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What is the PIP 14-Day Rule in the State of Florida?

on  Car Accidents

Florida PIP refers to the state’s “personal injury protection” coverage. Florida is a no-fault state. This means, your insurance company must provide coverage for your medical expenses and lost wages, regardless of who was at fault for your car accident. Florida requires a minimum PIP coverage of $10,000, but you have the option of acquiring additional coverage. To receive PIP benefits from your insurance company, you must receive medical treatment within two weeks (14 days) of the car accident.

According to Florida Statute § 627.736, individuals can receive insurance coverage provided they have received medical assistance within 14 days. Depending on the severity of your injuries and compliance with the PIP 14-day rule, you could receive the maximum benefits available under your policy.

Under this rule, if you suffered non-emergency injuries, you would receive a portion of the coverage. However, if you suffered an emergency medical condition – as defined by Florida Statute § 395.002(8) – you could receive a higher coverage percentage for your expenses. The statute defines an emergency medical condition as an incident that leads to “serious impairment of bodily function,” dysfunction, or poses a severe risk to the patient’s health.

How Do I Use My PIP Coverage?

The first thing you need to do after being involved in a car accident is to seek immediate medical attention. Getting checked by a physician can help you rule out further health issues. Additionally, the statute requires you to get medical attention within 14 days from the moment of the accident, so immediate medical care can put you on the right track to receive your PIP benefits. You should provide your medical provider with your auto insurance information so that they can bill your auto insurer. If you already have an insurance claim number, you should provide that number in addition to your insurance policy number to the medical provider. Remember, if you do not seek medical treatment withing 14 days of the accident, you will not likely be entitled to any PIP benefits.

Calling your insurer to report the accident and your injuries is sufficient to initiate your PIP claim. The  claims representative will provide the claim number during the call. It could take up to two months for your insurer to validate your claim due to Florida’s high insurance fraud rate. Despite the time it will take for the insurer to verify your claim, they must pay you for damages within 30 days, even if you are under suspicion of fraud.

Some insurance companies might argue you are not entitled to receive full PIP benefits. Remember, the insurance company does not work for you. As a business entity, they may try to save money by depriving you from receiving your full PIP benefits. They could try to argue your injuries are not severe enough to grant you full compensation. Furthermore, they could say your injury does not meet the “emergency medical condition” standard provided by the statute.

Generally, an auto insurance company that suspects that your injuries do not require further medical treatment will require that you attend an independent medical examination. If you fail to attend a scheduled independent medical exam, your insurer may have the right to stop providing your with PIP benefits. This means that the insurer will stop paying your medical bills.

The independent medical examination (IME) is conducted by a physician or chiropractor who’s been hired by the insurance company to evaluate your injuries. The physician conducting the IME reports to the insurer with their findings following the visit. If the physician opines that you no longer require medical treatment, your insurer may deny payment of any further medical benefits.

How are PIP Benefits Paid?

PIP benefits are generally paid directly to your medical provider for any medical expenses incurred and they are paid directly to you for any lost wage reimbursement.  However, PIP benefits do not pay 100% of medical expenses or lost wages. Instead, PIP benefits are generally paid at rate of 80% for medical expenses and 60% for lost wages. This means that your auto insurer will pay for 80% of your medical bills, leaving you responsible for the 20% balance. Additionally, your auto insurer will pay for just 60% of your lost wages. This means that if you have incurred $1,000.00 in lost wages, your insurer will reimburse you $600.00.  The full extent of a Florida auto insurer’s requirements to pay PIP benefits is detailed in Florida Statute § 627.737.

Keep in mind that medical assistance must be provided by a qualified healthcare provider. This means if you visit a care provider that is not explicitly recognized by the statute, you could lose your insurance coverage. The best way to avoid this pitfall is by visiting your nearest emergency room.

Can I Receive PIP Benefits for Pain and Suffering?

Unfortunately, you will not be able to recover compensation for pain and suffering from your PIP benefits. However, if the at-fault party caused you injury, you could still file a personal injury claim or eventually a lawsuit against them to seek compensation for pain and suffering and any other damages you may have incurred.

Miami Personal Injury Attorney Handling PIP Claims

The consequences of a car crash can be devastating for victims and their families. However, you don’t have to go through the aftermath alone. Miami personal injury lawyer Prosper Shaked can help you hold your wrongdoers accountable for your injuries. If you or a loved one was injured in a car accident, the moment to act is now. To learn more about your potential case in a free, confidential consultation, call Prosper Shaked Accident Injury Attorneys PA at (305) 694-2676 today.