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By Editorial Research Team · Florida injury guide ·

Florida No Fault Law Car Accident Guide: How PIP Claims Work in Hialeah

Florida no fault law car accident claims start with your own Personal Injury Protection (PIP) insurance, which pays 80% of reasonable medical bills and 60% of lost gross income, up to $10,000, no matter who caused the crash (Fla. Stat. § 627.736). Initial medical treatment must happen within 14 days of the accident, or PIP will not pay medical benefits. You can sue the at-fault driver for pain and suffering only if your injury meets a legal threshold, such as a permanent injury. This guide walks Hialeah drivers through each step, from the first phone call to the point where a lawsuit becomes an option.

Disclaimer: This guide is published by an independent information service and does not constitute formal legal advice. It is not affiliated with any law firm. For representation, consult a licensed Florida attorney.

What Is Florida’s No-Fault Law?

Florida’s no-fault system requires your own auto insurer to pay a first layer of medical and wage-loss benefits after a crash, regardless of fault. Owners of registered Florida vehicles with four or more wheels must carry at least $10,000 in PIP and $10,000 in property damage liability (PDL).

The idea is simple. Lawmakers wanted injured people paid quickly, without waiting months for a fault fight, and they wanted fewer small injury cases clogging the courts. In practice the system is a short-term safety net. It does not decide who was right, and it does not cover everything.

One point surprises newcomers. Florida does not require most drivers to carry bodily injury liability coverage as a condition of registering a car, so the person who hit you may have no insurance that pays for your injuries beyond your PIP. There is a catch, though. After certain crashes, such as those involving injuries, or after certain violations, the Florida Department of Highway Safety and Motor Vehicles (FLHSMV) can require a driver to show proof of bodily injury liability coverage to keep driving legally. Even so, that rule does not guarantee the driver who hit you was insured on the day of your crash. This is why your own uninsured/underinsured motorist (UM/UIM) coverage matters, and why Hialeah drivers often hear that the state minimums are thin.

PIP rules are also a live policy topic. Legislators have repeatedly considered changes, including proposals to repeal it. Confirm current requirements with your insurer or the Florida Department of Financial Services before relying on any summary, this one included.

Who Must Carry PIP in Florida?

Owners of registered vehicles with four or more wheels must carry PIP and PDL. Motorcycles, mopeds and similar two- or three-wheeled vehicles are generally not subject to the PIP requirement, though riders face their own risks and coverage options.

Letting coverage lapse has real consequences. The state can suspend your driver license, registration and license plate until you provide proof of insurance, and reinstatement fees apply. If you are hurt while uninsured, you may also lose access to PIP benefits and face limits on suing the other driver. When you switch policies, make sure the new one starts the same day the old one ends.

Does No-Fault Mean Nobody Is Blamed?

No. Only the initial round of medical and wage payments is fault-neutral, and fault still matters in several ways:

How Does PIP Work Under the Florida No Fault Law After a Car Accident?

After a crash, you report it, get medical care, and open a claim with your own insurer, which pays covered bills at 80% for medical and 60% for lost income, up to $10,000 total (Fla. Stat. § 627.736). The process is mostly paperwork, but small missteps can cost you money.

Most claims follow the same basic path, and each step below builds on the one before it.

  1. Call 911 if anyone is hurt and report the crash to police.
  2. Notify your own insurer promptly, even if you were not at fault.
  3. See a qualified provider within 14 days.
  4. The insurer opens a PIP claim and sends an application and other forms.
  5. Providers bill the insurer, or you submit bills yourself.
  6. The insurer pays 80% of reasonable, related, necessary medical expenses and 60% of lost income.

Deductibles. Many Florida policies carry a PIP deductible, commonly $250, $500 or $1,000. The deductible comes off your medical bills first, and then the 80% payment applies to the rest. Your declarations page shows yours.

Who PIP covers. Coverage generally extends to:

Whose policy responds can get complicated when several vehicles or households are involved, so ask the adjuster in writing which policy is handling your claim.

Payment timeline. Insurers generally must pay or deny within 30 days of receiving reasonable proof of the loss and the amount (Fla. Stat. § 627.736). Late payments can accrue interest. Disputes over what counts as reasonable are where claims tend to slow down.

What Does the $10,000 PIP Coverage Include?

Florida PIP coverage of $10,000 pays reasonable medical expenses, lost income, and a $5,000 death benefit (Fla. Stat. § 627.736). It does not cover vehicle damage, and it does not pay for pain and suffering.

The 80/60 split is where people get tripped up. Here is a worked example, assuming a $500 deductible:

ItemAmount
Medical bills$5,000
Minus deductible$500
Eligible medical balance$4,500
PIP pays 80% of that balance$3,600
Lost wages$2,000
PIP pays 60% of wages$1,200
Total PIP payment$4,800

That $4,800 is well inside the $10,000 limit, but it does not cover everything. On the medical side, you would still owe the $500 deductible plus the unpaid 20% of the $4,500 balance, which is $900, so $1,400 in total. On the wage side, you would absorb the $800 that PIP does not replace. Some people close that gap with health insurance or MedPay. Real calculations vary by policy and by how the insurer applies the fee schedule.

