Medical bills do not stop when your auto insurance benefits run out. After a car accident in Florida, personal injury protection (PIP) generally pays 80% of covered medical expenses, subject to eligibility requirements and coverage limits. The standard $10,000 limit is shared with lost-income and other disability benefits, so the full amount may not be available for treatment.

If your medical bills exceed PIP coverage, health insurance or optional Medical Payments coverage may help. You may also have a claim against an at-fault driver or through uninsured or underinsured motorist coverage. Which options apply depends on your policies and the circumstances of the crash. Running out of PIP does not necessarily mean you must pay every remaining bill yourself.

Key Takeaways: What Happens If Your Medical Bills Exceed PIP Coverage in Florida?

• Florida’s standard PIP coverage provides up to $10,000 in combined medical and disability benefits. Payments for lost income reduce the amount available for treatment.
• PIP generally pays 80% of covered medical expenses when you receive qualifying initial care within 14 days. Access to the higher medical limit requires an emergency medical condition determination.
• Health insurance and optional Medical Payments coverage may help with expenses PIP leaves unpaid.
• You may pursue unpaid medical expenses from an at-fault driver without having a permanent injury. A separate injury threshold generally applies to pain and suffering.
• Liability and uninsured or underinsured motorist claims generally provide compensation through a settlement or judgment rather than paying each medical bill as it arrives.
• Review unpaid bills before paying them. Billing restrictions, insurance adjustments, and provider agreements may affect what you owe.

How Much Does Florida PIP Pay Toward Medical Bills?

Florida PIP generally pays 80% of reasonable expenses for medically necessary accident-related care. To qualify for medical benefits, you must receive initial services and care within 14 days of the crash from an eligible provider.

The standard coverage includes:

• Medical benefits: Payment of 80% of covered medical expenses, subject to applicable limits.
• Disability benefits: Payment of 60% of accident-related lost gross income and earning capacity, unless that coverage was excluded under the policy. PIP also covers reasonable expenses for necessary household services you can no longer perform.
• Death benefits: A separate $5,000 benefit in addition to medical and disability benefits.

Medical and disability payments share the $10,000 limit. However, medical reimbursement is generally limited to $2,500 without a qualifying determination that you had an emergency medical condition.

An emergency medical condition involves acute symptoms serious enough that going without immediate medical attention could threaten your health or seriously impair a bodily function, organ, or body part. An eligible physician, dentist, physician assistant, or advanced practice registered nurse must make that determination.

An emergency medical condition finding makes the higher medical limit available; it does not increase the combined medical and disability limit beyond $10,000.

What Happens After You Exhaust PIP Benefits in Florida?

Once the applicable benefits are exhausted, PIP stops paying additional expenses under that coverage. Start by asking your insurer for a payment history and written confirmation of the remaining benefits.

Here is an example, assuming a qualifying emergency medical condition, no deductible, and fully covered charges:

• $9,000 in medical expenses results in $7,200 in PIP payments.
• $4,000 in lost income results in $2,400 in PIP payments.
• Together, those payments use $9,600 of the $10,000 limit.
• Another $500 covered medical expense results in a $400 payment, exhausting the remaining benefits.

Even before exhaustion, the unpaid 20% of covered medical expenses must be addressed. Other insurance may help, but the amount you owe depends on the applicable coverage and billing rules.

Your policy may also have a deductible. Review the declarations page and payment explanations rather than assuming every difference between a bill and a PIP payment is your responsibility.

Who Pays Medical Bills That PIP Does Not Cover?

Several sources may help with medical treatment costs after an accident. They serve different purposes and do not all pay bills on the same schedule.

Health Insurance

Health insurance may cover eligible treatment after PIP is exhausted. Your plan’s network requirements, deductibles, copayments, coinsurance, and authorization rules still apply.

Give providers your health insurance information and ask whether they need a PIP exhaustion letter before submitting claims. Do not assume bills will automatically transfer from your auto insurer to your health plan.

Medical Payments Coverage

Medical Payments coverage, often called MedPay, is optional auto insurance that may help pay covered accident-related medical expenses regardless of fault. Depending on the policy, it may help with the portion PIP does not pay or with expenses after PIP is exhausted.

Check whether your policy includes MedPay, its limit, and how it coordinates with other insurance.

The At-Fault Driver’s Bodily Injury Liability Coverage

If another driver caused your injuries and has bodily injury liability coverage, you may seek compensation for legally recoverable losses through that coverage.

These claims generally resolve through a settlement or judgment. The other driver’s insurer does not necessarily pay your providers as each bill arrives. You still need to address billing arrangements while the claim is pending.

Uninsured or Underinsured Motorist Coverage

Uninsured or underinsured motorist coverage, commonly called UM/UIM, may help when an at-fault driver has no bodily injury liability insurance or too little to cover your damages.

You must have applicable coverage and establish the other driver’s legal responsibility. UM/UIM does not duplicate benefits available from PIP or other applicable sources.

