida’s revised PIP statute, the victim must seek treatment within 14 days following the injury or accident, and receive a diagnosis of an injury requiring emergency medical treatment, by a qualifying medical professional, as defined by statute. As Auto Accident Attorneys, the Law Office of Alba & Yochim P.A. encourage you to take the time to fully understand the effect of Florida’s Revised PIP Statute.

Contractual Provisions, in terms of coverage exclusions authorized by statute, refer to the specific terms included within a particular person’s auto policy. These terms are agreed upon between the insurance provider and the policyholder during the process of contracting for auto insurance policy. Pursuant to Florida Statute, section 627.736(2), an insurer is authorized to exclude PIP coverage if:

(1)    The ‘named insured’ or ‘resident relative’ was injured while occupying another motor vehicle owned by the named insured;
(2)    The injured was operating an insured vehicle without the express or implied consent of the named insured;
(3)    The intentional conduct of the injured contributed to his or her injury;
(4)    The injury occurred  while committing a felony

It is important to note the emphasis on the words ‘authorized’ and ‘automatic’ when assessing entitlement to benefit coverage. In other words, certain persons may be entitled to coverage, and others may be denied coverage, regardless of policy provisions. For this reason, it is vital for accident victims to discuss the matter with an attorney experienced in handling auto accident cases, prior to making any self-determinations, or simply accepting an insurance provider’s decision to deny coverage.

The Law Office of Alba & Yochim P.A. understands that despite their duty to act in good faith, insurance companies do not always manage claims in a manner that adequately protects the claimant’s interests, and in some cases even act in bad faith. As such, ensuring the full protection of a victim’s rights is not only a concept our lawyers remain dedicated to, but is a founding principle upon which our firm is based.