Immediately following a car accident, adrenalin is pumping through your system and can mask pain. However, those involved in a vehicular accident often experience pain days or even weeks after the incident. While you may feel fine, it is important that you seek medical treatment immediately following an accident – not just to make sure no injury is missed or aggravated, but because waiting too long to see a doctor may cost you. In Florida, the 14-day rule states that if you do not seek medical treatment within 2 weeks of the accident, your insurance company has the right to deny your future claims under your personal injury protection (PIP) policy.

14-Day Rule Explained

We believe everyone involved in a car accident should get checked out immediately just to be safe. This will also provide assurance that your “silent” injuries or internal injuries are not being ignored. Often these internal type problems can go unchecked until they are far more serious. Insurance companies want you to treat problems as soon as possible, so that the injuries are not more complex – and thus more expensive to treat – at a later date.

The 14-day rule does not stipulate any specific type of medical care – you can go to a medical doctor, a chiropractor, visit the emergency room, or even have a dentist appointment if your head, neck or face was injured. (Keep in mind that some therapies such as massage may not be included.) If you do not see any type of approved medical doctor prior to 14 days, any subsequent claims are likely to be denied by your insurance company. The rule exists in order to combat potential insurance fraud, as well as to prevent individuals from submitting claims for injuries not related to the accident. After all, if you do not see a doctor for 90 days, it can be easily argued that you injured yourself in another way.

PIP Benefits and Limits

When the state of Florida changed the PIP law, it put limits on the types of benefits which would be accessible under the PIP policy. Individuals are required to have a minimum policy amount of $10,000, but that does not guarantee that you will receive all of that money after an accident. According to the PIP law currently on the books, the total amount of your maximum payout will depend on the severity of your actual injuries. Also:

You must seek out and procure treatment within the initial 14 days following an accident.
You are only eligible to receive only up to $2,500 if your injuries were classified as non-emergency injuries.
Those injuries which are deemed an “emergency medical condition” (see below) are likely to permit the maximum payout.

It is important to note that PIP only pays 80% of your medical expenses, up to the $10,000 limit. Therefore if you incur $10,000 worth of expenses you will receive $8,000. However, if you incur $18,000 in expenses, you will only receive $10,000.

PIP will also reimburse up to 60% of your lost salary and wages, again up to a limit of $10,000.
This section also provides reimbursement for services you would normally perform yourself, such as cleaning your home or cooking meals.
If you have been disabled by the accident and are unable to work, you should include a loss of earnings claim.

PIP coverage also typically includes up to $5,000 in death benefits. If the policyholder dies, burial and funeral expenses will be covered.

Emergency Medical Conditions

Because you will not receive the maximum payout of your policy unless you have suffered an emergency medical condition, it is important to understand what that means. According to Florida Statute section 395.002(8), a qualifying emergency condition is one where an individual has suffered acute symptoms that necessitate immediate medical attention to prevent impairment of a major body function; endangerment of health and wellbeing; or serious dysfunction of any body part or organ. The notes from your initial visit after the accident don’t necessarily have indicate an “emergency medical condition.” If you seek treatment within 14 days, you should be able to collect benefits.

Your PIP Claim Be Denied

Insurance companies will always look for ways to not pay – or pay less than expected. After all, they are in the business of making money. Common reasons for denial include not seeking treatment within 14 days; claiming injuries not suffered in the accident; not exhibiting a qualifying emergency medical condition.

The 14-day rule applies even during the pandemic. Check with your insurance company if telehealth will apply for your policy.

If you have been in a Sarasota car accident and need legal advice, call Probinsky & Associates. Whether the 14-day rule or any other Florida statutes regarding car accidents, we are here to help.