It goes without question that every state requires automobile insurance for vehicle owners. However, each state has its own requirements as to the terms and provisions for coverage provided to drivers. As a Miami car accident lawyer, helping those recover benefits and settlement proceeds stemming from personal injury is a top priority. Specifically, it is incredibly important to be knowledgeable of Florida Statute, 627.736, which is commonly referred to as the “PIP Statute.”
Why? A key aspect to a successful car accident case in Florida is prompt medical treatment. In many cases, treatment is covered by the patient’s Personal Injury Protection, or “PIP” coverage under their auto insurance policy.
What is PIP or Florida No Fault?
In the state of Florida, the only insurance coverage required to be carried by motorists is PIP coverage, also referred to as Florida No Fault. Simply put, this law ensures those injured in a car accident receive compensation for injuries regardless of who’s fault the accident was. PIP coverage provides up to $10,000 of benefits for either medical or lost wages – although those seeking medical care must do so within 14 days or they won’t be covered under PIP law.
Receiving Medical Treatment Within 14 days
PIP is designed to help look after you if you require medical care immediately after or continuously after an accident.
According to Florida Law, PIP coverage affords a person injured in a car accident a maximum of $10,000 of benefits to cover medical expenses if they seek consultation within the 14-day requirement.
However, this only pertains to 80% of the medical bills, as the injured person is responsible for the remaining 20%. 627.736 mandates that “eighty percent of all reasonable expenses for medically necessary” services will be covered under PIP. Pursuant to that language, it can be deduced that the patient then has responsibility for the remaining 20% of the bills.
If an injured person withholds receiving medical care for longer than 14 days after the accident, an insurance company can deny the claim and is no longer responsible for covering medical expenses. This results in the injured person being responsible for the entirety of his or her medical expenses.
In the past, PIP was susceptible to fraud from attorneys and doctors. Why would this happen? Injuries from auto accidents could be fabricated or exaggerated, making room for fake claims. Attorneys could refer clients to doctors who would then diagnose false illnesses and receive a cut from the doctor in return for the referral. The insurance company would have a difficult time proving that an injury was falsified if it was their word against a shady doctor’s.
Thanks to new laws, this practice has been cut back drastically. In 2012, Florida lawmakers approved new laws to reduce insurance fraud. As of January 1, 2013, there are new laws to Florida PIP benefits. Consequently, these laws reduce insurance fraud by placing limitations on what PIP covers. Additionally, these new laws reduced PIP benefits for everyone, not just fraudulent PIP clinics that appeared in the state. Specifically, the new law requires the following:
Timeline. You have 14 days to seek medical care for injuries if you were injured in a car accident.
Diagnosis. You must be diagnosed with an emergency medical condition by a qualified doctor (MD, DO, dentist or advanced nurse practitioner) in order to receive the $10,000.
Definition. An emergency medical condition is anything that causes serious impairments to your health, your bodily functions, or your organs/body parts.
Benefit. The benefit is reduced to $2,500 if you are not diagnosed with an emergency medical condition.
Defining an Emergency Medical Condition
According to Florida Statue 395.002, an “emergency medical condition” is defined as:
A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
1. Serious jeopardy to patient health, including a pregnant woman or fetus.
2. Serious impairment to bodily functions.
3. Serious dysfunction of any bodily organ or part.
With respect to a pregnant woman:
1. That there is inadequate time to effect a safe transfer to another hospital prior to delivery;
2. That a transfer may pose a threat to the health and safety of the patient or fetus; or
3. That there is evidence of the onset and persistence of uterine contractions or rupture of the membranes.
“Emergency services and care” means medical screening, examination, and evaluation by a physician, or, to the extent permitted by applicable law, by other appropriate personnel under the supervision of a physician, to determine if an emergency medical condition exists and, if it does, the care, treatment, or surgery by a physician necessary to relieve or eliminate the emergency medical condition, within the service capability of the facility.
It’s important to discuss the extent of an emergency medical condition with your doctor, who has documented your condition and has all the charts to prove you have suffered an emergency medical condition – this may help your case.
Although you must seek medical care within 14 days of an accident, there does not have to be a determination of whether your injury I an “emergency medical condition” within that 14-day time period.
It’s important to seek follow-up care after an accident in order to have a successful recovery. The money that the insurance company provides to those who have been injured in a car accident is designed to go towards follow-up care services. These include services from professionals like chiropractors, dentists, physicians, physician assistants and advanced nurse practitioners. It is important to note that the new law does not cover massage therapy or acupuncture.
What if the Insurers Refuse to Pay?
Even after you pay your premium every month, insurers will often try to get out of compensating you for your injuries or lost wages by claiming you:
- Did not seek medical care within the 14-day requirement
- Did not suffer an “emergency medical condition” according to legal outline
- Falsely claimed the injuries reported
The Florida car accident attorneys at SteinLaw can help protect you from insurers and help you to get the compensation you need.
Seeking Help From an Attorney
After a car accident, it is typically the lawyer’s responsibility to educate their client regarding PIP and the importance of getting treatment within 14 days after the accident.
Many Florida residents believe as long as they are injured in a car accident, a lawyer can assist them with the retrieval of $10,000 through PIP.
This is understandable considering all the misleading advertisements and marketing campaigns in Florida promising those injured in an accident “up to $10,000 of benefits if they’re injured in a car accident”. For this reason, it is important to make sure a client understands the PIP benefit rule in its entirety. Car accident and auto insurance laws in Florida are complex, confusing, and constantly changing.
Now that you know how to answer the question “what is personal injury protection?”, make sure you receive maximum compensation. If you have recently been in an automobile accident and need assistance, SteinLaw is staffed with experienced attorneys who can assist you.