Personal Injury Protection 14-Day Rule

Personal Injury Protection 14-Day Rule is Confusing to Consumers

Florida’s Personal Injury Protection statute and its 14-day rule are a source of great confusion for Florida drivers. People have a better understanding of the statute and rule today. But there are still times when Florida’s PIP statute confuses injury victims about what PIP covers and what the 14-day limit means.

Personal Injury Protection (“PIP”)

Florida is commonly known as a “no-fault” state. That means that every Florida auto insurance policy carries medical coverage for its insured. Regardless of whether a policyholder is at fault for an accident or not, their own PIP policy will cover their first $10,000.00 medical bills. However, insurance companies do not apply this full $10,000.00 automatically.

PIP coverage initially only covers the first $2,500.00 in medical bills. In order for PIP insurance to cover the full $10,000.00, a doctor must determine that an emergency medical condition (“EMC”) exists. I’ve discussed this topic at length elsewhere in this blog. However, simply put, an EMC determination is vital to providing full PIP insurance coverage.

What does Personal Injury Protection Cover?

The Florida legislature intended Personal Injury Protection coverage to provide quick hassle free payment of medical bills following an auto accident. Instead of liability insurance companies determining fault in a crash in order to pay medical bills, no-fault auto insurance policies provide quick payment of medical costs without waiting for a liability determination.

Aside from medical expenses, PIP coverage can also reimburse a policyholder for their lost wages. PIP policies require the claimant to provide a 13 week history of wages and signed documentation of their missed work. Then the PIP insurance provider will reimburse the claimant for 60% of their lost wages.

However, most policies limit PIP coverage to $10,000.00. Therefore, insurance companies may not reimburse all of a claimant’s lost wages or medical bills if those combined totals exceed $10,000.00. 

Typically, I advise my clients to determine which is more important: having their medical bills paid quickly or maintaining their income. That determination will allow us to decide how hard we want to push for wage loss reimbursement. 

An individual with good health insurance might want to be reimbursed for their lost wages from PIP. Those claimants will then have their health insurance pay their medical bills. Then the attorney will reimburse the health insurance company at the end of the case through subrogation.

What is the 14-Day Rule in PIP?

The personal injury protection 14-day rule is simple. An injury victim has 14 days from the date of an accident to begin medical treatment. Without treatment within the first 14 days, Florida car insurance policies will not pay for medical expenses. However, the statute confuses some Florida residents about what the 14-day rule means.

Clients have asked me if insurance requires them to file a lawsuit within 14 days of the crash. This is an extreme example, but Florida insurance companies have done a phenomenal job confusing the issue for Florida policyholders.

Essentially, the 14-day rule exists to prevent fraud. If an injury victim can wait years following a crash to begin treatment, the possibility for fraudulent activity skyrockets. However, while the stated goal was to decrease fraud within the personal injury system, Florida still remains one of the states with the highest rates of insurance fraud nationwide.

Another important distinction is that the 14-day rule has nothing to do with EMC determinations. The 14-day rule simply requires an injury victim to seek treatment within the first 14 days following a crash. However, there is no time frame within which a doctor must make an EMC determination. Often, EMC determinations can happen weeks or even months after the first 14 days following a crash.

If you are in a Car Accident, See a Doctor to Trigger your Personal Injury Protection Benefits

Many injury victims don’t think they need medical treatment immediately following a crash. Countless times, new clients tell me they felt sore after their crash initially. These victims ignored their pain and soreness and waited to see a doctor because they were certain the pain would go away. However, when it did not, they decided to call an attorney.

The problem with waiting to seek medical attention is three-fold. First, by delaying medical treatment, a victim will needlessly endure additional pain and discomfort. Second, an injury victim waiting to seek medical care runs the risk of missing the 14-day cutoff for PIP coverage. Third, by delaying treatment, an injury victim opens the door for the insurance company to question the cause of the victim’s injuries.

Insurance companies are looking for any excuse to not pay out on claims. By missing the 14-day deadline, injury victims make it easy for insurance companies to rightfully deny their claim. But even if a victim treats on the 13th day, an insurance company will claim that they must not be very hurt if they waited nearly two weeks to seek medical care.

Call Knapp Accident & Injury Law

I have represented thousands of clients involved in motor vehicle accidents. I can properly advise an injury victim how to properly prepare their case from the moment after the crash. If you or a loved one has been involved in a car accident and you have questions about how to protect your rights as an injury victim, call me today at (813 568-3724.

Other law firms may pitch their size as the reason to hire them. However, every client of Knapp Accident & Injury Law will speak to an attorney directly and will receive my personal cell phone number from the outset of their case. I offer free consultations and will help guide any potential client, regardless of whether they were the victim or at-fault for their crash.

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