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Sharing data has become easier, but securely sharing that data remains elusive for many providers and attorneys. Email is ubiquitous – everyone has it, and patients and clients want to use it. You may think that HIPAA says you cannot, but you can – if you secure it. The main goal here is to protect your client or patient data and send data securely. However you also want to protect your organization from other risks – phishing, business email compromise, reputation loss, and more.Here’s an easy 8-step guide on how to ensure you’re sharing your client’s data safely: 1. Use Email Encryption when sending email. Software vendors like Sophos allow you to send encrypted emails simply by adding “SECURE:” at the front of the subject line. This also protects against business email compromise (BEC) which is crucial for lawyers handling sensitive information. Sending encrypted emails is the only way to meet HIPAA for sending email – you can’t send data securely without it. 2. Use MFA for all of your email accounts. Google and Office365 have it. In fact, if you don’t have it, you may have voided your cyber liability policy by not enabling it for all users. Multifactor Authentication means that if someone gets your credentials they still need the code from your phone to log in. In fact, use MFA on all of your accounts, not just email. 3. Use a filtering service before your email hits your provider. This will stop junk, spam, and malware from reaching your mailbox. If its not in your inbox, you can’t be phished or scammed. 4. Enable “external sender” policies so you know when emails are coming from outside your domain. You will see a message cautioning the email was sent from outside your organization. 5. Enable VIP protection policies so that you know if someone is pretending to be a user from a different email address. 6. Verify if any “typo” domains exist, for example an “i” when capitalized will look like a lowercase L and can be used to target your clients and patients. Go buy those domains so no one else does and then uses them against you or your clients.Email is ubiquitous – everyone has it, and patients and clients want to use it. You may think that HIPAA says you cannot, but you can – if you secure it. 7. Audit your IT services. If you use internal staff or an outside company make sure that you audit the work. Any decent IT person should not be fearful of their work being wrong or improved by audits. 8. Do regular security and compliance training. This teaches your staff how to recognize scams, phishing attempts, and other threats. Training should include compliance requirements to ensure adherence to legal and regulatory requirements.  Andrew Renck is the owner of RootPoint, an IT services and Cybersecurity Provider located in Miami, FL. Andrew Renck is a 2003 graduate of the University of Miami with multiple degrees including Finance and Economics. While attending the University he created his computer consulting firm RootPoint. He has been providing secure systems integration long before “Cybersecurity” became a recognized term. Renck is an ethical hacker and has provided services for both offensive and defensive cybersecurity projects. Email is ubiquitous – everyone has it, and patients and clients want to use it. You may think that HIPAA says you cannot, but you can – if you secure it. Andrew Renck ROOT POINT (305) 726 9091 arenck@rootpoint.com www.RootPoint.com

In a recent decision, the Florida Supreme Court actually strengthened the billed amount statute of FS §627.736(5)(a)(5) which states: “An insurer may limit payment as authorized by this paragraph only if the insurance policy includes a notice at the time of issuance or renewal that the insurer may limit payment pursuant to the schedule of charges specified in this paragraph… If a provider submits a charge for an amount less than the amount allowed under subparagraph 1., the insurer may pay the amount of the charge submitted.” (Emphasis added) This Florida Supreme Court opinion makes the billed amount doctrine alive and well In simple terms, this statute means that if the medical provider submits a claim form billing an amount for a CPT code that is less than 80% of what the fee schedule would allow, then the insurance company is required to pay the full billed amount of the CPT code on a medical provider’s claim form without any reductions. In the recent Florida Supreme Court case, aster rendering services to the patient, the medical provider submitted a HCFA with a CPT code charging $100.00. The 80% of the fee schedule under FS §627.736(5)(a) (1) for the CPT code charged was $149.92. So, 80% of the maximum charge under the fee schedule was $119.94 which was higher than the submitted $100.00 charge. Because the charge of $100.00 was less than $119.94, FS §627.736(5)(a)(5) expressly allowed the 16 insurance company to pay the $100.00 amount billed. Instead of paying the $100.00 amount billed, the insurance company chose to pay 80% of the amount billed which was $80.00. The Florida Supreme Court allowed the insurance company to pay 80% of the $100.00 billed amount or $80.00 because the insurance company’s policy had specific language that allowed the insurance company to make that reduction. The Florida Supreme Court allowed insurance company to pay less than the billed amount if the insurance company’s policy specifically allowed it to: “pay 80% of a submitted charge if that charge is less than the amount reimbursable under the sched- ule or other statutory provisions, may the insurer pay 80% of the charge submitted by a medical provider.” The good news is that this also means if the insurance policy does not have this specific language in it, then they would have to pay the billed amount under FS §627.736(5)(a)(5). This case is positive for medical providers because trial courts have used cases from the District Courts of Appeal to claims that the billed amount doctrine was gone for good. This Florida Supreme Court opinion makes the billed amount doctrine alive and well. I have not seen many insurance company policies with this specific language mentioned in the Florida Supreme Court opinion. So, it is important to review the insurance policy before determining whether the insurance company erred in not paying the billed amount. George A. David, Esq. 500 South Dixie Hwy, Ste. 220 Coral Gables, FL. 33146 305-569-9980 gadeservice@gmail.com

While it doesn’t occur too often, it’s practically inevitable if you’re a Florida medical provider who treats patients for Personal Injury claims that you will eventually receive a request from a Personal Injury Protection (PIP) insurance carrier for a refund of a supposed overpayment. In the realm of PIP insurance, medical providers often find themselves grappling with refund requests from insurance companies. These requests can be daunting, prompting providers to question their legal standing and obligations. However, it’s crucial for Florida medical providers to understand their rights and defenses, particularly the concept of detrimental reliance. Detrimental reliance, also known as detrimental estoppel, is a legal principle that comes into play when one party reasonably relies on the actions or representations of another to their detriment. In the context of medical providers and PIP insurance companies, this principle holds significant weight. When a medical provider renders services to a patient covered by PIP insurance, they do so under the assumption that they will be compensated for their services in accordance with the terms of the insurance policy. This reliance on the insurance coverage is not only reasonable but also essential for the provider to continue offering care to injured individuals. However, complications arise when PIP insurance companies retroactively seek refunds for previously paid claims. In such cases, medical providers may invoke the defense of detrimental reliance to resist these refund requests. By demonstrating that they reasonably relied on the representations of the insurance company regarding coverage and payment, providers can assert their right to retain the compensation they received for services rendered. It’s important to note that detrimental reliance is not a blanket defense and must be supported by evidence. Medical providers should maintain thorough documentation of all communications with the insurance company, including claim submissions, payment receipts, and any correspondence regarding coverage or reimbursement policies. Additionally, medical providers should be prepared to demonstrate the detrimental consequences they would face if forced to refund payments already received. This may include financial losses, disruption of patient care, and/or damage to professional reputation. Complications arise when PIP insurance companies retroactively seek refunds for previously paid claims In navigating refund requests from Florida PIP insurance companies, medical providers should also be mindful of legal requirements and procedures. Consulting with experienced attorneys specializing in PIP Insurance claims can provide valuable guidance and representation throughout the process. Ultimately, the defense of detrimental reliance serves as a crucial safeguard for Florida medical providers facing refund requests from PIP insurance companies. By understanding and asserting this defense, providers can protect their rights, uphold their professional integrity, and continue to prioritize the care of their patients. In conclusion, while refund requests from Florida PIP insurance companies can be challenging, medical providers have legal recourse in the form of the defense of detrimental reliance. By leveraging this defense and seeking appropriate legal counsel, providers can navigate these requests with confidence and uphold their commitment to patient care. Christopher M. Tuccitto,Esq. FLORIDA ADVOCATES PA. Florida Advocates 45 East Sheridan Street Dania Beach, FL 33004 (754) 263-4252 chris@fladvocates.com https://www.fladvocates.com/

