EMC Florida: What Is An Emergency Medical Condition? Florida is one of 10 states that provide personal injury protection, or no-fault, car insurance. This is because the state wanted to provide injured parties with up to $10,000 of immediate medical coverage rather than having them go to court to prove liability and establish fault on behalf of the other driver. What Is PIP? PIP is an abbreviation for Personal Injury Protection that is most frequently used in reference to auto insurance. Florida is one of the only states in the nation to have personal injury protection, which means that it offers no-fault car insurance to its residents. The goal of PIP insurance is to provide an injured person(s) with up to $10,000 of personal injury compensation immediately to help offset the costs of medical fees, damages, and other expenses. PIP was put in place to help reduce payment delay for those who are injured and limit how frequently auto accident cases go to court. Florida requires every resident with a vehicle to purchase PIP coverage for cars registered in the state. This puts the responsibility for injuries incurred in an accident on the individual as opposed to the person who caused the motor vehicle accident. In 2012, Florida statutes surrounding PIP were drastically amended under the House Bill 119 and the new laws surrounding this statute went into effect in 2013. While 2013 may seem like some time ago, many people still don’t fully understand PIP law and miss out on utilizing this helpful component of their auto insurance. Florida PIP Laws And Statutes There are several important factors of the PIP statute that you should familiarize yourself with to ensure you take full advantage of this insurance component. One law is that the driver who is insured must maintain a minimum of $10,000 in personal injury coverage as part of their auto insurance plan. However, the amount paid out following an accident doesn’t always equal $10,000. Factors that largely relate to the injuries sustained during the accident and whether the injuries are considered an emergency medical condition (EMC) determine how much is paid out to the policyholder. In order to be eligible to receive funding through the personal injury protection component of your insurance, you must seek qualifying medical treatment within 14 days of the accident. This is known as the 14-day PIP rule. If you do not seek medical treatment within 14 days of the accident, you may lose your ability to utilize PIP medical benefits and will not be reimbursed with PIP. However, if you do receive qualified medical treatment, you’ll immediately be eligible for a minimum of $2,500 in PIP coverage, and after a determination that you’ve sustained an EMC, you may be eligible to receive the full $10,000 in PIP coverage. The 14-day PIP rule makes it crucial for you or your loved one to seek medical treatment within 14 days of a car accident, even if you don’t feel you’ve sustained injuries. Many injuries can arise days or even weeks after an accident. However, if you don’t have sufficient proof of qualified medical treatment within two weeks of the accident, you won’t receive compensation for your injuries, even if you do end up with a severe injury that presents after 14 days of the collision. This means you may be left paying out-of-pocket for medical expenses, lost wages, and other expenses associated with your injuries. Why Is There A 14-Day Provision? The Florida Office of Insurance Regulation claims that the 14-day PIP rule was put in place to reduce the frequency of PIP fraud. While the amount of accidents over recent years has remained relatively constant, the number of PIP claims and PIP payouts has dramatically increased. In fact, the National Insurance Crime Bureau has stated that Florida has several cities that have the highest number of “questionable claims” nationally in relation to PIP claims. According to the Florida Office of Insurance Regulation, PIP premiums account for an estimated 50% of fraud referrals in the state. 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Find out if you have a case we could help you win Speak To a Specialist What Is Considered An Emergency Medical Condition (EMC)? As mentioned earlier, individuals who are diagnosed with an emergency medical condition (EMC) within 14 days following their accident are eligible for up to the full $10,000 PIP payout. But, what is considered an emergency medical condition? The 2012 amendment to the PIP Statute states that an EMC is a medical condition that manifests by acute symptoms of “sufficient severity” and that without immediate medical treatment could result in serious health complications, serious impairment or bodily function, or serious dysfunction of any bodily organ or part. However, these designations are up to the discretion of the medical provider who treats the individual following the accident. Only qualified physicians, dentists, physician’s assistants, osteopathic physicians, and registered nurse practitioners are able to make an EMC determination. If the medical professional does not believe that the person’s injuries are not an EMC, the individual will only be eligible for $2,500 in PIP benefits for medical expenses and treatment costs. To make matters even more complicated, there is no EMC form that the qualified physician fills out to present to your insurance carrier. Instead, your medical record must show that you suffered an EMC as a result of a car accident. We Are Nationally Awarded Lawyers Working With An Experienced Personal Injury Attorney For Your PIP Claim Because the PIP Statute has so many gray areas, it’s crucial to work with an experienced personal injury attorney like those at Florin|Roebig to ensure you get the maximum compensation available for your injuries following an auto accident. Our dedicated attorneys deal with insurance companies on a regular basis and work hard to ensure our clients receive the compensation they need and deserve. If you’ve been denied PIP coverage or feel that you have not received adequate compensation from your insurance company, call us today for a 100% confidential and free consultation.
