Florida’s 14-Day PIP Rule: A Complete Guide for Accident Victims

If you’re a Florida driver, you may have heard of the 14-day rule. Understanding how this rule applies to you as a driver is critical in case you’re ever involved in a car accident in Florida, regardless of whether the accident is your fault or not.

Under Florida’s no-fault system, all drivers in the state are required to carry their own personal injury protection insurance (PIP insurance). In the event of a car accident, all involved parties must turn to their own PIP insurance first to recover compensation for bodily injury.

However, there are guidelines, such as the 14-day rule that applies. Under this rule, you must seek medical attention within 14 days of your car accident in order to pursue a claim for compensation through your no-fault, PIP coverage. 

All Florida drivers should be familiar with the 14-day rule so that they can take full advantage of their personal injury protection benefits. 

At Jack Bernstein, Injury Attorneys, our skilled Tampa car accident attorneys are here to help you understand your legal rights and options after a car accident, including explaining all the critical elements of the PIP 14-day rule. Schedule your free case evaluation today to learn more about your legal rights and options.

What Is the 14-Day PIP Rule in Florida?

The 14-day PIP rule is codified in Florida Statute 627.736. Under this rule, you must seek out medical care within 14 days of your car accident to be eligible for your personal injury protection benefits. If you fail to receive medical care within this time frame, it could disqualify you from tapping into benefits you may be entitled to. These are the benefits that will help cover the cost of your medical expenses and lost wages because of your car accident.

Other guidelines to consider include the type of care you seek. You must seek medical care from a qualified healthcare provider in this state. This can include a:

• Medical doctor
• Doctor of osteopathic medicine
• Chiropractor
• Dentist
• Hospital personnel

Your personal injury protection coverage extends to both emergency and non-emergency medical conditions. An emergency medical condition might be anything that is serious in nature or life-threatening. This might include things like severe bleeding, internal bleeding, respiratory issues, like asthma attacks, severe head injuries, and other severe bodily injuries. 

Non-emergency medical conditions tend to be more superficial and are not life-threatening. This can include anything from minor cuts and bruises to sprained ligaments and broken bones.

In Florida, medical treatment is a broad definition that involves the practice of medicine. This might include diagnosis, treatment, operation, and the prescription of medication. To adhere to the 14-day rule, you must seek any type of medical treatment listed above to satisfy the PIP 14-day rule. It’s essential to remember that the 14-day period starts on the day the car accident happened.

Florida Statute 627.736 and PIP Insurance Requirements 

Florida is a no-fault state and their no-fault auto insurance system is a framework that is designed to protect all individuals involved in a car accident, regardless of who was at fault for the car crash. This framework is applied in only a handful of states, with 12 states following the no-fault system.

Under the system, all drivers are required to carry personal injury protection insurance. The minimum requirements for this type of insurance include:

• $10,000 in personal injury protection per accident for all four-wheeled vehicles.
• $10,000 in property damage liability per accident for all four-wheeled vehicles.

Personal injury protection is designed to cover the cost of lost wages and medical bills after an accident, while the property damage liability payout covers the cost of property damage you’ve caused to another driver’s vehicle.

Personal injury protection insurance differs from other types of auto insurance options because it’s limited to covering your medical expenses, lost wages, and property damage of other drivers’ vehicles. However, you can add on additional auto insurance coverage options including:

• Collision insurance: This pays to repair or replace your vehicle after an accident.
• Comprehensive insurance: This covers the cost of damage to your vehicle from non-collision events, like vandalism, theft, and natural disasters.
• Uninsured/underinsured motorist coverage: This coverage protects you if you’ve been involved in a car accident with another motorist who does not have insurance to cover damages you’ve suffered.
• Bodily injury liability: This provides coverage for another driver’s injury or death in an accident that was your fault.

The state has codified personal injury protection requirements under Florida Statute § 627.736. The statute defines specific rules for treatment timelines, how reimbursement schedules work, and different benefit levels. Understanding this statute is essential to helping you make the best decision when registering your vehicle and choosing the right insurance policy.

