Florida PIP 14-Day Rule Explained: What Medical Providers Need to Ask Every Patient
Under Florida Statute § 627.736(1)(a), a person injured in a motor vehicle accident must receive initial medical evaluation and care within 14 days from the date of the accident for PIP coverage to apply.
✔ If treatment occurs within 14 days → PIP coverage is available
✘ If treatment begins on day 15 or later → PIP will not cover the claim
This rule is strict. Even if the patient has clear injuries, insurers can—and often do—deny all charges if this requirement is not met.
Who Can Provide the Initial 14-Day Treatment?
The first treatment can be performed by:
- MD or DO
- Dentist
- Chiropractor
- Hospital
- Urgent Care Center
- Licensed EMS personnel (initial evaluation counts)
After this initial visit, subsequent care can be provided by many other provider types, but the first evaluation must occur within the 14-day window.
Why the 14-Day Rule Matters for Providers
If the patient has not received treatment within 14 days:
- PIP benefits are completely unavailable
- All charges will be denied
- The patient may be personally responsible for payment
- The clinic may face avoidable billing issues or collections challenges
For this reason, verifying this requirement during intake is essential.
The Key Questions Providers Must Ask
To protect their clinic and ensure clean billing, providers should always ask two crucial questions during the first visit:
1. “When was the date of the accident?”
This immediately determines whether the 14-day window has been met.
- If the patient presents within 14 days, providers may continue with normal PIP billing.
- If the patient presents on day 15 or later, they should be informed that PIP may not apply.
Documenting the patient’s answer is equally important.
2. “Have you received any medical treatment since the accident?”
A patient may have received initial care somewhere else—even if they didn’t mention it at first.
Common initial treatment locations:
- ER or hospital
- Urgent care
- Primary care physician
- Chiropractic office
- EMS evaluation at the scene
- Walk-in clinic
- Telehealth visit (in some cases)
If the patient already treated within 14 days, your clinic can be the second provider, and PIP should still apply.
Why These Questions Are So Important
Asking these questions helps the clinic:
✔ Confirm PIP eligibility
✔ Prevent submitting claims that will automatically be denied
✔ Avoid billing delays
✔ Reduce administrative follow-up work
✔ Protect the clinic’s financial integrity
✔ Set clear expectations with the patient from day one
These simple intake questions can eliminate many preventable problems later in the billing cycle.
How Intake Staff Should Document the Answers
A good intake form includes:
- A specific question about the accident date
- A question asking whether prior treatment was received
- Where and when that treatment occurred
- Whether EMS evaluated the patient
- A signed patient confirmation
Clear documentation helps if an insurer questions whether the 14-day rule was met.
What If a Patient Misremembers or Isn’t Sure?
This is common. In these cases:
- Ask if they have discharge papers
- Check for hospital wristbands, paperwork, or post-visit instructions
- Ask if they received imaging, medications, or follow-up directions anywhere
- Document the patient’s best recollection
- Inform the patient why the date matters
It’s better to clarify upfront than to discover later that the initial exam happened outside the 14-day window.
Key Takeaways
- The 14-day rule determines whether PIP benefits are available at all.
- Patients must receive their first treatment or evaluation within 14 days of the accident.
- Providers should always ask:
(1) When was the accident?
(2) Have you received any prior treatment? - Confirming this early prevents claim denials and protects both the patient and the clinic.
- Proper intake documentation is essential.
