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What is Considered Medical Emergency Condition Under PIP

Medical Emergency Conditions & PIP Coverage

Under new Florida PIP coverage rules, medical emergency conditions are eligible for full $10,000 PIP benefits, while less severe injuries have a limit of only $2,500. Further, there’s now a 14-day window within which one must file an insurance claim under Florida PIP coverage. These changes went into effect January 1, 2013.

Florida Statute 627.732(16) defines a “medical emergency condition” as:

“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.”

It’s a pretty vague definition – who dictates what is “sufficient,” “severe,” “reasonable,” or “serious?” The answer may ultimately be either the insurance adjuster or the court, and their opinions are directly influenced by the evidence in the case. Victims may seek assistance from an Orlando car accident attorney to prove their conditions meets these criteria.

Proving You Suffered a Medical Emergency Condition

Claiming one suffered such a condition is more complicated than one may imagine.

First, to obtain a valid diagnosis, the victim must be seen by a:

  • medical doctor;
  • osteopathic physician;
  • dentist;
  • physician assistant; or
  • advanced registered nurse practitioner.

Furthermore, insurance companies may take advantage of the lax definition of a medical emergency condition. They may utilize expert witnesses who may be likely to claim that conditions such as a herniated disc were the product of a chronic, degenerative injury and not the result of a recent auto accident.

Admission to the emergency room immediately after a car accident is one very good way to show evidence that the condition warranted emergency treatment. However, I have seen many cases where an accident victim suffers a serious injury that takes a few days or even weeks to fully manifest.

Soft tissue injuries such as:

  • whiplash;
  • herniated discs; and
  • muscle strains may not be apparent right away.

The stiffness, pain and swelling may not become apparent until well after everyone has left the scene and refused ambulance transport to see a doctor.

It’s often argued that because an accident victim does not seek immediate medical treatment, injuries must not be a “medical emergency” under Florida PIP coverage laws.

Thus, those who are injured should see a doctor very soon after the accident if not immediately treated at the scene or in an emergency room. Those who encounter problems regarding classification of their injuries can seek legal assistance from an Orlando car accident attorney.

Questioning injury severity? An Orlando Car Accident Attorney Can Review Accident Victims’ Rights

Many of my auto accident cases involve victims who have suffered injuries that were not immediately apparent at the time of the crash. Their 14-day window is often expired, and they’re wondering if they have any legal recourse under Florida’s new PIP coverage laws.

I offer free consultations to Orlando residents who have suffered serious injuries in car accidents so they can make informed decisions about how to seek compensation for damages through their own Florida PIP coverage, the at-fault driver’s liability insurance, or through other means. Call 407-422-4529 to schedule an appointment with an Orlando car accident attorney and find out how you may be eligible for compensation for medical emergency conditions and other conditions after a wreck.

Are You in Need of Legal Assistance?

Contact us to schedule your free consultation today.

We know that accidents don’t always happen during business hours. That’s why our experienced lawyers are standing by, 24/7/365, to listen to your story, evaluate your claim, and help you decide what to do next. Call us now and we’ll see if we can pursue compensation for your injuries!

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