What is Considered Medical Emergency Condition Under PIP

After most motor vehicle accidents—including car, truck, bicycle, and pedestrian crashes, but not including motorcycle collisions—Florida law requires victims to first seek compensation through their own no-fault, personal injury protection (PIP) policies. If you suffer from an emergency medical condition, the law entitles you to more coverage—more money to pay your immediate medical bills. Insurers, however—even yours—may downgrade your injuries to reduce the compensation they pay you.

A car accident lawyer can assess your injuries and ensure the insurance company properly classifies them so it doesn’t stick you with a bill it should pay.

Here’s what you need to know about PIP insurance, how emergency medical conditions qualify under them, and why you need a car accident lawyer to help with your PIP claim.

Schedule A Free Consultation

What Is PIP Coverage?

Personal injury protection is a type of insurance coverage that falls within an auto insurance policy. This coverage applies regardless of who is at fault for an accident.

Motorists in Florida must purchase PIP coverage as part of their auto insurance policy. Along with Property Damage Liability (PDL) coverage, the state requires that motorists have sufficient PIP coverage for any vehicle they own.

When Does PIP Insurance Apply?

PIP insurance generally applies after an auto accident.

You may exercise your PIP insurance coverage after:

• A single-vehicle car accident
• A multi-vehicle car accident
• A truck accident
• A motorcycle accident
• A bicycle or scooter accident
• Any other single- or multi-vehicle accident to which PIP insurance coverage applies

An attorney can answer any questions about PIP insurance coverage in Florida.

What Are Emergency Medical Conditions?

Florida Statutes § 627.732 defines “emergency medical condition” as “a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain.”

The statute continues, explaining that an emergency medical condition may:

• Put your life at risk
• Impair certain bodily functions
• Impair specific organs or body parts

These definitions mean that many specific injuries may qualify as “emergency medical conditions.”

Coverage That PIP Insurance May Provide

PIP insurance coverage aims to account for an accident victim’s injuries. Florida is a no-fault insurance state, which means that even if you caused your accident, PIP insurance should cover 80 percent of your accident-related medical expenses.

Depending on the nature of your injuries, your accident-related medical services may include:

• Ambulance transportation
• Emergency care
• Wound care
• Medical imaging
• Hospitalization
• Dental care for oral injuries
• Medications
• Doctors visits
• Rehabilitation

Florida does not allow the same amount of PIP coverage for every victim. The severity of your injuries may determine how much PIP coverage you receive.

Why Emergency Medical Conditions Are Relevant to PIP Coverage in Florida

Florida statutes allow different amounts of PIP coverage for emergency and non-emergency injuries. If your injuries qualify as an emergency medical condition, you may be entitled to $10,000 in coverage limits.

If your injuries do not qualify as an emergency medical condition, you may only reeceive $2,500 in coverage limits. This is a significant difference between coverage limits, so it is in your interest for your injuries to qualify as emergency medical conditions.

Does PIP Cover Non-Emergency Medical Conditions?

Yes, but at a reduced coverage limit. Florida may hope to prevent accident victims from pursuing substantial insurance payments for non-emergency injuries, but this statute can put many accident victims in a difficult financial position.

If you suffer injuries that don’t qualify as emergency medical conditions but still require significant medical care, your medical costs may exceed the $2,500 coverage limit. However, Florida statutes will only allow you to receive $2,500 in PIP coverage.

If you find yourself in this situation or simply want help with your insurance claim, hire an attorney as soon as possible.

Should I Hire an Attorney to Help Me Seek PIP Insurance Coverage?

A lawyer can be a valuable resource after a motor vehicle accident. A lawyer will fight for the compensation you deserve if you’re seeking coverage for injuries, damage to your vehicle, or any other accident-related losses.

You may hire a lawyer after your accident because:

• You’re busy: Victims of motor vehicle accidents generally have jobs, families, and other responsibilities before the accident happens. Those responsibilities don’t simply go away because you’ve been in a motor vehicle collision. You may also face medical treatment, rehabilitation, and other injury-related responsibilities. Adding a lawsuit to your list of obligations may not be reasonable.
• You’re unfamiliar with insurance claims (or lawsuits): If you handle your claim on your own, you may need to learn about the claims process. If you don’t do your research, you may be at risk of the insurance company taking advantage of you. You may be even less prepared if your claim turns into a lawsuit.
• You value the benefits a law firm provides: A law firm does not simply handle a claim for you. The firm may also bring tangible value to your case. From handling case-related expenses to hiring experts and using a staff of personnel to complete your case, you may be attracted to the perks that a lawyer provides.

You absolutely have the right to handle a claim or lawsuit on your own. However, you may have much to lose. If an insurer argues that your injuries do not qualify as an emergency medical condition, you may have to convince it otherwise. Are you prepared to make this case on your own?

Why You Shouldn’t Wait to Hire an Attorney After an Accident

There are several reasons to hire an attorney as soon as possible after your motor vehicle accident. Florida’s 14-day PIP rule is one of those reasons.

In Florida, you must report an injury within 14 days of your accident for the injury to qualify for PIP coverage, per Florida Statutes § 627.736. If you wait to get medical treatment, this may also affect whether insurers categorize your injuries as emergency medical conditions or not.

