After a car crash in Florida, many people are shocked to learn they can’t immediately sue the other driver for the cost of their medical expenses, even if that driver was clearly at fault. Instead, Florida’s no-fault insurance system requires you to turn first to your Personal Injury Protection (PIP) coverage.
But if your injuries are severe, you may be eligible to pursue compensation beyond PIP, including damages for pain and suffering, by meeting the state’s serious injury threshold.
At Aigen Injury Law, an experienced Miami car accident lawyer can guide you through the claim process.
What PIP Covers and What It Doesn’t
PIP generally pays up to $10,000 in damages, depending on coverage limits: this includes 80% of reasonable medical expenses, 60% of lost income, and a $5,000 death benefit.
To qualify, you must get initial treatment within 14 days of the crash. If your injuries aren’t deemed an emergency medical condition, medical benefits are capped at $2,500.
So where does the at-fault driver’s insurance come in? Two ways:
- Economic Losses Beyond PIP: You can still pursue the at-fault driver for economic damages PIP didn’t cover (for example, the 20% of medical bills PIP doesn’t pay, lost wages beyond the 60% PIP share, or amounts over the $10,000 limit).
- Non-Economic Losses (Pain and Suffering): To claim these, you must cross Florida’s serious injury threshold: a legal gatekeeper that limits when you can step outside Florida’s no-fault insurance system and sue for pain and suffering, mental anguish, and similar harms.
What is Florida’s Serious Injury Threshold?
Under Florida Statutes § 627.737, you may seek non-economic damages from the at-fault driver only if your injury consists, in whole or in part, of one of the following:
- Significant and permanent loss of an important bodily function
- Permanent injury within a reasonable degree of medical probability
- Significant and permanent scarring or disfigurement
- Death
Your medical records and expert opinions must establish permanence or a qualifying condition, not just that you were badly hurt for a while.
Common Injuries That Often Meet the Threshold
Every case depends on medical proof, but injuries that frequently qualify include:
- Traumatic brain injuries with lasting cognitive or neurological deficits
- Spinal injuries (e.g., herniated discs) that result in permanent impairment or surgery with ongoing limitations
- Complex fractures (especially those requiring internal fixation) and joint injuries that permanently reduce function
- Significant facial scars or disfigurement
- Loss of limb or organ function
- Wrongful death
How Often Do Florida Crashes Reach the Serious Injury Threshold?
In 2023, the state recorded 12,456 incapacitating injury crashes out of about 164,413 total injury crashes, or roughly 7.6%.
That’s not a perfect one-to-one with the legal threshold (some incapacitating injuries won’t prove permanent, and some non-incapacitating injuries ultimately do), but it’s a helpful indicator of how often cases may rise to this level.
How PIP and a Personal Injury Claim Work Together
Think of your claim in layers, with each stage building on the last to help you recover the full amount you’re owed. Your PIP benefits are just the foundation to cover immediate medical bills and some lost income.
From there, additional layers of compensation may become available, depending on the severity of your injuries and the evidence supporting your case:
- Layer 1: PIP pays first (medical bills at 80%, wages at 60%, up to $10,000; $2,500 cap without an emergency medical condition; 14-day treatment requirement).
- Layer 2: Economic damages from the at-fault driver (anything PIP didn’t pay: uncovered medical bills, remaining wage loss, and other out-of-pocket costs), even if you do not meet the serious injury threshold.
- Layer 3: Non-economic damages (pain and suffering, mental anguish, loss of enjoyment of life) only if you prove a qualifying serious injury.
Also, remember Florida’s modified comparative negligence rule: if you’re more than 50% at fault, you can’t recover any damages outside of PIP. Insurers may try to inflate your share of blame to reduce or bar your claim.
Why Hiring a Lawyer Matters
Insurance companies actively look for ways to reduce or deny your claim. They may argue that your injuries aren’t permanent, that you didn’t have an emergency medical condition, or that your symptoms are the result of a pre-existing condition rather than the crash.
Some insurers even send victims to independent medical exams (IMEs) with doctors hired by those insurers to minimize the severity of their injuries or dispute causation.
Because of these tactics, proving that your injuries meet Florida’s serious injury threshold requires a strategic legal approach that includes:
- Immediate and consistent medical documentation from qualified providers
- Expert opinions tying your limitations to the crash and addressing permanence
- A complete accounting of future medical needs, wage loss, and life-impact
- Strategic use of imaging, specialist reports, and functional capacity evidence
At Aigen Injury Law, your Miami car accident lawyer helps build this proof from day one, coordinating with your doctors, gathering expert opinions, and pushing back when insurers minimize your injuries.
We handle PIP issues, pursue the at-fault driver for uncovered economic losses, and, when the facts support it, seek full non-economic damages by establishing that you meet Florida’s serious injury threshold.
Get Experienced Legal Help for Your Florida Car Accident Claim
If you’ve been hurt in a South Florida crash, call Aigen Injury Law for a free consultation. Our experienced Miami car accident lawyers know how to build strong cases, counter insurance company tactics, and prove that your injuries meet the state’s serious injury threshold.