According to Florida Highway Safety and Motor Vehicles, 394,936 car accidents occurred in the state of Florida. But did you know that these accident victims only had two weeks to start medical treatment from the date of their accident for their insurance company to cover their medical expenses? Many car accident victims are not aware of these highly time-sensitive laws and miss out on payment for their medical care.ย
The personal injury attorneys at Gould Cooksey Fennell Law Firm are experienced at handling insurance claims and car accident cases. We can explain the legal requirements under the Florida 14-day accident law and how we can help during a free consultation.
Floridaโs No-Fault Insurance System
Florida is a no-fault state for car accidents. After getting into a motor vehicle accident, each driver turns to their personal injury protection (PIP) insurance for coverage, regardless of fault.
Floridaโs no-fault insurance law helps provide a faster and more convenient way for motorists to have certain accident-related expenses covered than engaging in an adversarial process with the insurance company for the at-fault party. However, for claimants to receive benefits under their PIP insurance, they must comply with the 14-day rule.
What Personal Injury Protection Insurance Covers
All motorists in Florida are required to maintain insurance in at least the minimum amounts to comply with the stateโs no-fault insurance system. This includes $10,000 in PIP insurance and $10,000 in property damage liability (PDL) coverage.ย
PIP insurance covers 80% of all โreasonable expenses for medically necessary medical servicesโ after an auto accident, up to policy limits. This includes payment for:
- Emergency treatment – Your PIP insurance can help cover the costs of emergency treatment you receive after an accident.ย
- Ambulance charges – You could be reimbursed for medical costs you incurred for ambulance rides.
- Surgical costs – If you broke a leg or suffered a serious injury that required surgical intervention, these costs may be covered under your PIP insurance if you comply with the 14-day insurance law.
- X-ray services – PIP insurance also covers the costs of diagnostic tests, including X-rays.
- Dental services – PIP insurance can also cover dental services related to the traffic accident.ย
- Rehabilitation costs – You can also recover compensation for the costs of rehabilitation after the accident.ย
- Prosthetic devices – You could receive financial compensation for the purchase of artificial limbs, wheelchairs, crutches, canes, or other assistive devices necessitated by the car crash.
- Hospital stays – Hospital stays related to your medical condition caused by the traffic accident can also be included as part of your PIP insurance benefits.
- Nursing services – Floridaโs PIP insurance can help pay for the costs of skilled nursing care.
- Medication – If your doctor prescribed medication, you can be reimbursed for the costs.
A physician, dentist, chiropractor, advanced practice registered nurse, or hospital must prescribe these initial services. This includes payment for medical services the car accident victim received shortly after the accident and follow-up services, such as your doctor removing stitches or recommending additional medical treatments.
You can qualify for the full amount of your PIP benefits if a qualifying healthcare provider deems you had an โemergency medical conditionโ when you sought medical assistance. An emergency medical condition could endanger your health and well-being, impair a major body function, or cause serious dysfunction of any body part or organ if you did not seek immediate medical attention. If the authorized medical provider determines that the injured person did not have an emergency medical condition, the limit for reimbursement is $2,500.
PIP insurance also pays for 60% of gross income and loss of earning capacity due to an injury sustained in an auto accident, plus all expenses reasonably incurred in obtaining replacement services for ordinary and necessary services the individual would have performed had they not been injured, such as childcare or housecleaning. Floridaโs PIP insurance also provides $5,000 in death benefits per individual. Notably, PIP insurance does not apply to motorcycle accidents.
Our personal injury protection attorneys can assist you with all aspects of your claim, but you must comply with Floridaโs 14-day PIP rule to be reimbursed for your losses by your insurer.
Medical Treatment within 14 Days
To receive payment for medical expenses related to your medical expenses, you must see a doctor for diagnosis and treatment within 14 days of the accident date. If you fail to see a healthcare provider within 14 days, your auto insurer can deny your claim, failing to pay for your eventual medical visits and any future care related to your car accident injuries.
Schedule of Maximum Charges
The Florida 14-day accident law states that the PIP insurer may limit reimbursement to 80% of the following schedule of maximum charges:
- Emergency transport and treatment – 200% of Medicare costs
- Emergency services and care from a hospital – 75% of the hospitalโs usual and customary charges
- Emergency services in a facility rendered by a physician or dentist and related hospital inpatient services – The usual and customary charges in the community
- Hospital inpatient services other than emergency services and care – 200% of the Medicare Part A prospective payment
- Hospital outpatient services other than emergency services and care – 200% of the Medicare Part A Ambulatory Payment Classification
- All other medical services, supplies, and care – 200% of the allowable amount under the participating physicianโs fee schedule or other applicable portion of Medicare Part B
What Is the Purpose of the Florida 14-Day PIP Rule?