Emergency Medical Condition vs. Non-Emergency ($10,000 vs. $2,500 Benefit Levels)

An essential part of Florida’s PIP law that impacts the availability of your benefits is a diagnosis, or what’s legally known as an emergency medical condition (EMC). Under Florida Statute § 627.732, an EMC is a condition that manifests itself with symptoms of significant severity which require evaluation and immediate treatment to prevent you from the following: 

• Serious jeopardy to your health: This is a condition that is life-threatening or could lead to a permanent injury, if it’s not treated immediately.
• Serious impairment to your bodily functions: This might include the significant loss of a bodily function, such as the inability to use your limbs or walk.
• Serious dysfunction of any bodily organ or body part: This is classified as an injury that can cause an organ or a body part to stop functioning properly.

Some specific types of injuries that will typically qualify as an EMC might include traumatic brain injuries, spinal cord injuries, fractures, and internal injuries.

If a qualified medical professional diagnoses you with an EMC, then you are eligible to claim the full $10,000 benefit of your personal injury protection coverage.

Your injuries could also be deemed non-emergency. These are injuries that tend to be superficial, are resolved within 24 to 48 hours, and are generally not life-threatening. This might include things like bruising, minor cuts and scrapes, and sprained ligaments. If your injury is classified as a non-emergency injury, you’ll typically be able to only recover $2,500 of your personal injury protection coverage.

Medical professionals who can make an EMC determination must be state licensed and include:

• Medical doctors
• Doctors of osteopathic medicine
• Dentists
• Advanced practice registered nurses
• Other hospital medical care professionals

Related: Florida Car Accident Statistics

Qualified Healthcare Providers Under Florida’s 14-Day Rule 

To activate your PIP insurance coverage, Florida State Statute § 627.736 mandates that you receive medical care within 14 days of your car accident. This “14-day rule” is strict, and failure to obtain treatment by this deadline can result in a complete denial of your claim. Furthermore, it is not enough to simply see any provider. You must also receive care from a qualified and licensed healthcare practitioner recognized by the statute.

Examples of qualified providers include:

• Medical doctors (MDs) and doctors of osteopathic medicine (DOs): These physicians offer the broadest scope of medical care under PIP law. They are fully licensed to diagnose all conditions, including emergency medical conditions (EMCs), order all necessary testing, and provide comprehensive treatment. For a thorough initial evaluation, they are often the most strategic first choice.
• Chiropractors (DCs): The authority of chiropractors is limited under PIP law. While they are qualified to provide care and treatment for musculoskeletal injuries, they are not permitted to diagnose an emergency medical condition. If a chiropractor suspects an EMC, they are legally obligated to refer you to an MD or DO for an official diagnosis to determine your benefit level.
• Dentists: Dentists are fully qualified providers for injuries related to the teeth, jaw, and other oral structures. Seeking an initial consultation or treatment from a dentist for such injuries will satisfy the 14-day PIP rule.
• Hospitals and emergency room personnel: Any medical service provided at a hospital, including care from emergency room physicians, physician assistants, and nursing staff, fulfills the 14-day requirement. This is a common and reliable avenue for individuals seeking immediate medical evaluation following a collision.
• Advanced practice registered nurses (APRNs): APRNs were recently added to the state’s list of qualified providers. They are authorized to diagnose and treat injuries, as well as make a legally recognized EMC determination.

It is critical to understand that certain therapies, such as massage therapy or acupuncture, are not recognized as initial medical treatment under the 14-day PIP rule. Visiting only these types of providers will not activate your benefits.

Finally, you must be strategic in seeking an EMC diagnosis, as not all qualified providers are required to accept PIP insurance as payment, which could lead to out-of-pocket costs. 

What Medical Expenses and Benefits Does Florida PIP Cover?

The purpose behind Florida’s PIP insurance coverage is to provide immediate benefits that will cover the cost of medical bills and lost wages because of your car accident. However, it’s essential to understand how these benefits are applied to coverage needs you have.

The primary component of PIP insurance is to cover the cost of medical bills and reasonable medical care you need because of your injuries. 

This includes coverage for:

• Hospital inpatient and outpatient services.
• Surgical and diagnostic testing like X-rays, MRIs, and CT scans.
• Required medications and prescriptions.
• Rehabilitation and therapeutic services.

