Jeffrey P. Gale, P.A. // Florida PIP Coverage for Foreign Country Medical Care

Personal Injury Protection (PIP) is a type of insurance coverage that is mandatory on operational motor vehicles registered in Florida. See Florida statute 627.736. It provides “protection to the named insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in the motor vehicle, and other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle.” 627.736(1).  

Like most insurance carriers, PIP carriers are practiced at findings legitimate and some less than legitimate reasons for denying coverage, even for medical care provided in Florida. Standard excuses include application misrepresentation and failure to cooperate. Foreign care presents additional hurdles.

The greatest hurdle can be getting the foreign medical provider to even be able to comply with Florida’s unusual billing requirements. Besides having to use forms unique to America’s medical/insurance system — 627.736(5)(d) requires use of CMS/UB forms — the bills have to be provided (on those forms) within thirty-five (35) days of the furnishing of treatment. See, 627.736(5)(c). Florida law also requires the patient to execute a set of forms no foreign provider will have in its possession.

One route patients take to overcome these hurdles is by paying out-of-pocket for the care then seeking reimbursement from the PIP carrier. Some carriers will even pay without a fight. Many will not.

In theory, as long as the claimant qualified for PIP under the particular policy at the time of the accident, the only constraint on reimbursement for medical expense should be the reasonableness of the charges, regardless of where the medical care is rendered. For example, a person who gets in an accident and is getting his Florida medical bills paid by his PIP carrier goes overseas on vacation and has an acute flare-up of his ongoing problems and requires immediate care. The PIP carrier may balk at whether the care is necessary, or the expense incurred in a foreign country is reasonable, but it is not a coverage issue per se.

If it were only that simple.