Slip and fall cases have long been the albatross of the personal injury industry. Now, with the implementation of the Florida Tort Reform Act 768.0427 it has become even more of a task to be able to successfully handle these types of cases. This starts with the victim following practical measures after a slip and fall incident occurs. First, when the incident occurs, as difficult as it may be, it is very important that the victim document the conditions that lead to the slip and fall occurring. That means if there is liquid on the floor, they want to take pictures of the liquid before the premises staff or manager cleans it up. If there are track marks or footprints through the liquid, be sure to capture those images. Additionally, make sure to alert the store or premises manager so that they can create an incident report. Request a copy of the incident report for your own records. Please note that some stores will provide them with a copy of the report while others may not, due to their work product privilege. This is one of the reasons it’s so important to have your own documentation. After completing the incident report, the victim should immediately get examined either at the emergency room or an urgent care facility. Be sure to recall to the medical provider every detail to paint a clear picture of exactly how the incident occurred and how it led to the injury. Proximity of the medical treatment to the injury is always something that the insurance adjuster will try to use to decrease the value of the case if it did not immediately occur. Now, based on the injury that the victim suffered in the slip and fall, their medical provider will come up with a treatment plan to help them to get better. The treatment plan will usually begin with conservative care, such as chiropractic care or physical therapy, depending on the injury, and then graduate to more invasive care if the victim’s injury is not responding to conservative care. The type of treatment prescribed will also depend, in large part, on the diagnostic imaging results once the victim is sent for an MRL The most important thing is that the victim must remain compliant with the doctor’s orders. Failure to do so makes the attorney’s job much more difficult to relate the injury and need for care to the injury suffered as a result of the accident. Proximity of the medical treatment to the injury is always something that the insurance adjuster will try to use to decrease the value of the case if it did not immediately occur. Remember, although slip and fall cases can be difficult, a slip and fall victim’s case is due the same amount of vigor and aggressiveness that a car accident victim receives. It’s important that you follow the above recommendations to give yourself the best chance of success. Michael Mills, Esq. I.A.N.INJURY ASSISTANCE NETWORK 823 N. Thornton Ave Orlando, FL 32803 (800) 988-2341 mmills@injuryassistancenetwork.com www.injuryassistancenetwork.com

Thankfully, the 2024 legislative session has ended without inflicting any cataclysmic changes on the Personal Injury industry. Although none of them passed, there were some bills introduced in this session that are worth our attention, because they may be resurrected in future sessions. Motor Vehicle Insurance HB 653 and the identical SB 464 is a perennial effort to do away with Personal Injury Protection (PIP) coverage under Florida’s No-Fault insurance law and replace it with bodily injury (BI) liability coverage. The primary difference between PIP and mandatory BI is that under PIP, someone injured in an auto accident seeks coverage first under their own PIP policy, whereas under mandatory BI, someone injured in an auto accident would seek recovery from a responsible third party’s (other driver’s) BI coverage. The bills are like the bill vetoed in 2022 by Governor DeSantis and filed again in 2023. Last spring’s bills were never heard by a committee and neither of these bills received a hearing this session. Insurance Claims HB 731 passed its first committee on February 6th, 2024 by a 15-1 vote in the House Insurance & Banking Subcommittee. It requires insurance companies to report to the Office of Insurance Regulation (OIR) the recovery of funds from automobile claim judgments, settlements, and attorney fees and costs, as well as repayment of claims paid from unlawful acts. OIR, in turn, would be required to consider recovery of those funds in reviewing companies’ rates. The bill also specifies that a policyholder’s payment of a deductible or copayment is not a condition of a carrier’s payment obligations. There is a similar bill in the Senate (SB 1024) that never received a hearing. Litigation Financing SB 1276 and HB 1179 are identical bills to regulate third-party financing of lawsuits against businesses. The bill requires a court’s consideration of potential conflicts of interest that may arise from the existence of a litigation financing agreement in specified circumstances; prohibits specified acts by litigation financiers; requires certain disclosures related to litigation