Justice Demands Diligence

How EMC diagnoses impact PIP benefit entitlement

On Behalf of | Dec 15, 2023 | Insurance

Florida law requires drivers to maintain Personal Injury Protection (PIP) insurance to drive. This type of coverage, often called “no-fault” insurance, provides for medical expenses and compensates for lost wages after a car accident, regardless of who caused it. However, how much PIP benefits cover for medical expenses depends on the diagnosis of an Emergency Medical Condition (EMC).

It’s crucial to understand what an EMC is and how it impacts your compensation after an accident.

In case of a car accident

An EMC refers to a severe medical condition that has resulted from a car accident and requires immediate attention. If such an accident occurs, a physician or other medical providers will assess if your injury falls under the EMC category.

This assessment is based on whether your symptoms have the potential to:

  • Pose a risk to your health
  • Cause impairment of your bodily functions
  • Lead to damage to your organs

If your symptoms meet the above criteria, you may be diagnosed with an EMC.

The 14-day window

Under Florida law, PIP coverage can reach up to $10,000. If you’re diagnosed with an EMC, you could qualify for the total amount for your medical expenses. But without an EMC diagnosis or if you haven’t sought medical treatment within the first 14 days after the accident, you can only receive up to $2,500.

In addition, you don’t need to receive an EMC diagnosis within this 14-day period. A later EMC diagnosis is still valid just as long as you sought medical treatment within this time frame. This highlights the importance of seeking prompt medical treatment and the potential role of an EMC diagnosis on your PIP benefits.

Covering costs of your recovery

PIP coverage is crucial for both minor and major accidents. However, in more severe incidents, it may not cover all costs. If you’re considering a claim against the at-fault driver’s insurance or a personal injury lawsuit for additional expenses, you could consult a personal injury attorney to help you gain valuable guidance and peace of mind.