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By: Wayne Hogan and Leslie Goller

The news is not good. Starting January 1, 2013, mandatory PIP insurance of $10,000.00 will pay $7,500.00 LESS in Florida for most motor vehicle accident medical claims than it did in 2012. Below are some highlights of the new PIP law:

14 Days “Use it or Lose it” — If you do not seek medical attention within fourteen (14) days of your motor vehicle accident you will be entitled to $0.00 in medical benefits. In order to be entitled to receive at least $2,500.00 in PIP benefits you must seek medical care within 14 days of your motor vehicle accident.

Medical Coverage Benefits Limited to $2,500.00 unless “Emergency Medical Condition” — In order to be entitled to the full $10,000.00 in PIP medical benefits you must have an “Emergency Medical Condition (EMC).” An EMC is a medical condition manifesting itself by acute symptoms of suffi­cient severity, which includes severe pain, which without immediate medical attention could reasonably be expected to result in:

  • Serious jeopardy to patient;
  • Serious impairment to bodily function; or
  • Serious dysfunction of any bodily organ or part.

Further, an EMC can only be certified by a physician or a physican assistant licensed under Florida Statutes Chapter 458 or 459 of the Florida Statutes, a dentist under Chapter 466, or an advanced regis­tered nurse practi­tioner under Chapter 363.

Impor­tantly, a chiro­practor cannot certify an Emergency Medical Condition.

Medical Coverage Limited to $2,500 if not an EMC or if Initial Treatment with Chiro­practor — If you are not diagnosed with an EMC or if you seek initial treatment directly with a chiro­practor, you only have $2,500.00 in reimbursed PIP medical benefits.

Medical Coverage Limited to Initial Injury Diagnosis — The new PIP coverage limits follow-up care for the $2,500.00 in coverage to medical treatment only that is “consistent with the initial diagnosis.” Thus if the initial diagnosis was cervical (neck) strain and lower back pain also later develops, treatment on your lower back is not covered.

Massage and Acupuncture treat­ments are no longer covered

As such, it is imper­ative that you seek immediate medical attention at an emergency medical facility, if needed, or with a physician to document your EMC condition to ensure suffi­cient coverage for your medical expenses. DO NOT DELAY!