If the thresholds in my previous mentioned blogs have been met, there are two (2) different levels of PIP medial benefits that a person paying for PIP may receive.
1. $10,000.00 of medical bills could be paid if the person has an “emergency medical condition”.
2. $2,500.00 for treatment that is not for an initially diagnosed “emergency condition”
This difference is significant. For the past 40 years, persons in the state of Florida who paid for PIP received $10,000.00 of benefits whether they were responsible for the accident or not. The Florida Supreme Court has stated this is the reason how they have upheld the tort threshold is that compensates for taking away people’s right; however the institution of this $2,500.00 amount could easily wipe away the tort threshold[i] in the state of Florida for people who are injured. The fact that an emergency medical condition was not initially diagnosed or realized is going to be a serious problem for many individuals. A doctor may have failed to notice it, the doctors in emergency rooms or walk-in clinics may not care to diagnosis it or even want to get involved in litigation. Thus, there are a number of reasons why a person still may qualify for emergency medical condition but yet not have it initially diagnosed by the treating medical doctor, DO, DS or Physician Assistant or Advanced Registered Nurse Practitioner (ARNP).
The “definition” under the new PIP State of an emergency medical condition is stated as such:
“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.
(b) and (c) are the two sections of this definition which may allow individuals to receive the high level of PIP benefits. Thus, if someone is in severe enough pain that impairs a bodily function such as using the neck, back, shoulders, arms or knees or causes a serious dysfunction in any bodily organ or part, which could be the inability to use it in its full capacity then that individual may be able to use the full $10,000.00 in PIP benefits to pay their medical
[i] The requirement in auto cases which requires an injured person, to get non economic damages (pain suffering and loss of enjoyment of life), they must have a permanent injury. The “threshold” does not appear wnywhere else in the law.
To read Part 6 click here.
