Florida’s personal injury protection law has one rule that costs more people more money than any other: if you are not seen by a medical provider within 14 days of a crash, your own insurer owes you nothing for your injuries. Not reduced benefits; nothing. The rule has been in the statute since 2013, it applies no matter who caused the crash, and it catches people who were “waiting to see if it got better,” people who were treated at the scene but not by a provider the statute recognizes, and people who went to a chiropractor or massage therapist first and found out later that the clock had already run. This article explains how PIP works, the 14-day rule and the other provisions that quietly cut benefits, and how to protect the coverage you paid for.
What PIP pays, and to whom
Every Florida car must carry $10,000 of PIP, and it pays regardless of fault: 80 percent of reasonable medical expenses and 60 percent of lost wages, plus a $5,000 death benefit, up to the $10,000 limit. It covers the named insured, resident relatives, passengers who do not own a car, and pedestrians and bicyclists struck by the car who do not have PIP of their own. If you own a car, your own policy is the one that pays, even when you were a passenger in someone else’s car or on foot. If you own no car and no relative you live with does, the PIP on the car you were riding in pays if you were a passenger, and the PIP on the vehicle that struck you pays if you were on foot or on a bicycle and live in Florida. The coverage is the first layer of every Florida injury claim; the claim against the at-fault driver comes on top of it, and only for what PIP did not pay.
The 14-day rule
Section 627.736 requires initial treatment within 14 days after the crash, and it says who counts: a hospital, an ambulance, a physician, a dentist, a chiropractor, a physician assistant or an advanced practice registered nurse. A visit to the emergency room, an urgent care clinic or your own doctor on day 1 through day 14 opens the coverage. A massage therapist or acupuncturist does not, and since the 2012 reform PIP does not pay for massage or acupuncture at all. The most common way people lose PIP is simple: the adrenaline wears off on day three, the neck pain starts on day five, and the appointment is on day sixteen.
The emergency medical condition rule
Even with treatment inside 14 days, the full $10,000 is available only if a physician, a dentist, a physician assistant or an APRN determines that you have an emergency medical condition, a term the statute defines as symptoms serious enough that the absence of immediate care could reasonably be expected to put your health in serious jeopardy or cause serious impairment or dysfunction. Without that determination the benefit is capped at $2,500. The determination does not have to be made at the first visit, and a chiropractor cannot make it; the physician who follows the chiropractor can. The practical rule is that the medical record has to say the words, and in a case worth pursuing it usually does, because the injuries are real. A record that never addresses it leaves $7,500 of the coverage unpaid.
The other provisions that cut benefits
- The fee schedule. Most PIP policies pay physician bills at 200 percent of the Medicare rate rather than the billed charge, with hospital and emergency charges on their own schedules, and providers who accept PIP agree to it. What matters to you is that the $10,000 goes further than it would at billed charges.
- The examination under oath and the medical examination. Your insurer can require both, and refusing either can void the coverage. They are conditions of the policy, and you attend with counsel.
- The deductible. A policy with a $1,000 PIP deductible, which many people chose for a lower premium, pays nothing until the first $1,000 of bills has been absorbed.
- Lost wages. Covered at 60 percent, but only with documentation from the employer and the treating provider that you were unable to work, which is routinely missing.
- The 30-day payment rule. Once the insurer has reasonable proof of a bill, it has 30 days to pay or it owes interest, and a provider or insured can sue for a wrongly denied bill. Insurers know this and still deny; the demand letter the statute requires is what gets the bill paid.
What PIP has to do with your claim against the other driver
PIP is also the gate to the tort claim. Because PIP exists, Florida bars a claim for pain and suffering against the at-fault driver unless the injury meets the threshold in section 627.737: a permanent injury within a reasonable degree of medical probability, significant and permanent scarring or disfigurement, permanent loss of an important bodily function, or death. The physicians who treat you inside the PIP system are the ones whose records establish that threshold, which is why treatment is not only about getting better. Gaps in treatment, discharges against advice and months without a visit are the facts the at-fault driver’s insurer uses to argue that nothing permanent happened. Our personal injury protection page covers the statute section by section.
What to do after a crash
- Be seen within 14 days by a provider the statute recognizes: the emergency room, urgent care, your physician or a chiropractor. Day one is better than day thirteen.
- Tell the provider everything that hurts, including what seems minor; the record written that day is the one every insurer reads.
- Ask about the emergency medical condition determination at the first physician visit, and make sure the record addresses it.
- Report the crash to your own insurer promptly, but give the recorded statement with counsel, not before.
- Keep every bill and every pay stub. The 60 percent wage benefit is the one most often left on the table.
Talk to a Florida car accident lawyer
If you were hurt in a crash in Florida, call or text 727-847-4878 or contact us online for a free consultation, 24 hours a day. We open the PIP claim, make sure the 14-day and emergency-condition rules are met, and build the claim against the at-fault driver from the same records, and you owe no fees and no costs unless we win. Start with the Florida car accident page for how these claims work.
The hiring of a lawyer is an important decision that should not be based solely upon advertisements. This article is general information about Florida law as of its publication date and is not legal advice about any particular case; past results do not guarantee a similar outcome.
