If I fail to treat within 14-days after my accident – can I still use the full $10,000 in PIP benefits to pay my medical providers? Unfortunately, Fla. Stat. 627.736 says “no” and this “no” is not negotiable.
Recall that in my prior article, I explained that PIP benefits are not automatically paid directly to the injured claimant following an accident (with exceptions), pursuant to Fla. Stat. 627.736. Rather, PIP benefits are most commonly used to pay medical providers for treatment received after an accident. Now that we have debunked the misconception that injured claimants automatically receive $10,000 following an accident, it is important to be aware of the 14-day rule relating to medical treatment and PIP benefits. In order to fully appreciate the importance of this 14-day rule, consider the following example:
You carry $10,000 in PIP coverage. You pay a premium for your $10,000 in PIP coverage, hoping you never need it. Unfortunately, you find yourself involved in an accident and have injuries. Due to other commitments and obligations, you neglect to visit a doctor within 14-days of your accident. On the 15th day, you visit a chiropractor, informing the chiropractor that you were in an accident and providing your insurance information. You mistakenly believe that PIP will pay up to 80% of the provider’s bill, leaving you with (hopefully) a small 20% payment. Your provider submits their bill to your PIP carrier and the claim/bill is denied, leaving you confused and nervous. What went wrong? Unfortunately, this is a common situation that could have potentially been avoided, had you sought treatment within 14-days.
Fla. Stat. 627.736(1)(a) is clear that in order to qualify for full $10,000 PIP benefits (i.e. have PIP pay any portion of your provider bills), the injured claimant must seek medically necessary services, within 14 days after an accident. If an injured claimant fails to treat with one of the qualified provider set forth in Fla. Stat. 627.736, within 14-days, the claimant could be disqualified from receiving PIP benefits altogether[1]. In other words, if an injured claimant wants to fully use their entire $10,000 PIP benefits to pay medical providers, for treatment relating to an accident, treatment must be sought within 14-days of the accident, and treatment must be with one of the providers set forth in the Statute. In my experience, this is a non-negotiable area of law that is consistently relied upon by insurance carriers to disqualify claimants. This is but one caveat that may stand in your way of receiving full $10,000 PIP benefits to pay your medical providers, but it is not the only one.
Assuming you have sought treatment from a qualified provider within 14-days, Florida law imposes yet another requirement on claimants—the “emergency medical condition”. In a following article, the author will explain the necessity of the “emergency medical condition”, most commonly referred to as the EMC in the legal world. The EMC is an important aspect of PIP law, as claimants could be stuck to $2,500 in PIP benefits, if they do not meet this essential statutory requirement.
But why does any of this matter? Why can’t I use my health insurance to pay my medical bills? Why can’t I use settlement funds to pay my providers after I settle my case? In my next article, I will explain why PIP is so important and why it is crucial to claim and receive the full $10,000.
[1] Please note that there are a myriad of other factors, reasons, and circumstances that could also disqualify an injured claimant from receiving full PIP benefits, even if an injured claimant seeks treatment within 14 days. Please consult with an attorney to discuss your rights under the PIP statute, as this article is not intended to address or cover every unique circumstance.