For these types of medical expenses, your PIP insurance coverage will reimburse you for about 80% of your reasonable cost. Another element of your PIP coverage is disability benefits, which cover 60% of any lost wages you’ve incurred because your injuries have kept you from being able to go to work.

Finally, your PIP insurance coverage will also include a $5,000 death benefit, which will be made payable to your estate if a car accident results in your fatality.

Certain losses are not covered under your PIP insurance coverage, and this includes damages like pain and suffering, and property damage. 

Depending on your injuries and the nature of your car accident, you may be able to recover non-economic damages, such as pain and suffering, through a separate personal injury lawsuit. However, in order to file a lawsuit, your injury must reach the threshold of a serious injury. 

Additionally, property damage to your vehicle is not covered under PIP protection but may be covered if you have comprehensive insurance, an optional add-on to your insurance coverage benefits.

Another important element to note is a fee schedule, which is imposed by Florida law. This fee schedule sets the maximum charges for certain services. This may also affect how much of your PIP coverage will kick in for certain treatments.

Lastly, it’s important to recognize that both your medical and disability benefits will be pulled from the same $10,000 policy limit. This means that if you use $7,000 to cover medical services that are rendered, there’s only $3,000 remaining to cover any lost wages or other benefits.

Consequences of Missing the 14-Day Deadline 

The consequences of missing the 14-day PIP deadline can cost you financially, physically, and mentally. This deadline is strict and should not be ignored if you’ve been involved in a car accident in Florida.

The most immediate and worst-case outcome of missing the 14-day deadline is that your claim will be denied and you forfeit your ability to tap into your PIP benefits. The denial will be for treatment coverage, even if you see a healthcare provider outside of the 14-day window. Even if you have a legitimate injury, your denial will keep you from accessing benefits to help pay for needed medical care.

The burden of proof lies entirely with you as the accident victim to demonstrate that you’ve complied with the 14-day rule. Florida courts do recognize that there are extreme circumstances which could bar a victim from seeking out medical care. However, these exceptions are limited and are extended to extreme scenarios in which a victim might be in a coma during the 14-day period or have other extenuating circumstances that make it difficult or impossible for them to adhere to the 14-day rule.

In addition to barring you from receiving medical care, not adhering to the 14-day rule can damage your credibility with insurance adjusters. Additionally, if you do decide to take additional legal action down the road through a personal injury lawsuit, your credibility could hinder your case as well.

If you are facing deadline challenges, having documentation can help support your case that you bring to your insurance provider, but this is not a foolproof method to helping you receive the PIP insurance benefits you need.

Step-By-Step Guide: What To Do Immediately After a Florida Car Accident

It’s important to know what to do after you’ve been involved in a car accident. Here’s a step-by-step guide that can help protect you.

• Call 911: Seeking out medical care immediately after a Florida car accident is essential. If you’re experiencing severe bleeding, neck or head trauma, or suspect internal injuries, these can be life-threatening injuries that require emergency medical care. You can call 911 in this case. If you don’t feel immediate symptoms, you should still seek out medical care because oftentimes, injuries can be masked due to the adrenaline rush and shock of the accident.
• Document the scene if you’re able: This includes taking photos and videos of the car accident, as well as taking down any statements and contact information from witnesses who observed the accident.
• Report the accident to local authorities within 10 days of your accident: Often, when you call 911, police will be dispatched to the accident scene and the police report will be made there.
• Alert your insurance company: This will start the claims process and you must adhere to any timelines or deadlines they have in place.
• Get legal support: Reach out to speak with a Tampa car accident lawyer and schedule your free case consultation with a personal injury attorney. 

With Jack Bernstein, Injury Attorneys, you can get a detailed breakdown of what to do after a car accident so that your rights and options stay protected. 

How To Maximize Your PIP Benefits: Strategic Considerations 

To secure the full $10,000 value of your PIP benefits, you’ll need to be strategic in how you proceed with your claim. At the core of all claims is proper documentation, keeping up with doctor’s appointments, and, of course, adhering to necessary deadlines is a strong way to start. 

When you first go in for your initial medical evaluation after a car accident, it’s important to choose the right healthcare provider. This ensures you receive the specialized care you need without having to move through unnecessary medical treatments first.

Seek out a medical provider or medical institution that is experienced in treating car accident injury victims. Additionally, ensure that the healthcare provider or medical institution you’re working with has experience with the PIP billing process.

