Accident Injuries & why

You were just in a car accident in Tampa — and now your doctor’s office is telling you that your PIP coverage only paid 80% of your medical bills. The other 20% is sitting on your kitchen table, and you have no idea who’s supposed to pay it. Here’s what Florida law actually says about that gap, and what your options are. TL;DR — QUICK SUMMARY Florida’s Personal Injury Protection (PIP) insurance covers 80% of reasonable and necessary medical expenses up to the $10,000 policy limit — leaving a 20% gap you may owe out of pocket unless other coverage applies. If another driver caused your accident, their bodily injury liability (BIL) coverage — or a lawsuit against them — can cover the 20% gap and any costs beyond your PIP limit. Your health insurance may cover the unpaid 20%, but coordination of benefits rules and subrogation rights can complicate how that works. Under Florida Statute § 95.11(3)(a), you have two years from the date of your crash to file a personal injury lawsuit to recover that gap and all other damages from an at-fault driver. Medical providers cannot legally balance-bill you for amounts above the PIP fee schedule unless you signed an assignment of benefits or a separate agreement — knowing this can protect you from improper bills. The Reyes Firm Confused About Your PIP Bills After a Tampa Crash? Get clear answers about the 20% gap and who should really be paying it. Had a bad day? Contact Us Now $10,000 Florida minimum PIP coverage limit Fla. Stat. § 627.736 80% PIP pays of covered medical bills Fla. Stat. § 627.736(1)(a) 2 Years Florida personal injury statute of limitations Fla. Stat. § 95.11(3)(a) $0 Cost to consult The Reyes Firm Contingency fee — no recovery, no fee What is Florida’s PIP 20% gap and do you have to pay it? Florida’s Personal Injury Protection law requires that your auto insurance cover 80% of reasonable and necessary medical expenses — and only 80%. That 20% remainder is what people call the “PIP gap.” Whether you personally owe it depends on several factors: who caused the accident, what other insurance you carry, and what agreements you signed with your medical provider. Florida is a no-fault state, which means after a car accident, your own PIP coverage pays first — regardless of who was at fault. Under Florida Statute § 627.736, every Florida driver must carry at least $10,000 in PIP coverage, and that coverage pays 80% of covered medical costs and 60% of lost wages. The 20% gap on medical bills is built into the statute itself — it’s not a billing error and it’s not optional. The question is who ends up responsible for covering it. If the accident was someone else’s fault, you may have a legal claim against the at-fault driver that covers the 20% gap, all medical costs beyond your $10,000 PIP limit, lost income, pain and suffering, and more. That’s where a Tampa personal injury attorney can make a real difference. ⚠️ Deadline Warning: Under Florida Statute § 95.11(3)(a), you have two years from the date of your crash to file a personal injury lawsuit against the at-fault driver. If you’ve been carrying the 20% gap yourself and another driver was responsible, waiting too long could permanently close the door on recovery. Call a lawyer before that deadline passes. How does Florida PIP insurance actually work after a car accident? Florida PIP works by paying directly to your medical providers — not to you — based on a statutory fee schedule. When you receive treatment after an accident, your provider bills your PIP insurer. The insurer pays 80% of the allowable amount under the fee schedule. The remaining 20% is either written off by the provider, covered by your health insurance, or billed to you depending on what agreements are in place. There are a few important things to understand about how PIP processes your bills: The fee schedule controls what’s “reasonable.” Florida PIP doesn’t simply pay 80% of whatever a provider charges. It pays 80% of the amount set by the Medicare fee schedule or 200% of Medicare — whichever applies to the provider. If a provider charges more than the schedule allows, PIP will not cover the excess, and the provider generally cannot bill you for the difference under Florida law. Emergency vs. non-emergency treatment matters. Under Fla. Stat. § 627.736, if your injury is classified as an emergency medical condition (EMC), you can access the full $10,000 PIP limit. If your treating provider does not certify an EMC, your accessible PIP benefit is capped at $2,500. This is one of the most misunderstood and financially damaging aspects of Florida PIP. You must seek treatment within 14 days. Florida law requires that you seek initial medical treatment within 14 days of the accident to be eligible to use your PIP benefits at all. Missing this window means losing your PIP coverage entirely — regardless of how serious your injuries are. Watch: Do You Pay 20% After a Car Accident?  Who pays the 20% PIP gap — you, your health insurer, or the at-fault driver? The answer depends on your specific situation, and there’s no single rule that applies to every accident victim. The 20% gap can be absorbed in several different ways. Option 1 — The at-fault driver’s bodily injury liability coverage. If another driver caused your accident, their liability insurance may cover your 20% co-pay, all medical expenses above your $10,000 PIP limit, lost wages not covered by PIP, and pain and suffering damages. Florida does not require drivers to carry bodily injury liability (BIL) insurance, but many drivers do carry it — and if they do, it’s often the best source of recovery for your gap costs. Option 2 — Your health insurance. If you have private health insurance, an employer plan, Medicare, or Medicaid, your health insurer may pick up the 20% co-pay after PIP pays its 80%.