Florida PIP Statute Increases Restrictions After Auto Accidents With TBI
June 13th, 2012
There are a number of states, including Florida, that have no-fault motor vehicle laws designed to provide medical, disability, and wage loss compensation for injured motorists regardless of fault called personal injury protection or PIP. In return for this benefit, an injured driver has to meet certain thresholds before being allowed to bring a claim for damages against the responsible party.
Florida requires that all motorists carry a minimum of $10,000 in PIP coverage. Recently, Florida legislators placed additional restrictions on the state’s no-fault law that affect an injured driver’s ability to claim PIP benefits following an accident.
Among the more significant changes to the PIP law that may also affect drivers who sustain a traumatic brain injury (TBI), there are the following:
- 14-Day Requirement: Anyone injured in a car accident must seek medical treatment within 14-days of the accident.
- Emergency Medical Condition: To receive the full $10,000 in PIP benefits, an M.D., D.O., P.A., or ARNP must diagnose the patient as having a condition that could reasonably result in serious jeopardy to one’s health, or serious impairment of bodily function, or serious dysfunction of a body part or organ.
- Should an injured party in an auto accident not seek treatment within 14-days, he or she may not be eligible for any PIP benefits, which probably means an insurer will not pay any benefits unless there are extenuating circumstances.
Consequences for TBI Victims
For those victims who have suffered a traumatic brain injury, the new measure could have even more serious implications. A car accident can produce head trauma that may result in immediate symptoms of disorientation, headache, dizziness, or nausea that many victims may discount as not serious and not seek any medical treatment. More complicating symptoms in TBI victims often become manifest days or even weeks later such as the following:
- Profound confusion
- Slurred speech
- Mood changes
- Convulsions or seizures
- Loss of coordination
- Weakness in the extremities
- Loss of bladder control
If the injured victim seeks medical care more than 14-days after the accident, it is likely no PIP benefits will be paid. Should more serious symptoms begin to arise after the 14-day period, then a physician or other qualified health practitioner, and not a chiropractor or acupuncturist, would need to diagnose the victim as having an emergency medical condition that is related to the auto accident. If the victim only sought chiropractic care, he or she is only entitled to $2,500.00 in PIP benefits, which may not include any diagnostic procedures.
Problems could arise for TBI victims who have delayed or underlying symptoms that either are not treated or are not considered within the definition of an emergency medical condition until weeks after the accident.
Further, the insurer can require the victim to sit for an examination under oath, or EUO, before any benefits are awarded. In this instance, a patient may not know the extent of his or her condition or the more serious symptoms may not yet have been manifested. The insurer can also withhold any benefits if it reasonably believes fraud is suspected.
Once the more serious symptoms do appear and a qualified physician is able to diagnose a condition of TBI, which would classify as an emergency medical condition, an insurer may challenge the diagnosis or contend that the condition was not related to the accident injuries. A strong medical report and a physician who is willing to advocate for the patient is essential under these circumstances if full PIP benefits are to awarded to a TBI victim.
In any event, auto accident victims who delay in seeking treatment, who do not seek treatment from a physician, or who experience a delay in serious symptoms that would otherwise qualify as an emergency medical condition, may likely face uncertain litigation just to collect PIP benefits.
There are a number of states, including Florida, that have no-fault motor vehicle laws designed to provide medical, disability, and wage loss compensation for injured motorists regardless of fault called personal injury protection or PIP. In return for this benefit, an injured driver has to meet certain thresholds before being allowed to bring a claim for damages against the responsible party.
Florida requires that all motorists carry a minimum of $10,000 in PIP coverage. Recently, Florida legislators placed additional restrictions on the state’s no-fault law that affect an injured driver’s ability to claim PIP benefits following an accident.
Among the more significant changes to the PIP law that may also affect drivers who sustain a traumatic brain injury (TBI), there are the following:
- 14-Day Requirement: Anyone injured in a car accident must seek medical treatment within 14-days of the accident.
- Emergency Medical Condition: To receive the full $10,000 in PIP benefits, an M.D., D.O., P.A., or ARNP must diagnose the patient as having a condition that could reasonably result in serious jeopardy to one’s health, or serious impairment of bodily function, or serious dysfunction of a body part or organ.
- Should an injured party in an auto accident not seek treatment within 14-days, he or she may not be eligible for any PIP benefits, which probably means an insurer will not pay any benefits unless there are extenuating circumstances.
Consequences for TBI Victims
For those victims who have suffered a traumatic brain injury, the new measure could have even more serious implications. A car accident can produce head trauma that may result in immediate symptoms of disorientation, headache, dizziness, or nausea that many victims may discount as not serious and not seek any medical treatment. More complicating symptoms in TBI victims often become manifest days or even weeks later such as the following:
- Profound confusion
- Slurred speech
- Mood changes
- Convulsions or seizures
- Loss of coordination
- Weakness in the extremities
- Loss of bladder control
If the injured victim seeks medical care more than 14-days after the accident, it is likely no PIP benefits will be paid. Should more serious symptoms begin to arise after the 14-day period, then a physician or other qualified health practitioner, and not a chiropractor or acupuncturist, would need to diagnose the victim as having an emergency medical condition that is related to the auto accident. If the victim only sought chiropractic care, he or she is only entitled to $2,500.00 in PIP benefits, which may not include any diagnostic procedures.
Problems could arise for TBI victims who have delayed or underlying symptoms that either are not treated or are not considered within the definition of an emergency medical condition until weeks after the accident.
Further, the insurer can require the victim to sit for an examination under oath, or EUO, before any benefits are awarded. In this instance, a patient may not know the extent of his or her condition or the more serious symptoms may not yet have been manifested. The insurer can also withhold any benefits if it reasonably believes fraud is suspected.
Once the more serious symptoms do appear and a qualified physician is able to diagnose a condition of TBI, which would classify as an emergency medical condition, an insurer may challenge the diagnosis or contend that the condition was not related to the accident injuries. A strong medical report and a physician who is willing to advocate for the patient is essential under these circumstances if full PIP benefits are to awarded to a TBI victim.
In any event, auto accident victims who delay in seeking treatment, who do not seek treatment from a physician, or who experience a delay in serious symptoms that would otherwise qualify as an emergency medical condition, may likely face uncertain litigation just to collect PIP benefits.