PIP also does not pay for your car, rental costs, or non-economic losses like pain and suffering. Certain services, such as massage therapy and acupuncture, are excluded from PIP medical benefits under the statute.

What Happens If Your Bills Exceed $10,000?

If your bills exceed the PIP limit, you look to other sources of payment. Which ones apply depends on your policy and on who caused the crash.

The Florida PIP 14-Day Rule: Why You Must Seek Treatment Fast

Under the PIP insurance claim Florida 14 days rule, you must receive initial medical treatment within 14 days of the crash or PIP will not pay medical benefits (Fla. Stat. § 627.736). Of all the PIP rules, this one causes the most avoidable denials.

Treatment must come from a qualifying provider. Under the statute, that includes:

There is a second limit that matters just as much. PIP pays up to the full $10,000 only if a physician, dentist, PA or APRN determines you had an emergency medical condition (EMC). If no emergency medical condition is determined, medical benefits are limited to $2,500 (Fla. Stat. § 627.736). Chiropractors can treat you, but they cannot make the EMC determination, so if you start with a chiropractor you may need a separate evaluation from a medical provider.

For Hialeah residents, the practical options are straightforward. Hospital emergency rooms like Palmetto General or Hialeah Hospital can document an injury right away. Urgent care centers along West 49th Street and other main corridors are usually faster and cheaper for non-life-threatening problems. A primary care doctor works too if you can get in within the window. If language is a barrier, ask for an interpreter or find a bilingual provider so your symptoms are accurately recorded.

What Counts as Initial Treatment?

Initial treatment means a real evaluation or care from a qualifying provider, such as an ER visit, urgent care appointment or visit to a doctor’s office. Calling a clinic or booking a future appointment does not count if no one actually examined you.

Keep these records:

What If Symptoms Appear After 14 Days?

If you were not seen within 14 days, PIP can refuse to pay medical benefits, and the deadline is applied strictly. Get evaluated immediately anyway and document when the symptoms began. Waiting to see whether the pain fades on its own is the most common way people lose coverage.

Delayed pain is common. Neck and back soft-tissue injuries, mild concussions and shoulder strains often feel minor on the day of a crash, then worsen over several days once adrenaline fades. A driver who feels fine after a fender-bender on the Palmetto Expressway may wake up stiff on day three. The safest habit is to get checked within a day or two, even if you think you are fine.

Missing the PIP window does not necessarily end every claim. Other claims, such as a bodily injury claim against the at-fault driver, can survive even if PIP is lost, which is one reason to speak with an attorney quickly.

How to File a PIP Claim After a Crash in Hialeah

Filing a PIP claim means reporting the crash, getting care within 14 days, notifying your insurer quickly and returning the forms it sends. Doing these things in order, and keeping copies, prevents most problems for people seeking PIP benefits after a car accident in Hialeah.

Who responds to the scene depends on where the crash happens, and the steps below apply no matter which agency shows up.

Use this checklist:

  1. Call 911 if there are injuries. Hialeah Police Department handles most crashes on city streets, Miami-Dade Police may respond in nearby unincorporated areas, and the Florida Highway Patrol typically covers expressways and state roads.
  2. Get the police report number. If police don’t respond, you may need to file a self-report within the time the state allows.
  3. Take photos of vehicles, plates, the road, signs, skid marks and visible injuries.
  4. Exchange information with the other driver, including insurance details, and get witness contact info.
  5. Notify your insurer promptly. Delay can give the company a reason to push back.
  6. Complete the PIP application and return it quickly.
  7. Sign the forms the insurer or provider sends. This may include an assignment of benefits, which lets a provider bill the insurer directly, and a wage and salary verification form for lost income.
  8. Keep every record in one folder, physical or digital.

Be careful with recorded statements. Your own insurer can ask for a sworn statement and, in some cases, an Examination Under Oath (EUO). Failing to cooperate can jeopardize benefits, so answer truthfully, and think about getting legal advice before an EUO. The insurer can also request an independent medical examination (IME), which you should attend.

Once the insurer has your bills and proof of loss, it generally has 30 days to pay or deny. If it does neither, a formal demand letter under Florida law is often the next step.

Florida No-Fault Insurance: When Can You Sue?

Under Florida no fault insurance, you can sue the at-fault driver for pain and suffering only if your injury meets Florida’s tort threshold. Otherwise, your recovery for non-economic damages is limited.

Economic damages work differently from non-economic ones. Medical costs and lost income beyond what PIP pays may be recoverable from the at-fault driver without meeting the permanency threshold.

