Florida 14-Day Accident Law

If you are in an accident, you need to familiarize yourself with the Florida 14-day accident law. This law states that injured victims must seek medical treatment within 14 days of the accident for their personal injury protection (PIP) coverage to apply.

PIP coverage is your no-fault insurance that covers medical expenses and some of your other damages. If you have questions about PIP and the 14-day accident law, let the experienced Tampa auto accident lawyers at Abrahamson & Uiterwyk help.

Failure to adhere to this 14-day rule could mean trouble for your personal injury protection claim. It could adversely affect your ability to get reimbursed for your damages, which means you would be paying for your expenses out of pocket.

Deciphering the 14-Day Rule

Seeking medical treatment after an accident is always a good idea. Even if you don’t think you are seriously injured, you should get checked out. Some injuries are not visible, so you want to rule out any internal damage as well.

Florida’s 14-day PIP rule says that you must at least have an initial medical examination within 14 days of the accident. If you don’t, your insurance company has the right to deny any subsequent claim that you present under your personal injury policy.

There is no specific type of doctor you need to see, which means almost any kind of medical care with a qualified health care provider could meet the requirement. For example, you might visit an:

• Emergency room physician,
• Medical doctor,
• Chiropractor, or
• Dentist.

It’s crucial to note that health care providers that are not listed in the specific law may not qualify. Massage therapists and physical therapists are two examples that may not be eligible.

If you see a massage therapist but not a medical doctor, your insurance company will likely deny your claim. You can see a massage therapist on your own if you need it; it just will not be reimbursed. The important thing is to get to the emergency room or make an appointment with a doctor first to ensure you satisfy the 14-day rule.  

Some people don’t see the rule’s importance and are shocked when their claim is denied for not seeking treatment in time. There are several reasons why this 14-day rule exists, including to deter potential insurance fraud and claims for unconnected injuries.

If someone waits two months to see a doctor, the insurance provider can easily deny the claim on the basis that the person was likely injured somewhere else. Other reasons the 14-day rule exists are to help facilitate quick medical diagnoses and avoid medical complications.

Personal Injury Protection Payout Limits

When Florida amended the PIP law, it also limited what benefits are available under the policy. You must have a minimum policy amount of $10,000, but that doesn’t mean you are entitled to receive the full amount after an accident. Under the current PIP law, the amount of your maximum benefit will depend on the severity of your injuries.

You must seek treatment within 14 days, and you will be eligible to receive only up to $2,500 in benefits if you sustained non-emergency injuries. If your injuries fall under an “emergency medical condition,” then you could receive the maximum payout under your policy.

However, PIP only pays 80% of your medical costs. Take a $10,000 PIP policy, for example. If your medical expenses are $10,000, then you would receive only $8,000 under your policy. If your expenses are $20,000, you would receive the whole $10,000.

PIP also covers 60% of your lost wages, up to $10,000. If you are disabled and unable to work, then you would want to include a loss of earnings claim. Payment under this section also provides compensation for services you would normally do, such as cleaning your home, laundry, etc.

Your personal injury policy also usually includes up to $5,000 in death benefits. If the policyholder dies, your PIP coverage will pay for the burial and funeral expenses, in addition to the other benefits.

What Is Considered an “Emergency Medical Condition”?

Under Florida Statute section 395.002(8), you’ll find the definition of an “emergency medical condition.” A qualifying emergency condition is one where you suffer acute symptoms that require immediate medical attention to prevent:

• Impairment of a major body function;
• Endangerment of your health and wellbeing; or
• A serious dysfunction of any body part or organ.

Be sure to talk with your doctor about what is going on with you after the accident. They can note in your chart that you had a condition that qualifies for some benefits under your PIP.

The notes don’t have to reflect it was an “emergency medical condition.” As long as there is proof that you sought treatment within 14 days, you should be entitled to some benefits from your policy.

The determination of whether you have a qualifying condition doesn’t have to take place within 14 days either. You need to show only that you sought initial treatment from a qualifying provider to meet the legal requirement.

What If Your PIP Claim Is Denied?

Even though you pay a monthly premium for your personal injury protection coverage, it doesn’t mean that the insurer will always pay you the benefits you think you are owed. Insurance companies are in the business of making money, and therefore they will look for ways to reduce their payouts whenever possible.

Common reasons for denials include:

• Not seeking treatment within 14 days;
• Not suffering injuries in this accident as you claim; and
• Not suffering a qualifying emergency medical condition.

Many doctors and facilities still offer telephone and virtual appointments if it is difficult for you to go in person. The telehealth option would most likely satisfy the 14-day rule. You can check with your insurance company to verify first.

Contact a Tampa Car Accident Lawyer Today 

Don’t try to fight a PIP denial on your own. Instead, let the experienced team of Florida car accident lawyers at Abrahamson & Uiterwyk help. Contact our office today to schedule an initial consultation.

We have over 30 years of experience assisting Florida clients with their injury needs. We’ve served over 20,000 clients, collecting over $800 million dollars on their behalf. Let us put our skills and knowledge to work for you and help you get the PIP benefits you’re entitled to after an injury accident.