What Is the Florida PIP 14-day Rule? You have 14 days to get medical care for the injuries you suffered in a Florida car accident or your PIP provider may deny your claim for benefits.

The Florida PIP 14-day rule requires any injured victims to seek medical care within 14 days of an accident. If you believe you suffered injuries, it is paramount you see a doctor right away to get the care you need. If you fail to seek care within the first two weeks after an accident, your insurer will likely deny your claim.

It is a good idea to seek medical care even if you are unsure whether you suffered injuries. Many injuries take hours or even days to appear.

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Get Approved Medical Care on Time

Under the 2013 PIP law change, an accident victim must get “initial services and care” within two weeks of a crash if they want to receive benefits through their PIP coverage. Almost any type of medical attention will meet this requirement as long as it comes from a qualified healthcare provider, or a qualified healthcare provider supervised or prescribed the care.

A qualified healthcare provider might include:

  • A medical doctor
  • A dentist
  • A chiropractor
  • An emergency medical technician

It is important to note that seeing a physical therapist, massage therapist, or other care provider not specifically listed in the statute will likely not meet the criteria. Your insurance company will likely deny your claim, and you will not receive benefits. 

It is always a good idea to go to the emergency department or see your doctor as soon as possible after a crash, both to ensure you are healthy and to meet this qualification as outlined in the Florida PIP 14-day rule.

The Florida PIP 14-Day Rule and Payout Limits

When Florida passed the amendment to its PIP law, the new statute also established limits on the benefits available through a personal injury protection claim. Under the new rules, if you received treatment within 14 days and:

  • Suffered only non-emergency injuries, you can only receive $2,500 in benefits
  • Suffered an “emergency medical condition,” you can receive the maximum payout available from your PIP coverage

You should have at least $10,000 in coverage available to you. This is the state’s minimum amount of PIP coverage required; however, you might carry a larger policy.

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Defining an “Emergency Medical Condition”

Florida Statutes § 395.002(8) defines an “emergency medical condition” as it applies to PIP insurance claims in the state. The statute outlines this as a situation where victims suffered from acute symptoms that require immediate attention to prevent:

  • Endangering their health and wellbeing
  • Impairment of a major body function
  • Serious dysfunction of any organ or body part

It is a good idea to discuss this with your doctor, who can note in your charts that you suffered an emergency medical condition. This may help your case. It is important to note there does not have to be a determination of whether your injury is an “emergency medical condition” within the first 14 days after an accident. As long as you seek medical care within the first two weeks, you should be eligible for some type of payout from your PIP insurance provider.

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What does My PIP Insurance Cover?

If you get the required medical care within 14 days, your insurance should cover up to 80 percent of your accident-related medical bills up to the designated amount. This is according to the Florida Department of Highway Safety and Motor Vehicles (FHSMV). This could include but is not limited to:

  • Emergency treatment: If you had to ride in an ambulance or get emergency surgery, your insurance should cover it.
  • Assistive devices: Canes, crutches, wheelchairs, hearing aids, artificial limbs, and any other device that helps you live your life should be covered, whether you need these devices temporarily or permanently.
  • Follow-up care: This includes appointments where your doctor assesses your condition, removes stitches, suggests additional treatments, and so on.
  • Medication: If your doctor prescribed medication, you could be reimbursed for the cost of those drugs.
  • Disability: If your injury prevents you from working or earning as much as you once did, PIP insurance may cover part of your lost wages.

Per Florida Statutes § 627.736(1)(C), PIP insurance also offers death benefits if the policyholder does not survive the crash. These benefit – up to $5,000 – may be split among the executor of the victim’s will, the victim’s relatives, and/or any other parties who have a legal entitlement to the victim’s benefits.

What does PIP Insurance Not Cover?

PIP policies only cover expenses related to personal, or bodily, injury. As such, you will need to rely on other types of insurance policies to get compensation for other expenses. These include costs related to car repair or psychological care.

What if your medical bills exceed the amount your insurance covers, or if you are expecting to need a lot more medical care in the future? In that case, you can hire a lawyer to investigate the accident, identify the at-fault party, and sue the at-fault party for additional damages.

Items you can sue for include all sorts of financial losses not covered by your insurance, including repairs and excess medical expenses. You can also sue for non-economic (physical and emotional) damages, such as:

  • Disfigurement: You suffered severe scarring from burns, surgery, or other injuries.
  • Loss of consortium: Your relationship with your spouse or another relative has deteriorated or even ended as a result of your injuries.
  • Reduced quality of life: The injuries make it difficult or impossible for you to live as you once did. You may need someone to take care of you and perform basic, everyday tasks, such as cooking or washing dishes.
  • Pain and suffering: Suffering a car accident injury can leave you with distressing physical symptoms, which in turn may lead to emotional anguish.
  • Emotional trauma: The accident itself can also cause psychological trauma for which you may need counseling or medication or to make lifestyle adjustments.

What If My Insurer Refuses to Pay?

While your insurer should be dedicated to helping you recover the benefits you need – after all, you do pay a premium every month – this is not always the case. Insurers are businesses and, as such, will do what they can to pay you as little as possible. To do so, they might claim:

  • You did not receive medical care within 14 days.
  • You did not suffer an emergency medical condition.
  • You did not suffer injuries in the accident as you claimed.

Dealing with insurance companies can be a difficult and time-consuming process, especially if you have not fully recovered from your car accident. You could benefit from hiring a car accident lawyer to explain your rights, figure out what your policy covers, and negotiate with the liable party’s insurance company for a fair settlement.

Talk to a Florida Car Accident Attorney About Your Case

You do not need to handle this fight alone. The car accident team at the Law Offices of Anidjar & Levine can protect you from your insurer and get you the compensation you need.

If you have questions about recovering benefits from your PIP policy after a car accident, the legal team from the Law Offices of Anidjar & Levine offers free case reviews and consultations. Call us at 1-800-747-3733 to get started.