financing agreements and the involvement of foreign persons, foreign principals, or sovereign wealth funds; and requires the indemnification of specified fees, costs, and sanctions by a litigation financier in specified circumstances, among other provisions. Despite the Senate bill making it through all committees and the House bill getting through its initial committee, neither reached a floor vote. Attorney’s Fees SB 1782 and HB 1651 both seek to reestablish the right to attorney’s fees for the prevailing Plaintiff in a PIP lawsuit. As I’m sure you recall, the the passing of HB 837 last year removed this right, which was previously in existence since 1896. Unfortunately, despite their noble efforts, neither of these bills have received much traction within the legislature, with neither of them advancing beyond the initial committees that reviewed them in early January. Worker’s Compensation SB 362 and HB 161 are related bills that seek to increase a health care provider’s witness fee for a deposition and the reimbursement amounts under Worker’s Compensation for physicians and surgical procedures. Both the Senate and House bill would increase the medical provider’s witness fee to $300.00 per hour. The Senate bill increases the maximum reimbursement for a physician licensed under chapter 458 or chapter 459 and for surgical procedures to 200% of the Medicare allowable amount. The House bill would raise Worker’s Compensation reimbursement amounts to 150% of Medicare. While both bills were advancing through committees in January and February 2024, both the Senate and the House have decided to postpone consideration of these bills, at least temporarily. Due to this postponement so late within the session, neither version had a chance of passing this year. Based on the above, 2024 was a relatively uneventful year for our industry when it comes to legislative changes. Lately, it seems that no change is good for us, although it would’ve been nice to have attorney’s fees reinstated in PIP lawsuits. Maybe this bill will gain greater traction in future sessions if it is reintroduced. We shall see. Stay tuned. Christopher M. Tuccitto,Esq. FLORIDA ADVOCATES PA. Florida Advocates 45 East Sheridan Street Dania Beach, FL 33004 (754) 263-4252 chris@fladvocates.com https://www.fladvocates.com/

One of the most common questions our company gets regarding the billing and coding of orthopedic bracing is what type of brace to prescribe and dispense? When it comes to bracing, the two main classifications are off-the-shelf and custom prefabricated. Knowing the difference can be very important in order to remain compliant.  The first type of orthopedic bracing is custom prefabricated. Examples of these codes for lumbar braces are Lo627, Lo631 and Lo637. These braces are required to be trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. You may ask, who is considered a person with expertise? This becomes a bit complicated based on the insurance you are billing. According to Medicare, a person with expertise is an Orthotist/ Prosthetist, MD, DO, APRN or PA. What is required to custom fit a brace? Many of the bracing manufacturers provide documentation worksheets showing the steps needed to customize a specific brace whether it be lumbar, knee or wrist. This includes steps on how the patient was measured, how the product was trimmed, and/or how it was molded to specifically fit the patient. This document needs to be filled out in detail to remain compliant when dispensing these custom prefabricated braces. The second type of orthopedic bracing is the off-theshelf or OTS. OTS braces are the most common braces being dispensed by providers. According to CGS Medicare, these braces require minimal self-adjustment for fitting at the time of delivery. Fitting these OTS braces does not require fitting by a person with expertise. Essentially, these braces should be able to be taken out of the package and adjusted to fit the patient by simply reading the instructions. The reimbursement between the custom prefabricated and the off-the-shelf does differ. Since there is more of a fitting required, the custom prefabricated braces reimburse higher. Many of the brace manufacturers have had their products dual-coded. This Way, physicians can choose how they would like to fit the patient. Many patients need more of a custom fit, and others just need a standard fit. One code will be the custom prefabricated code and one will be the OTS code. When dispensing orthopedic bracing it is very important to know the difference between the different classifications. At JMS Med Supply, we can provide physicians and billing personnel with the necessary documents in order to bill both classifications of orthopedic bracing. When it comes to bracing, the two main classifications are off-the-shelf and custom prefabricated. Knowing the difference can be very important in order to remain compliant. Matt Snyder PRESIDENT, JMS MED SUPPLY 855-700-5960 matt@jmsmedsupply.com https://www.jmsmedsupply.com