Working with a provider that offers this background makes it easier for you to receive and keep track of proper documentation related to your case. This documentation will be the backbone of proving your claim so that you can access your benefits.

You should also have an understanding of the billing process as well. With PIP benefits, medical bills will be sent directly to your PIP insurance provider which can help simplify the process. There may be cases, however, where you’ll need to coordinate treatment coverage through your health insurance provider as well.

Filing PIP Claims: Process, Timeline, and Requirements 

It’s important to understand the difference between seeking out medical treatment and formally filing a PIP claim. After you’ve been involved in a car accident, you should seek out medical care immediately. This ensures that any emergency or non-emergency health issues are addressed early on so as to avoid any further health complications.

Just because you sought out medical care does not mean the PIP insurance claim process has been started automatically. This is something that you will have to do separately. To activate your PIP coverage, you should formally notify your insurance company of the accident and your intent to claim the benefits. Victims generally have 30 days from the date of the accident to file a claim.

This 30-day timeline is different from the 14-day rule, which requires you to seek medical attention before the 14th day after your accident.

Once you have filed your claim, your insurance provider also has obligations as well. Among those is a 30-day deadline to pay for any valid medical bills you have. To receive payment, you must submit required documentation, required applications and paperwork, and provide copies of your bills.

The insurance company does have the right to investigate your claim, and this may be done through an examination under oath or through the use of an independent medical examination. If for whatever reason your claim is denied or delayed, you have the right to appeal as well.

In cases where your insurance wrongfully denies your claim, you may be able to proceed with a bad faith claim against your insurance provider for failing to fulfill their contractual duties.

Related: How Long After a Car Accident Can You Claim an Injury?

When PIP Benefits Aren’t Enough: Third-Party Claims and Additional Options

When the $10,000 PIP insurance benefit is not enough to cover the cost of your injuries, you can pursue a claim against the at-fault driver. This is done by stepping outside of the state’s no-fault insurance system and pursuing a personal injury lawsuit. To do this, however, your injuries must meet the serious injury threshold. 

These injuries typically consist of:

• Permanent loss or impairment of a bodily function.
• Significant scarring or disfigurement.
• An injury that poses a substantial risk of death.

If you do pursue a third-party claim through a personal injury lawsuit, it’s important to recognize that any compensation you recover through a lawsuit can be minimized by any PIP benefits that have been paid out to you.

As with PIP insurance benefits, there are timelines you must follow if you’re going to pursue a third-party claim.

Recent legislation under the 2023 House Bill 837 has modified the deadlines, reducing the personal injury statute of limitations, or the time you have to bring forward a claim, from four years to two years. 

Additionally, there are comparative fault laws you must follow. Florida follows a modified comparative negligence rule, meaning you are still able to recover compensation even if you were partially at fault for the accident. However, you must not have been more than 50% at fault. If you do recover damages through a third-party claim, your damages will be limited by your percentage of fault as well.

In some instances, there may be other avenues of financial compensation you can turn to beyond third-party claims. This might include any optional coverage, like uninsured/underinsured motorist coverage and any health insurance coverage you might have.

Related: How Long Does an Insurance Company Have to Settle a Claim in Florida?

Common Mistakes That Can Jeopardize Your PIP Claim

Many PIP claims that are denied receive a denial because of often avoidable errors. Knowing these errors can help you better understand your options and responsibilities when it comes to filing a PIP claim.

One of the most common denials is not seeking out appropriate medical attention early or within the 14-day time period. Victims who wait even a couple of days after their accident to seek medical attention can weaken their claim that their injuries were caused by the car accident.

Another common reason for denial is poor communication with your healthcare provider. This can result in inadequate documentation that can weaken your claim for PIP insurance benefits. To steer clear of this issue, it’s best to work with healthcare providers who specialize in helping car accident victims through their recovery journey.

Let’s take a closer look at how these errors and others can stand in your way of recovering the compensation you’re entitled to. Understanding these issues can help you be prepared as you move through your own PIP claim process.

Documentation Failures 

Having thorough documentation of your accident is critical. This documentation is the literal proof that supports your claims that your injuries were caused by the car accident you were involved in. 