The 14-day PIP rule exists for several reasons. It allows you to receive the medical treatment you need immediately. You can get this care without having to engage in an adversarial process with the at-fault driverโs liability insurance provider. It also encourages car accident victims to seek care promptly so that it is less likely they exacerbate their medical condition.
Receiving prompt medical treatment also helps the insurance company see the connection between the injury and the accident. If months go between the accident and treatment, the insurance company could argue that you could have suffered injuries in some other way. Finally, the 14-day PIP rule exists to help reduce fraudulent claims. The state assumes that a car accident victim who suffers a legitimate injury will seek medical treatment within two weeks of the accident.
Making a Claim Under PIP Insurance
Even though you will be dealing with your own insurance provider, following the 14-day law and all of the associated rules can be difficult. Some ways to preserve your right to PIP benefits include:
- Seek immediate medical attention.
- Give your medical care provider your auto insurance information and policy number so they can bill your provider.
- Call your insurer to report the accident. Write down the claim number.ย
- Provide written notification of the accident and your claim promptly to your insurance carrier.
Even if you receive medical services within the 14 days required by Florida law, your insurance carrier may still refuse your claim. The insurance company could ask that you attend an independent medical examination. During an independent medical examination, a physician that the insurance company hires examines you and reports their findings to the insurance companies. If the physician concludes that you no longer require medical treatment, your insurer could deny payment for future medical expenses. If you refuse to attend the appointment, the insurer could stop providing PIP benefits, and you could be responsible for paying your own medical bills.
If your auto insurer approves your claim, it pays PIP benefits directly to the healthcare provider where you incurred the cost. It pays you directly for a portion of your lost wages.
Denied Claims Under the 14-Day Law
Insurance companies may deny claims under your PIP policy for various reasons, such as claiming you:
- Did not seek medical attention within the required 14-day period
- Did not suffer severe enough injuries to warrant full compensation
- Did not suffer an emergency medical conditionย
- Were not injured in the auto accident
- Submitted a fraudulent insurance claim
Dealing with an insurance company after an accident – even if it is your own – can be challenging and frustrating. Insurance companies are for-profit businesses that make millions of dollars by receiving more in insurance premiums than they pay out in claims. Insurance adjusters are trained to minimize payouts as much as possible. An experienced car accident attorney can explain your rights, review your auto insurance policy, and negotiate for fair compensation on your behalf.
Third-Party Claims
If you did not seek medical treatment within the 14-day timeframe, you will not be eligible to receive reimbursement for your medical expenses under your PIP policy. However, you may have other options for recovering compensation for your accident-related expenses, including filing a third-party claim against the at-fault driver.
You can file a claim against the driverโs property damage liability insurance carrier to cover the costs of your car repairs. If your economic losses exceed your insurance coverage, you can seek compensation from the at-fault driver to cover them. You may be able to step outside the PIP insurance system and seek compensation for the full extent of your damages, including pain and suffering if you suffered injuries that caused:
- Significant and permanent loss of an important bodily function
- Permanent injury within a reasonable degree of medical probability
- Significant and permanent scarring or disfigurement
If your loved one died in an auto accident, you can consult with a personal injury attorney about filing a wrongful death claim.
What Damages Can I Recover in a Car Accident Lawsuit?
Through a third-party claim, you can seek compensation for the following economic and non-economic damages:
- The cost of all medical expenses associated with your injuries
- Future medical expenses for rehabilitation, physical therapy, and follow-up appointments
- The full extent of your lost wages
- Your reduced earning capacity
- Cost to repair or replace your damaged vehicleย
- Pain and suffering
- Mental anguish and emotional distress
- Lost quality of lifeย
Because the stakes are so high, itโs in your best interests to consult with an experienced car accident lawyer who can evaluate your case and pursue compensation for all of your accident-related losses.
What Is the Deadline to File a Personal Injury Lawsuit in Florida?
If you have a legal claim against another driver who acted negligently in causing the accident, you may choose to sue them. In Florida, there is a statute of limitations that limits the amount of time you have to file a personal injury lawsuit. In most car accident cases, this deadline is two years from the accident date. If you miss this deadline and you have not filed your case, you can lose your opportunity to seek compensation for your injuries. Protect your rights by contacting an experienced personal injury lawyer.
Contact an Experienced Accident Lawyer for Help with Your Car Accident Case
If you were injured in a motor vehicle accident that was not your fault, you should not have to shoulder the financial burden someone elseโs negligence caused. An experienced car accident attorney from the Gould Cooksey Fennell Law Firm can review your case and explain your legal options during a free consultation.
Because we work on a contingency fee basis, there is no fee until we win. We have recovered more than $150 million in recent personal injury verdicts and settlements and have been named as one of the U.S. News & World Reportโs โBest Law Firmsโ for ten consecutive years. Trust our experience and dedication to capably handle your personal injury claim.
Contact us today for your free case review.