Living in South Florida, you should familiarize yourself with this 14-day auto accident rule. For personal injury protection (PIP) coverage to apply, injured victims must seek medical treatment within 14 days of an auto accident.
A PIP policy protects you against medical expenses and some other types of damages. The experienced South Florida auto accident lawyers at Bodden & Bennett can answer any questions about PIP coverage and the 14-day auto accident rule.
If you do not follow this 14-day rule, you may have difficulty filing a claim for personal injury protection. If this happens, you might be unable to receive reimbursement for your damages, which would mean paying for your expenses yourself.
Understanding the 14-Day Rule
It is always a good idea to seek medical attention after an accident. It’s vital to get checked out even if you don’t think you are seriously hurt. It is essential to rule out any internal damage since some injuries may not be visible at the time of the accident.
PIP rules in South Florida require that you have a medical examination within 14 days of an auto accident. Otherwise, your insurance company can deny any subsequent claim under your personal injury policy.
You don’t necessarily have to see a specific kind of doctor, so almost any form of medical care with a qualified health care provider can satisfy this requirement. For example, you might visit an emergency room physician, a medical doctor, a chiropractor, or even your dentist.
A healthcare provider not included in the specific law may not be eligible. Two examples of therapists who may not be suitable are massage and physical therapists.
Your insurance company will likely deny your claim if you go to a massage therapist instead of a doctor. If you need a massage therapist, you can see one independently; it may just not be reimbursed. To ensure you satisfy the 14-day rule, you should go to the emergency room, urgent care facility, or schedule an appointment with a doctor right away.
People who do not understand the 14-day rule’s importance may be shocked when their claim is denied for not receiving treatment in time. The Florida Legislature stated that the 14-day rule was created for several reasons, including to prevent insurance fraud and claims unrelated to the incident.
In most cases, insurance companies will deny a claim if the injured party does not see a doctor for two months, stating they were likely injured somewhere else. The 14-day rule also exists to make medical diagnoses quickly, and medical complications can be avoided.
Florida Personal Injury Protection Payout Limits
The Florida legislature also limited what benefits are available under the PIP law when it amended it. The minimum amount of your insurance must be $10,000, but you aren’t guaranteed to receive the total amount in the event of an accident. Your maximum benefit amount will be determined by the severity of your injury under the current PIP law.
If you sustain non-emergency injuries, you will be eligible to receive only up to $2,500 in benefits. The maximum payout may be available under your policy if your injuries qualify as an “emergency medical condition.”
Regardless, PIP only covers 80% of the cost of your medical care. Consider a policy that covers $10,000 in medical expenses. According to your policy, if your medical expenses are $10,000, you would receive only $8,000. Should your medical expenses be $15,000, you would receive the entire $10,000.
In addition, 60% of your lost wages are covered, up to $10,000. An individual who is disabled and unable to work would include a loss of earnings claim. Under this section, you can also receive compensation for everyday household tasks such as cleaning, laundry, etc.
You may also be covered for death benefits up to $5,000 under your personal injury policy. Additional to other benefits, if the policyholder dies, your PIP coverage will cover burial and funeral expenses.
What Constitutes an “Emergency Medical Condition”?
Florida Statutes section 395.002(8) defines an “emergency medical condition.” You suffer acute symptoms that require immediate medical attention to prevent significant impairment of a body function, danger to your health and wellbeing, or dysfunction of any body part or organ.
It would be best if you discussed the effects of the accident with your doctor. It can be noted in your chart that you had a condition that qualifies you for some PIP benefits.
In the notes, it doesn’t need to be stated that it was an “emergency medical condition.” If you seek treatment within 14 days, you should be eligible for benefits under your policy.
Also, you don’t have to be determined as having a qualifying condition within 14 days. To comply with the law, you must show that you sought treatment from a qualified provider.
If Your PIP Claim Is Denied, What Should You Do?
While you may pay a monthly premium for your personal injury protection coverage, it does not guarantee that the insurer will pay the benefits you expect. Because insurance companies are in the business of making money, they will do anything possible to reduce their payouts.
Denials are frequently due to the following reasons:
- Failure to seek treatment within 14 days;
- The accident did not cause you injuries as you claim; and
- There is no qualifying emergency medical condition.
You still need to seek treatment within 14 days despite the current pandemic situation. You may be able to satisfy the 14-day rule with a telehealth visit. Contact your insurer to make sure.
Get a Free Case Evaluation with a South Florida Car Accident Attorney
If your PIP claim is denied, don’t fight it alone. Let Bodden & Bennett’s South Florida auto accident lawyers help you instead.
Get a free case evaluation by contacting us today.
We’ll use our skills and knowledge to help you get the PIP benefits you’re entitled to following a South Florida auto accident.
