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POLICY NUMBER: COMMERCIAL AUTO CA 22 50 01 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA EXTENDED PERSONAL INJURY PROTECTION For a covered auto” licensed or principally
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How to fill out FL extended PIP form:

01
Begin by gathering all the necessary information and documents. This may include your personal information, insurance details, medical records related to the accident, and any other relevant paperwork.
02
Carefully read through the form to understand what information is required in each section. Pay attention to any instructions or special requirements mentioned in the form.
03
Start by providing your basic personal information, such as your name, address, contact details, and insurance policy number. Make sure to double-check for any typos or errors before moving on.
04
Proceed to fill in the details of the accident. This may include the date, time, and location of the incident, as well as a brief description of how it occurred. Provide as much detail as possible to accurately reflect the circumstances of the accident.
05
If there were any witnesses to the accident, provide their names and contact information. Witnesses can play a crucial role in supporting your claim, so ensure their details are accurate.
06
In the medical information section, detail your injuries sustained from the accident. Include any diagnosis, treatments received, and medical professionals involved in your care. Attach relevant medical records or reports if required.
07
Provide information about any lost wages or income as a result of the accident. This may require you to provide documentation from your employer, such as pay stubs or letters confirming the time missed from work.
08
Finally, review the completed form for any mistakes or omissions. It's essential to ensure that all the information provided is accurate and up-to-date. Make any necessary corrections before submitting the form.

Who needs FL extended PIP form?

01
Individuals who have been involved in a car accident in the state of Florida may need to fill out the FL extended PIP form.
02
This form is specifically for those seeking additional Personal Injury Protection (PIP) benefits beyond the basic coverage required by Florida law.
03
Individuals who have suffered significant injuries, medical expenses, lost wages, or other damages may require the FL extended PIP form to claim additional compensation from their insurance provider.
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The FL Extended PIP form is a form used to apply for extended personal injury protection benefits in the state of Florida.
Any individual who has exhausted their standard personal injury protection benefits may be required to file the FL Extended PIP form.
To fill out the FL Extended PIP form, you must provide detailed information about your medical condition and treatment, as well as any additional expenses related to the injury.
The purpose of the FL Extended PIP form is to request additional personal injury protection benefits beyond the standard coverage limits.
The FL Extended PIP form requires information such as medical records, treatment history, and itemized expenses related to the injury.
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