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What Is Florida’s 14-Day Rule in PIP?

On Behalf of Fiol Law Group|Posted in Car Accidents on April 23, 2018

It can be difficult to navigate Florida’s “no-fault” auto insurance laws. One issue that often arises after a collision is Florida’s 14-day rule in personal injury protection (PIP) insurance. It’s very important to understand the 14-day rule as a crash victim. Otherwise, you could face major hurdles in trying to secure benefits – or lose your right to compensation entirely. Here’s a breakdown of how the personal injury protection rule works.

What Is the 14-Day Rule?

You must obtain medical care within 14 days if you suffer injuries in a traffic accident in Florida, or else run the risk of your insurance company denying your claim. Florida Statute 627.736, the no-fault insurance law, is the law that requires medical attention within 14 days. Subsection 1a states that an insurance policy must cover at least 80% of a victim’s medically necessary care as long as the individual receives the initial medical services and care within 14 days after the accident. The types of benefits you can obtain if you comply with the 14-day personal injury protection rule include:

  • Up to $10,000 in medical and disability benefits
  • Up to $5,000 in death benefits
  • Up to 80% coverage for surgeries, x-rays, and rehabilitative services
  • Up to 80% coverage for ambulatory fees, hospital visits, and nursing care

A claimant must fulfill one condition to qualify for these personal injury protection benefits in Florida – going to the doctor within two weeks of the accident. Failing to receive medical attention and services within 14 days after the auto accident gives your insurance company the right to deny medical benefits. The law permits insurance companies to withhold compensation for medical care if the policyholder does not receive medical care within the time limit.

Why Does the 14-Day Rule Exist?

Florida’s 14-day rule exists for many reasons. For one, it is an effort to stop insurance fraud. For example, the 14-day rule would allow an auto insurance company to deny medical benefits if someone injures his neck while jumping on a trampoline but tries to blame the injury on a car accident that happened a month ago. Prompt medical care is the best way to diagnose an injury accurately.

Waiting to receive medical care can also exacerbate an injury, leading to an increase in costs for the insurance company. The rule can result in lower costs for insurance coverage in Florida, as insurance companies can minimize the costs of medical care by requiring prompt treatment. The 14-day rule came about in 2013, along with several other changes to Florida’s insurance laws.

The Importance of Prompt Medical Care After an Accident

It’s always important to seek immediate medical care after a car accident – not just for insurance purposes. Failing to see a doctor right away can worsen your prognosis for recovery. Injuries such as those to the brain or organs require prompt medical attention for the best chance of healing.

Go to the hospital for a checkup even if you don’t think you have any injuries. Many injuries can have delayed symptoms, including traumatic brain injuries and back/neck injuries. Go to the hospital right away no matter what type of injury you’ve sustained. In Florida, you must go to the hospital and a physician must diagnose you with an “emergency medical condition” within 14 days to receive personal injury protection insurance benefits. Otherwise, you will not be eligible for PIP coverage.

The insurance law does not, however, restrict the place in which a victim seeks medical attention.  You can elect to wait and see your own doctor, as long as your appointment remains within the 14-day window. Note that acupuncturists and massage therapists no longer qualify as healthcare providers under Florida law as of 2013.

For more information on car insurance laws in Florida, please get in touch with one of our car accident attorneys.