Your Own Responsibility for Valid Unpaid Charges

You may remain responsible for valid charges that insurance does not cover. However, applicable billing restrictions and provider agreements can affect the amount owed.

If you cannot afford medical treatment after an accident, ask providers about payment plans or financial assistance. Review disputed balances before agreeing to pay them.

Can You Recover Unpaid Medical Expenses From the At-Fault Driver?

You may seek compensation for accident-related medical expenses PIP did not pay if another driver was legally responsible. You must establish fault, connect the treatment to the crash, and prove the recoverable amount.

You generally cannot recover the same losses twice. Florida law excludes damages for which PIP benefits were paid or remain payable.

A permanent injury is not generally required to pursue unpaid medical expenses or other recoverable economic losses. Pain and suffering is different. When Florida’s motor vehicle injury threshold applies, the injury must involve:

• Significant and permanent loss of an important bodily function
• Permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement
• Significant and permanent scarring or disfigurement
• Death

The amount printed on a medical bill also does not automatically establish its value in a lawsuit. Florida law governs the evidence used to prove medical expenses, including amounts paid and amounts needed to satisfy unpaid charges.

Can Health Insurance Seek Repayment From Your Settlement?

A health plan that pays accident-related bills may have a right to reimbursement from a later recovery. This is often discussed as subrogation or reimbursement.

The rules depend on the plan and applicable law. Medicare, Medicaid, and certain employer health plans can involve different requirements.

Keep reimbursement notices with your accident records. Before settlement funds are distributed, any claimed repayment rights should be reviewed to determine whether they apply and how much is owed.

How Does Fault Affect Recovery for Bills Beyond PIP?

PIP generally pays covered benefits regardless of who caused the crash. Recovering additional compensation from another driver requires proof that the driver was legally responsible.

Useful evidence may include witness accounts, photographs, video footage, vehicle damage, and other crash-related records. If fault is disputed, the claim may require further investigation or litigation. An insurer’s denial does not automatically end the matter.

Under Florida’s current comparative negligence rules, your share of fault generally reduces your recovery in a car-accident negligence claim. If you are more than 50% responsible for your own harm, you generally cannot recover damages.

For example, if your recoverable damages are $50,000 and you are 20% at fault, the fault reduction leaves $40,000. At 51% fault, recovery is generally barred. This rule does not determine eligibility for ordinary no-fault PIP benefits.

What Should You Do Before PIP Benefits Run Out?

Keeping track of benefits early gives you more time to arrange payment for continued care.

• Track payments. Keep bills and insurance payment records, and ask your PIP insurer how much coverage remains.
• Confirm the emergency medical condition determination. Ask whether an eligible provider has documented the finding needed for the higher medical limit.
• Review other coverage. Check for MedPay and UM/UIM, and ask your health plan how it handles accident-related treatment.
• Give providers updated information. Share applicable health insurance details and any PIP exhaustion notice.
• Keep records of missed work. Lost-income payments affect the PIP balance, and wage records may also support a liability claim.
• Discuss ongoing treatment with your provider. A low PIP balance is a reason to review payment options and coverage while you continue making medical decisions with your treating provider.

Frequently Asked Questions About Florida PIP Coverage

How long do I have to file a lawsuit after a Florida car accident?

Florida generally allows two years from the crash date to file a negligence lawsuit for accidents occurring on or after March 24, 2023. Exceptions can affect the deadline, so confirm the filing date for your circumstances early.

Does my PIP cover passengers in my car?

A passenger may receive PIP benefits through their own policy or an applicable policy belonging to a relative in the same household. Your vehicle’s PIP generally applies when the passenger is not otherwise entitled to PIP benefits. Coverage depends on the passenger’s circumstances and the applicable policies.

Can a clinic bill me because it submitted its PIP claim too late?

Florida generally prohibits a provider from shifting charges to you when they went unpaid because the provider missed the applicable PIP billing deadline.

For many services, bills must be submitted within 35 days. That period may extend to 75 days if the provider submits notice of treatment within 21 days of the first examination or treatment. Certain hospital and emergency services are exempt, and incorrect insurance information can affect the deadline.

Can I sue the at-fault driver personally if insurance is insufficient?

You may be able to pursue the driver personally for damages that exceed available insurance. A permanent injury is not generally required to seek unpaid medical expenses, although a separate threshold usually applies to pain and suffering. Whether you can collect a judgment depends on available assets and applicable legal protections.

Will filing a PIP claim raise my premium?

Florida generally prohibits an insurer from imposing an additional premium solely because you were involved in an accident unless it determines in good faith that you were substantially at fault. That protection does not prevent unrelated premium changes, such as general rate increases.

Get Legal Help with Brandon J. Broderick, Attorney at Law

When PIP runs out, understanding your remaining coverage can help you address medical bills and plan for continued treatment. An attorney can review your policies, investigate the crash, and explain whether you have a claim for compensation beyond PIP.

At Brandon J. Broderick, Attorney at Law, we help injured people understand their options after a Florida car accident. Our team is available 24/7, and we offer a free consultation to discuss your situation.

Contact us today.