There are even more reasons to act quickly when hiring a lawyer, including:

• The sensitivity of evidence: Some evidence may not be available for long. Video footage, witness accounts, and physical evidence may become completely unavailable or not usable over time. The sooner you hire an attorney, the sooner they can seek out evidence for your claim.
• The protection of your rights: You may not know it, but insurers and those liable for your accident may be scheming. One or both of these parties may be working to undermine your claim. Whether by trying to assign fault to you, undervaluing your claim, or other means, parties may be targeting your claim right now.
• Other case-related deadlines: You may face deadlines other than the 14-day rule. For example, Florida generally sets a deadline for filing a personal injury lawsuit. If this deadline expires, you may have less leverage when negotiating with insurers and may not file a successful lawsuit.

Though you may be busy, hiring a lawyer as soon as possible is in your best interest.

How an Attorney May Assist With Your PIP Insurance Claim

A PIP insurance lawyer can handle the claims process for you. If you choose to file a lawsuit, your attorney can handle that process as well.

Attorneys generally mold their approach to their client’s unique circumstances. In motor vehicle accident cases, attorneys generally assist their clients by:

Becoming Familiar With Your Insurance Policy

Though every motorist in Florida must have PIP insurance, the details of each policy matter. Your attorney will review your auto insurance policy. They may look for any additional insurance coverage you’ve purchased, which may entitle you to higher coverage limits for your losses.

An insurer may assume you’re not familiar with the intricate details of your policy. By digesting your policy inside and out, your lawyer will be thoroughly prepared for negotiations with your insurer.

Determining Liability for Your Accident

If you didn’t cause your accident, the at-fault party’s insurance might cover some of your losses. While your PIP insurance will cover some portion of your losses, your losses can exceed your policy’s coverage limits. In this case, the at-fault party’s insurance may cover any losses beyond your own policy’s coverage limits.

It may also be worth filing a lawsuit against the at-fault party.

Depending on the details of your accident, the at-fault party may be:

• Another motorist
• A vehicle manufacturer or seller
• A municipality in Florida
• An automotive repair professional
• A pedestrian, bicyclist, or scooter rider

Your attorney will identify the liable party and craft a plan for seeking compensation from that party (or parties).

Helping Prove Your Emergency Medical Condition (and Any Other Covered Injuries)

Since the emergency medical condition designation is important to any PIP claim, your attorney may try to show that your injury qualifies as an emergency condition.

Your lawyer may seek this designation by:

• Obtaining your medical records
• Obtaining testimony from your doctor(s) about the severity of your injuries
• Obtaining testimony from medical experts about your injuries
• Explaining how your injuries have affected your life, which may show that the injuries are, in fact, serious

The difference in the emergency condition designation can be, at least, $7,500 in insurance coverage limits. Your attorney will work hard to obtain this designation for your claim.

Calculating the Total Cost of Your Losses

Your attorney will determine the cost of all of your accident-related damages, including:

• Damage to your vehicle
• Damage to personal property such as your phone, sunglasses, clothing, and jewelry
• Pain and suffering
• Treatment you need for accident-related trauma, such as counseling or medication
• Lost income and other professional damages

Motor vehicle accidents can become fatal. If you lose a loved one from accident-related injuries, an attorney can seek justice. They can lead your wrongful death claim for you, seeking coverage for your tragic loss.

Disabling injuries can cost millions of dollars. Your attorney will complete an accurate valuation of your case, ensuring that they seek a fair settlement for your losses.

Negotiating With Insurers

Negotiations are a pivotal step in any claim or lawsuit. Your lawyer will go toe-to-toe with insurance representatives. Your attorney will lay out your losses, explain their calculation of those losses, and make a comprehensive argument in your favor.

If insurers refuse to compensate you fairly, your lawyer may explain that they’re willing to take legal action if necessary. If the insurer still does not settle fairly, your lawyer may pursue a lawsuit or other necessary actions.

Handling All Other Claim-Related Duties

Your lawyer will oversee every aspect of the complicated claims process.

In addition to the duties listed here, your attorney may also:

• Complete all claim-related paperwork
• Communicate with insurers and others involved in your claim or lawsuit
• Obtain and manage all case-related evidence
• Document your losses with medical bills and other paperwork
• Arrange case-related meetings
• Monitor the progress of your claim with insurance companies
• Handle any other case-related duties

By hiring an attorney, you allow yourself to focus wholeheartedly on your recovery.

How Much Does It Cost to Hire a Lawyer for an Insurance Claim?

Personal injury attorneys generally offer their services for a contingency fee. Rather than requiring upfront or hourly payment, the attorney will receive a portion of your financial recovery. You will not have to pay anything out of your own pocket to hire a lawyer.

Call an Injury Lawyer Today to Seek Fair Compensation for Your Motor Vehicle Accident

You can research local personal injury attorneys in your area. Consider their experience, client testimonials, and other criteria that are important to you. Attorneys also offer free consultations, during which time you can ask specific questions of a firm that you’re considering. The important thing is that you have the right help seeking maximum compensation for your injuries and losses.

Schedule A Free Consultation