Types of documentation that can help strengthen your case include:

• Itemized bills from all providers.
• Documentation of medical equipment you require.
• Documentation that shows your diagnosis and overall treatment plan.

The timing of documentation is also important, as documentation that’s created concurrently to your treatment services will hold more strength than documents created later.

Treatment Gaps and Delays 

Treatment gaps can also cause issues with your PIP claim. Having gaps or delays in your treatment can cause your insurance carrier to push back against the credibility of your injury. Because of this, it is critical that you keep up with all scheduled doctor’s appointments and you follow your treatment plan.

The Role of Medical Providers in Florida PIP Claims 

Throughout your PIP insurance claims process, you’ll work closely with your healthcare provider as they are essential to helping you build a strong claim. Under the state’s PIP laws, there is a strict 35-day deadline to submit any medical services you’ve received to your PIP insurance provider. This includes the submission of thorough documentation that supports your case. 

Having good communication with your healthcare provider and working with a provider who has experience navigating PIP cases can be essential to helping you build a strong claim.

If you’re working with a healthcare provider that does not accept PIP insurance, you are able to pay upfront for your medical care and then seek reimbursement for yourself. If you switch providers for whatever reason, this state’s statutory request process (a 627.736(6)(b) request) allows providers to obtain your medical records from another provider in order to help you build a complete profile of your medical needs and care.

Recent Changes to Florida PIP Law and What They Mean for You 

By staying current with state laws and legal changes, you can ensure your rights remain protected. In Florida, the most recent and most significant change has been House Bill 837, which was passed in 2023. This bill primarily affects personal injury lawsuits as an avenue for victims to recover compensation if they’ve suffered a serious injury because of another driver’s negligence. This recently passed bill reduces the statute of limitations for bringing a personal injury lawsuit forward from four years to two years.

The bill also changes Florida’s comparative fault system to what’s known as a modified model. Under this model, if you are found to be more at fault for the car accident than the other driver is, you will be barred from being able to recover damages from the other driver via a personal injury lawsuit.

PIP coverage levels, however, remain unchanged, though there are ongoing efforts throughout the state to change the no-fault system altogether. However, no legislation regarding this insurance recovery model has passed.

Related: Average Car Accident Settlements

Deadline To File a PIP Lawsuit Against the Insurance Company

When you file a PIP insurance claim in Florida, the insurance company should process the claim and pay you fairly. But what happens when they don’t? What happens if they don’t pay you at all? Or what happens if they don’t pay you the amount that you deserve under the contract?

If your insurance company doesn’t pay you fairly, you have the option to bring a lawsuit against your own insurance company. Essentially, your claim is a claim to enforce the contract between you and the insurance company. In Florida, the statute of limitations for breach of contract is five years. The time limit is listed in Florida law 95.11(2)(b). 

When the insurance company doesn’t pay you fairly, and you’ve done everything that you were supposed to do to make the claim, you can bring a lawsuit to require your own insurance company to honor the contract. You can have representation from a Florida car accident attorney bring the claim on your behalf.

Why You Need an Experienced Florida Car Accident Attorney 

Florida’s PIP system and its insurance regulations can be complex, especially if your car accident involves several vehicles, uninsured/underinsured drivers, and even commercial vehicles.

One of the best ways to navigate the PIP claims process while ensuring your legal rights and options stay protected is by seeking out the support of an experienced personal injury attorney.

The right legal counsel can help you understand what actions to take so that you maintain the strength of your case, as well as strategic avenues to consider in order to recover the PIP coverage benefits you may be entitled to.

In instances where insurance companies engage in bad faith, the right attorney will step in to fight back against wrongful denials or other issues on the part of your insurance provider that are delaying your access to your benefits.

With over 40 years of experience and a track record of results, the team at Jack Bernstein, Injury Attorneys, brings the tangible tactics you need to ensure you recover the compensation you’re entitled to. 

Composed of six lawyers and over 40 staff members, our firm will support you through various resources and individualized counseling to help you navigate the legal process. 

Serving residents throughout Tampa, Sarasota, St. Petersburg, and Clearwater, it’s our dedication to fighting for the rights of victims like you that has earned us the spot as one of the leading personal injury attorneys in the region. Reach out today to schedule your free case evaluation.