Non-economic damages become available when the injury results in one of these:

Two other rules matter here, and both changed with the 2023 tort reform (HB 837):

What Injuries Meet the Permanent Injury Threshold?

Injuries that may meet the threshold are those a physician says will last, with lasting impairment. Common examples include:

The key is medical evidence. A doctor’s permanency opinion, based on exams, imaging and treatment history, is usually central. Insurers often dispute it and may hire their own doctors, so the quality of your records counts.

What Damages Can You Recover Outside No-Fault?

If you meet the threshold, you can seek damages beyond PIP from the at-fault driver:

Collecting depends on available insurance. If the at-fault driver has bodily injury coverage, that is the first source. If they have little or none, your UM/UIM coverage may apply. Reviewing your own policy before a crash is worth more than most people expect.

Common Reasons PIP Claims Are Denied or Delayed

Most PIP denials come down to missed deadlines, paperwork gaps or disputes about whether treatment was related and necessary. Knowing the common triggers helps you avoid them.

If you receive a denial, take these steps:

  1. Ask for the reason in writing.
  2. Gather your medical records, bills and the police report.
  3. Check the policy language and your deadlines.
  4. Submit any missing documents.
  5. Send a pre-suit demand letter, which Florida law requires before most PIP lawsuits, usually through an attorney.
  6. Consult a Florida attorney if the insurer doesn’t fix the problem.

You can also contact the Florida Department of Financial Services, which handles consumer complaints about insurers, if you believe a claim is being mishandled.

Do You Need a Car Accident Lawyer for a PIP Claim?

Not always. If you had a minor injury, saw a doctor right away, and the insurer is paying on time, you can often handle a simple PIP claim on your own. A lawyer becomes worth considering when the stakes or the friction rise.

Consider hiring one if:

Most personal injury attorneys in Florida work on contingency, meaning they take a percentage of any recovery instead of charging hourly, and many offer free consultations. The Florida Bar sets the ground rules (Rule 4-1.5 of the Rules Regulating The Florida Bar). A contingency fee agreement must be in writing and signed by both you and the lawyer, and you must receive a Statement of Client’s Rights. For personal injury cases, the presumptively reasonable maximums are 33⅓% of any recovery up to $1 million if the case resolves before an answer is filed (or the time to answer expires), and 40% of any recovery up to $1 million after that point through trial. Lower percentages apply to amounts above $1 million. Costs are a separate question, so ask how they are handled.

Good questions to ask at a consultation:

No honest attorney can guarantee an outcome, so be wary of anyone who promises one.

This article provides general information about Florida’s no-fault law and is not legal, insurance or financial advice. Laws change, including through Florida’s 2023 tort reform and ongoing proposals to alter or repeal PIP, so some details may be out of date by the time you read this. Reading it does not create an attorney-client relationship. For advice on your own situation, consult a licensed Florida attorney or insurance professional.

About This Guide and Its Sources

This guide was prepared by the Editorial Research Team of Florida Car Accident Lawyers Guide, an independent information service. We are not a law firm, an insurer or a lawyer referral service, and we are not affiliated with any provider. The legal points above rest on the statutes and rule cited in the text. Check the primary sources yourself:

Frequently Asked Questions

Is Florida a no-fault state for car accidents?

Yes. Your own PIP coverage pays first regardless of who caused the crash (Fla. Stat. § 627.736). You can still pursue the at-fault driver if your injuries meet the legal threshold.

What is the 14-day rule for PIP in Florida?

You must get initial medical care within 14 days of the crash or PIP will not pay medical benefits (Fla. Stat. § 627.736). The care must come from a qualifying provider, such as an MD, DO, dentist, chiropractor, or a PA or APRN under supervision.

How much does PIP cover in Florida?

PIP covers up to $10,000: 80% of reasonable medical expenses and 60% of lost gross income. If no emergency medical condition is determined, medical benefits are limited to $2,500 (Fla. Stat. § 627.736).

Can I sue after a car accident in Florida if I have PIP?

Yes. You can seek pain and suffering damages if you have a permanent injury, significant and permanent scarring or disfigurement, or a death occurred. Economic losses above what PIP pays may also be claimed.

Does PIP cover my car repairs?

No. Vehicle damage is covered by your collision coverage, the at-fault driver’s property damage liability, or both.

Does PIP cover passengers and pedestrians?

Often, yes, when they have no PIP of their own. Coverage depends on residency, vehicle ownership and the facts of the crash, so ask the insurer in writing which policy is handling the claim.

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

Generally two years for negligence claims that arise on or after March 24, 2023, and four years before that date (Fla. Stat. § 95.11). Other claim types have their own rules, so confirm the deadline for your situation.

What should I do if my PIP claim is denied in Hialeah?

Ask for the denial in writing, gather your medical records and bills, and submit any missing documents. Send a pre-suit demand letter if needed, and consider speaking with a Florida attorney.