The Florida 14-Day Rule and the Emergency Medical Condition Test

By the FigureMyTax Editorial Team · How we calculate

Florida PIP medical benefits are payable only if you receive initial services and care within 14 days after the accident. Reimbursement is up to $10,000 if a listed professional determines you had an emergency medical condition, and limited to $2,500 if a provider determines you did not.

The 14-day rule

Fla. Stat. 627.736(1)(a) makes medical benefits payable if the individual receives initial services and care within 14 days after the motor vehicle accident. Disability benefits, which pay for lost income, are in a separate paragraph and do not contain that condition.

Who can give initial care

Initial services must be lawfully provided, supervised, ordered or prescribed by a physician, a dentist, a chiropractic physician or an advanced practice registered nurse, or provided in a hospital or a facility owned by a hospital. A licensed emergency transportation and treatment provider may also give initial care.

Follow-up care

Follow-up care consistent with the diagnosis must be on referral from an initial provider and may be provided by those practitioners, a hospital or surgical center, an entity wholly owned by physicians, chiropractors, nurses or dentists, a hospital-owned entity, a physical therapist on referral, or an accredited or qualified health care clinic that meets the statute's conditions.

Emergency medical condition

Reimbursement for initial and follow-up care is up to $10,000 if a physician, dentist, physician assistant or advanced practice registered nurse determined the injured person had an emergency medical condition, and limited to $2,500 if a listed provider determined the person did not.

A worked example

With $18,000 of medical bills and no emergency finding, 80 percent would be $14,400 but reimbursement is limited to $2,500. With the finding, the $10,000 limit applies. Compare both in the Florida no-fault calculator.

Next steps

Read what PIP covers in Florida PIP benefits and when pain and suffering opens in the threshold post. If an insurer or program claims part of a settlement, see Florida medical liens.

This is general information, not legal advice, and the state comparisons above are illustrative, not an exhaustive survey. Confirm how Florida's rules apply to your specific case with a licensed Florida attorney.