Human error remains the Achilles’ heel of law firms or medical practices’ cybersecurity.   As a partner at Internos, I’ve had the privilege of working with legal professionals, and I’m eager to discuss this vulnerability and how law firms and medical practices can fortify their defenses against potential legal consequences. Understanding Human Vulnerability Human error is something we have to think about. We are not perfect. We make mistakes. We’re emotional beings and sometimes we’re not at our best.  People, processes and technology determine your level of cybersecurity. When you have amazing tech and don’t have the technical know-how to use it, it’s like having an Boo-horsepower car but you never drive more than 20 miles per hour.  Processes determine your level of organizational security, and together, combined with your people, is how you get the best out of all three elements. Balancing Accessibility and Security Achieving a balance between accessibility and security means not taking for granted or making any assumptions about your technology and processes.  Many small business leaders like to think cybercrime won’t affect them. Unfortunately, that belief is challenged when they or someone close to them is targeted. Here’s the reality: Nothing is more secure or less secure than anything else. Every system has to be properly configured and maintained. Pll and Leveraging Technology The number one thing law firms and medical practices need to focus on is protecting PH (personal identifiable information). Ask yourself, “Where do we store and how do we share PII?” That leads us to focus on where you need hardening for protection.  You can follow all the standard practices like updating, multi-factor authentication and SaaS tools, but you need to make sure everything is properly configured and figure out who is accessing what.  Ask yourself, “Am I exposing more than is necessary?” It would be easy to say there’s a one-size-fits-all solution, but because all environments are different, things are used differently, and for many other reasons that aren’t always logical, security solutions must be customized. The Current Cybercrime Landscape The rise of cyber incidents and the damage they’ve caused has changed drastically and cybercrime has gone up exponentially in the past three years. You should make sure the premiums you pay out for cyber insurance will give you coverage in the event of an incident.  We, as technology providers, owe it to ourselves and our clients to better educate them on how things have changed. That’s why we take the time to talk about the latest threats with our clients and with others in our sphere of influence, like readers of this magazine. Cultivating a Security-Conscious Mindset The biggest failure anyone can have is thinking cybercrime won’t happen to them. It’s also a challenge when business owners are afraid or embarrassed to admit that they’ve been a victim. As experts in this field, we know these crimes are under-reported. People, processes and technology determine your level of cybersecurity. When you have amazing tech and don’t have the technical know-how to use it, it’s like having an 800-horsepower car but you never drive more than 20 miles per hour. If people were more open and honest about when things were going wrong, everyone would be more prone to safeguard against these types of incidents, proactively instead of reactively. The strength of a law firm or medical practice’s cybersecurity is not just a matter of protecting PII but also a testament to its commitment to client trust and professional integrity. Jairo Avila PARTNER AT INTERNOS 5781 B NW 151st Street, Miami Lakes, FL. 33014 (305) 590 5333 javila@gointernos.com Home

According to the AMA Guides, “Pain is an essential determinant of the incapacitation of many individuals who undergo impairment evaluation. When pain persists, it has the capacity to dominate a person’s existence, contributing to significant impairment, reduction in the quality of life, functional limitations, and disability.” An impairment rating quantifies the injury and scales the impairment’s severity. This rating acts as one of the most important pieces of information for determining case settlement outcomes in auto insurance claims. It carries immense weight in the determination of case settlement values and the amount of financial compensation an injured party is entitled to receive. The AMA Guides operate under the premise that injuries cause deficits in functioning and can be quantitatively assessed during an impairment evaluation and consider pain intensity, emotional distress related to pain, and ADL deficits secondary to pain. The Guides give the greatest weight to interference with ADL’s. Traditionally, pain assessment has relied on subjective means such as patient-reported findings (o-10 Analog Score) or pain questionnaires. According to the Guides, “A basic challenge for a system of rating pain-related impairment is to incorporate the subjectivity associated with pain into an impairment rating system whose fundamental premise is that impairment assessment should be based on objective findings.” For pain to be considered in an impairment rating, it must be quantified in the evaluation. If pain-related impairment is ratable, the examiner may award a pain-related increase of an impairment rating score.  