Tuesday, December 30, 2014

What Qualifies as an Emergency Medical Condition for PIP Purposes?



On January 1, 2013, the Florida legislature1 passed changes to the laws regarding Personal Injury Protection (PIP) insurance coverage. These changes limited the maximum amount of settlement an injured motorist could receive unless that motorist suffered an “emergency medical condition” in the accident. The limits for PIP payouts are now as follows:

·        $2,500 maximum if no emergency medical condition was suffered
·        $10,000 maximum if a victim suffered an emergency medical condition

This new distinction naturally led many people to wonder: what qualifies as an emergency medical condition under the new laws2 and how will I know if I am eligible for a higher payout?

Requirement for emergency medical conditions
The definition of emergency medical condition under Florida law is not completely clear. The injury must have acute and severe symptoms, which may include substantial pain or inability to move around. Additionally, an emergency medical condition can result in one of the following if you fail to seek immediate medical assistance:

·        Serious deficiency or dysfunction of an important organ or body part
·        Serious impairment to important bodily functions
·        Other serious negative implications to a victim's health

Again, these requirements are not clear-cut. While serious and paralyzing spinal cord injury would almost always be considered an emergency medical condition, an equally disabling brain injury may not qualify if it does not present immediate and noticeable symptoms.

If you believe you have suffered an emergency medical condition for the purposes of PIP yet are being denied proper benefits by an insurance company, you have the right to bring a legal claim. It will then be up to a jury of your peers to determine whether your particular injuries were serious enough to be considered an emergency medical condition.

Furthermore, the PIP laws require that a certified medical professional must agree that your injury was serious enough to warrant immediate medical treatment. Such documentation must come from one of the following:

·        Licensed medical doctor
·        Advanced registered nurse practitioner
·        Osteopathic physician
·        Physician's assistant
·        Dentist

Other types of medical treatments, including acupuncture, chiropractic, or massage therapy, are not acceptable forms of treatment to satisfy the emergency medical condition requirement.

Always seek a medical evaluation in a timely manner
An additional important requirement to receive a payout for an emergency medical condition under PIP laws is that a victim  must seek out medical treatment for the injury or condition within fourteen days of the accident and injury. If you wait longer than two weeks to seek medical treatment, you will likely not be eligible for any payout under PIP insurance. For this reason, it is always important that you undergo a full medical evaluation as soon as possible following an accident in order to identify and document any potential serious injuries. Even if you do not believe that your symptoms are severe, you should visit a doctor as symptoms of many different injuries have the ability to gradually develop and/or worsen over time without the necessary treatment.

Even if you do seek medical attention within fourteen days, there is still a chance that the insurance company will attempt to limit your payout to only $2,500 by claiming that your injury was not severe enough to qualify as an emergency medical condition.

If you have only been offered a settlement that is inadequate to cover your personal injury losses, an experienced Clearwater, Florida PIP attorney at the Dolman Law Group in Florida can help you. We know how to negotiate with insurance companies and represent your best interests in court if necessary. Please do not hesitate to call an experienced personal injury lawyer at 727-451-6900 for a free consultation today.


Dolman Law Group
800 North Belcher Road
Clearwater, FL 33756
(727) 451-6900