Emergency Medical Conditions Under PIP in Florida

Personal Injury Protection (PIP) coverage contributes to Florida’s no-fault rule, in which you go through your own auto insurance for your medical bills and treatment. This is regardless of who is at fault. While this may seem strange at first, it minimizes time you have to wait until receiving medical care after an impact—because sometimes, seeing a physician simply can’t wait. Actually, in the case of most accidents, medical treatment should never wait.

That said, we are here to explain some of the stipulations of PIP, including emergency medical conditions (or an EMC) and how it affects your allocated funds from your auto insurance company.

Understanding the Personal Injury Protection (PIP) Coverage

In Florida, Personal Injury Protection (PIP) is part of your auto insurance coverage and is designed to provide you benefits for injuries sustained in an auto accident, regardless of who is at fault. It's often referred as "no-fault" insurance, and it can cover up to 80% of your medical bills and 60% of lost wages, to a limit of $10,000.

What Qualifies as an Emergency Medical Condition?

The term "Emergency Medical Condition" (EMC) under Florida law refers to 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 serious jeopardy to patient health, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

Summed up, it is a medical condition that, if not treated immediately, could result in “placing the health of the individual in serious jeopardy,” or causing “serious impairment” or “serious dysfunction.”

Importance of EMC in PIP

Why does the term EMC matter in PIP? The answer lies in the coverage limit. If a medical practitioner, after examining you post-accident, declares your condition to be an EMC, you may be eligible for the full $10,000 PIP benefits. In the absence of an EMC, the amount you can receive from PIP is limited to $2,500. This makes it critical to seek medical attention immediately after an accident.

Those of you who have reviewed your declarations page know that PIP pays 80% of $10,000 dollars toward your medical bills for injuries related to the accident (it also pays for lost wages and transportation, if applicable).

PIP Adjustments Made in 2013

In 2013, however, the PIP laws were adjusted in the following ways:

• You must receive treatment within 14 days of an accident or you won’t be eligible for your PIP coverage
• To receive the entire $10,000, you must get clearance of an EMC by a qualified physician; otherwise, you’re only able to receive $2,500
• Massage therapy and acupuncture are no longer covered under PIP

What This Means for Diagnoses

Unfortunately, the aforementioned points mean that a chiropractor cannot give you an EMC. According to the new laws, only doctors such as an M.D. can diagnose an EMC to warrant $10,000 under PIP.

Make sure you contact an expert personal injury attorney in order to assist you further with your claim, as well as your treating physician concerning the EMC.

Why was this rule placed into effect, you may be asking? In an effort to reduce fraud and help reinforce that all injuries are causational to the accident itself and not another incident. This is why it’s integral on your first trip to the hospital or doctor to let them know about all the aches and pains you’ve gotten since the accident happened. Keep a diary of this if you need to; this will make it easier for you to receive PIP for those injuries than if you decide to tell the doctor a month later.

Emergency Medical Condition FAQs

Knowing the stipulations of PIP coverage, including the definition of emergency medical conditions, can help you better understand your rights and options when seeking medical care after an auto accident in Florida.

How Long Do You Have to Seek Medical Attention After a Car Accident?

Under Florida law, you have up to 14 days after the accident to seek medical treatment for injuries sustained in an auto accident. This is why it's important not to delay seeking medical attention, as waiting beyond this time limit may affect your PIP coverage.

Can I Receive More Than $10,000 in PIP Benefits?

No, the maximum amount of PIP benefits that can be received is $10,000 per person. However, if your medical bills exceed this amount and you have additional coverage through health insurance or other sources, these may be used to cover the remaining expenses.

Do I Still Receive PIP Benefits If I Am At Fault for the Accident?

Yes, PIP coverage applies regardless of who is at fault for the accident. This is the purpose of no-fault insurance in Florida.

Do I Need to File a Claim With My Health Insurance If I Have PIP Coverage?

Yes, you will need to file a claim with your health insurance if you have it in addition to PIP coverage. Your health insurance may cover expenses that are not fully paid for by PIP, such as co-pays or deductibles.

Examples of Emergency Medical Conditions

Emergency Medical Conditions (EMCs) under Florida law are typically severe and require immediate medical attention to prevent serious health repercussions. They can range from acute physical injuries to severe mental health crises. Here are a few examples:

1. Severe Trauma: This includes conditions like fractures, dislocations, deep lacerations or severe burns. These injuries usually result from high-impact collisions and require immediate medical care.
2. Significant Head Injuries: Concussions or traumatic brain injuries, characterized by symptoms like severe headache, vomiting, dizziness, or unconsciousness, are considered EMCs.
3. Severe Pain In Chest: If an individual experiences severe chest pain post-accident, it could be indicative of a heart attack.
4. Difficulty in Breathing: Shortness of breath, or breathing difficulties, could signal a serious respiratory problem or internal injury that requires immediate attention.
5. Significant Bleeding: Heavy or uncontrollable bleeding can lead to severe consequences if not treated promptly.
6. Loss of Vision or Sudden Eye Pain: These symptoms may indicate serious eye injuries or conditions.
7. Sudden Paralysis or Weakness: This could be a symptom of a severe neurological condition like a stroke.
8. Severe Abdominal Pain: Severe pain in the abdominal region be indicative of internal injuries or severe conditions like appendicitis.

Remember, this list is not exhaustive and many other conditions could qualify as EMCs post a car accident. The key is to seek immediate medical attention if you suffer from severe symptoms after an accident. Not only is this important for your health, but it also impacts the benefits you may receive from your PIP coverage.

Get Help from a Florida Car Accident Attorney in Hernando County

Being in a car accident is frightening and can be very disorienting. At the very least, take away this knowledge regarding PIP and how it can help you take some of the burden off while you recover.  

Still have questions about how the EMC affects your PIP coverage, or the PIP coverage of your loved ones? Were you in an accident and feel lost? Don’t worry—there are many resources we have that can help, including the opportunity to speak to an attorney with no obligation.

We understand that everyone’s situation is unique, which is why it’s so important to contact an attorney regarding your accident and case circumstances. At Lowman Law Firm, we service Hernando County and the surrounding areas. Our hometown team of personal injury attorneys is here to help.