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Florida’s Revised PIP Statute


Personal Injury

As many are aware, important changes regarding Personal Injury Protection (PIP) went into effect in 2012 and 2013. The primary goals in Florida’s Revided PIP Statute, were aimed at reducing fraud, lowering auto insurance costs, and limiting litigation costs associated with auto accidents. The Accident & Injury Attorneys of the Law Office of Alba & Yochim P.A. provide the following to assist the residents of Gainesville and Ocala in understanding their rights and obligations under the revised law.

The most significant effect of this legislation is the limitations it places on an accident victim’s right to receive PIP benefits. In addition to time limitations, there are also restrictions associated with where initial treatment is received, as well as the way in which an injury is diagnosed, that can effect entitlement to PIP benefits.

In Florida, Personal Injury Protection (PIP) must be included within all auto insurance policies. In order to better understand the effect of revisions to the PIP statute, it is helpful to understand auto policies in Florida. For more information regarding coverage in Florida, see our discussion on Minimum Requirements and Additional Coverage related to Florida Auto Insurance.

Entitlement to medical benefits under Florida’s revised PIP statute, beyond $2,500.00, can be simplified by considering three primary factors: (1) Time Limitation; (2) Medical Professional Providing Initial Treatment; and (3) Medical Diagnosis, each of which are discussed below:

(1) Time Limitation. Medical treatment must be sought within 14-days following the motor vehicle accident;


(2) Medical Professional Providing Initial Treatment. Initial treatment must be provided in a hospital or licensed clinic, or by a one or more of the licensed medical professionals specified by statute, including a medical doctor, osteopathic doctor, dentist, physician assistant, or advanced registered nurse practitioner;


(3) Medical Diagnosis.  The victim’s injuries must be diagnosed as an emergency medical condition, as defined by statute, and as determined by a medical professional included within the statute.

It is important to note the “AND” referenced between each of the factors above. In other words, all three requirements must be adhered to in order for a victim to be entitled to PIP benefits under the revised statute. These revised statutory changes and issues created by their legal uncertainty often creates confusion for accident victims, particularly with regard to the ‘medical diagnosis’ requirement.

Florida Statute, section 627.732(16) defines ‘emergency medical condition’ as:

Emergency medical condition” means 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.

In some cases, such as where a victim was transported from the accident scene via ambulance and an appropriate diagnosis is made in the emergency room, the requirements under the revised PIP statute will generally have been met. There has been much controversy over the language provided in the revised statute, on this, and a number of issues. Consequently, seeking consultation with an attorney is critical.

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In other cases, an injury may not be immediately evident following a car wreck. In these cases in particular, the victim needs to pay careful attention to the requirements enumerated within the revised statute, in order to avoid the potential consequence of denial of PIP benefits. Some victims may think that by visiting their primary physician within 14 days, the requirements may be met—but this is not always the case.

Other victims may think that the statutory requirements will be met by seeking treatment at a hospital. In either scenario, the injured must ALSO receive a diagnosis of an ‘emergency medical condition’ in order to be entitled to PIP benefits.

The changes to the statute have been litigated and led to certain periods where the emergency medical condition was temporarily declared invalid.  It is important to contact an attorney to find out the current status of the law and how it impacts your individual situation.