Algometry testing: An objective assessment of pain Algometry testing is an objective, quantifiable method for assessing pain. Because of its reliability and reproducibility, algometry can be used for medico-legal documentation of pain intensity. Algometry testing measures pressure applied to specific locations on the patient. Pressure Threshold Testing is the minimum pressure required to cause the patient pain. Measurements are performed over areas of muscle tenderness at specific trigger points. Normative data exists for males and females in the areas which trigger points are frequently found. Clinical cutoff values have also been established in determining a clinically abnormal response to pain/pressure stimulus. Bilateral deficits from the opposite side are also considered positive Algometry test findings. Duties Under Duress/Loss Of Enjoyment Of Life Duties Under Duress (DUD) and Loss Of Enjoyment of Life (LOE) are two of the largest value drivers auto insurance companies take into account which can significantly contribute to increased case settlement values. DUD relates to pain experienced while performing an activity despite pain they experience, while LOE relates to a person unable to continue performing an activity due to an injury. This can include work, household/ domestic activities, hobbies, and recreational activities. Two things are needed for auto insurances to assign a value for DUD/LOE:  Experiencing pain while performing an activity. Documentation of the activity and pain in medical records. In addition to quantifying pain through Algometry testing, documenting pain-related behaviors during the physical examination can also assist in validating injury severity. Examples include documenting patient-reported complaints of pain during ROM testing and observations of pain-related behaviors such as wincing/grimacing during testing and correlating these to DUD/LOE to further validate injury severity. Objectively assessing pain through Algometry testing further facilitates meeting the value drivers used by auto insurance companies in determining case settlement outcomes, and ensures your patients and clients receive the fair case settlement value they deserve. Erik Groberg CLINICAL DIRECTOR AT JTECH MEDICAL 7633 S. Main St. Bldg. D Midvale, UT 84047 (385) 695-5011 erikg@jtechmedical.com https://www.jtechmedical.com

This is the third article in a series that lights the way to success under Florida Tort Reform’s Section 768.042Z This article will provide a deeper analysis of the distinctions between Subsections (2)(a) and (2)(b) and lay the foundation for the deeper dives into the four parts of Subsection (2)(b) that will be presented in later articles.  Section 2 of the Statute governs admissible evidence to prove the amount of damages for medical services. Subsection (2)(a) applies to bills for past medical services that have already been satisfied and Subsection (2)(b) applies to such bills that have not been satisfied. Tax Guidance for Structured Attorney Fees (a) Evidence offered to prove the amount of damages for past medical treatment or services that have been satisfied is limited to evidence of the amount actually  Ltd, regardless of the source of payment. First, because Subsection (2)(a) deals with admissibility rather than pre-trial discovery, the relevant time to consider the satisfaction of bills is the date of trial. Thus, Subsection (2)(a) applies only to bills satisfied before trial. Second, the only evidence a plaintiff can present to a jury is the amount that was paid to satisfy the bill. Thus, a plaintiff cannot present a medical provider’s charged amount. Third, Subsection (2)(a) applies to all pre-trial payment sources: (a) commercial health insurance (including out-of-network payments which can be 100% of the charged amount), (b) government programs, and (c) self-pay patients. Importantly, Section 4 of the Statute states that a jury award cannot exceed the amount that a jury may consider under Section 2. Thus, the jury cannot award more than the amount that was paid to satisfy a bill before trial. Subsection (2)(a) cannot apply to (a) commercial health insurance payments that were not yet made at the time of trial, such as when a health insurer denies payment and the denial is under appeal at the time of trial; (b) reimbursements from a patient or the patient’s law firm that occur after trial; nor (c) assignments of medical bills to purchasers of accounts receivable. Subsection (2)(b), on the other hand, applies to evidence relating to unsatisfied medical bills: (b) Evidence offered to prove the amount necessary to satisfy unpaid charges for incurred medical treatment or services shall include, but is not limited  k, evidence as provided in this paragraph. First, Subsection (2)(b) applies whenever a medical provider (a) does not take health insurance at all, (b) opts out of Medicare, (c) takes health insurance, but (i) permits patients to waive use of health insurance so the patients can avoid co-payments, (ii) uses modalities that health insurance will not reimburse, or (iii) fails to properly submit bills, or (d) sells the account receivable to a third party. Second, Subsection (2)(b) expressly states that the evidence that can be presented regarding unsatisfied charges is “not limited to” the evidence expressly rendered admissible in the four parts contained within Subsection (2)(b). This is critical because Subsection (2)(b)(5) is a “catchall” that renders admissible “any evidence of reasonable amounts billed.” For reasons that cannot be addressed in this short article, Subsection (2)(b)(5) will include charged amounts. Thus, unlike Subsection (2)(a), Subsection (2)(b) does allow a plaintiff to present a provider’s charged amount.  Importantly, Section 4 of the Statute allows a jury to award an amount that the jury was permitted to consider under Section 2. Because Subsection (2)(b) allows a jury to consider charged amounts, a jury may award the full charged amount. The subject of upcoming articles is how to convince a jury to award an amount approaching the full charge. Aaron Proulx, Esq. THE DOCTOR’S LAWYER, PLLC. (813) 486-7321 aaron@doclawfirm.com Home

I have noticed recently an alarming high rate of PIP claims being denied by various insurance companies based on a patient not receiving treatment within 14 days of the date of the accident. It seems to me that insurance companies have a conference as to what their latest maneuver will be to deny claims and then all of a sudden you see different insurance companies denying claims for the same reason. So, let me remind you of the 14-day rule and how it works. FS §627.736(1)(a) requires a patient to receive treatment, medical care or some type of initial services within 14 days of the accident as shown below：  REQUIRED BENEFITS.—An insurance policy complying with the security requirements of s. 627.733 must provide personal injury protection to the named insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in the motor vehicle, and other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle, subject to subsection (2) and paragraph (4)(e), to a limit of $10,000 in medical and disability benefits and S5.000 in death benefits resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle as follows: Medical benefits.—Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital, and nursing services if the individual receives initial services and care Pursuant to subparagraph 1. within 14 days after the motor vehicle accident. (Emphasis added). The 14-day limitation has been challenged and courts have found the provision to be constitutional so we must live with the 14-day limitation. I find that the 14-day rule is a favorite for insurance companies to deny medical treatment as it is an easy rule for them to follow. Below is a list of “treatment” options by a patient that will satisfy the 14-day rule： EMS treatment at the scene of the accident; Transportation by an ambulance type service to a hospital； Treatment from any recognizable physician or nurse under the PIP statute;  Radiological testing of any sort recognizable under the PIP statute; Any other treatment payable under the PIP statute. It makes no difference as to whether a medical provider submits a PIP claim for any medical treatment within 14 days, all that’s needed is that the patient treats within 14 days for accident-related injuries. As long as there is treatment recognizable under the PIP statute within 14 days, a PIP insurance carrier cannot properly deny a claim under FS §627.736(1)(a). Lazy or incompetent adjusters will not catch treatment that occurs within 14 days. I find that once an insurance company denies under the 14-day rule, they are stubborn to relinquish that denial. So, how can medical providers work with the 14-day rule? Most medical providers will obtain a history of treatment that will include treatment within the first 14 days. It is important to also ask for EMS treatment at the scene, look at the police report to see if there was EMS treatment and see if there was transportation to a hospital. Patients can forget about or do not understand that EMS treatment at the scene constitutes treatment under FS §627.736(1)(a). Patients can also go to their family doctor first before seeing automobile accident healthcare specialists and forget about telling their specialists about those medical appointments. Medical providers should provide a comprehensive questioning to patients for a full history of their medical treatment. This practice not only helps in establishing medical treatment within 14 days but also helps in providing a medical provider with a full knowledge of a patient’s past medical treatment.  George A. David, Esq. 500 South Dixie Hwy, Ste. 220 Coral Gables, FL. 33146 305-569-9980 gadeservice@gmail.com