Florida’s no fault law requires auto owners to carry personal injury protection (PIP) insurance. This covers up to $10,000 in medical and disability (lost earnings and wages) resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle. See, Florida Statute Section 627.736(1), Fla. Stat. (2013).
But, the injured person can only get up to $10,000 if a physician licensed under Florida Statutes chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced registered nurse practitioner licensed under chapter 464 has determined that the injured person had an “emergency medical condition.” See, Florida Statutes, Section 627.736(1)(a)(3)-(4) which states:
“Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. is limited to $2,500 if any provider listed in subparagraph 1. or subparagraph 2. determines that the injured person did not have an emergency medical condition.
An emergency medical condition is a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
(a) Serious jeopardy to patient health.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.”
This limitation on the insurance benefits available to injured persons in Florida auto accidents, unfortunately, has withstood challenge in the Second District Court of Appeal, the Florida appeals court which overseees all cases in our Twentieth Judicial Circuit here in Naples, Bonita Springs and Fort Myers.
“Benefits above $2,500 are available only where a medical provider determines an emergency medical condition exists. Where a medical provider does not make a determination that there is an emergency medical condition, benefits above $2,500 are not available.” Med. Ctr. of the Palm Beaches v. USAA Cas. Ins. Co., 41 Fla. L. Weekly 2018 (Dist. Ct. App. 2016)
The lesson here is simple, if you are injured in an accident, it is critical to seek medical attention immediately. Often, the best option is to visit a hospital emergency room to ensure that you will immediately receive all appropriate diagnostic testing and an appropriate physical examination by a licensed medical physician.