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  • Attending Physician S Report Date: Policy Holder: Date Of Accident: To Assist Us In Determining

Get Attending Physician S Report Date: Policy Holder: Date Of Accident: To Assist Us In Determining

ATTENDING PHYSICIAN S REPORT Date: Policy Holder: Date of Accident: TO ASSIST US IN DETERMINING BENEFITS DUE UNDER THE AUTOBOMILE PERSONAL INJURY PROTECTION LAW, THE ATTENDING PHYSICIAN MUST COMPLETE.

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627.736” and state with specificity: 1. The name of the insured upon which such benefits are being sought, including a copy of the assignment giving rights to the claimant if the claimant is not the insured.

Florida Statute 627.736(6)(b) states in part, “every physician, hospital, clinic, or other medical institution providing, before or after bodily injury upon which a claim for personal injury protection insurance benefits is based, any productions, services, or accommodations in relation to that or any other injury, or ...

Further, Florida Statute 727.736 provides that in order for your injuries to be included in your personal injury claim, you must seek medical assistance within two weeks.

The Florida 14-day accident law requires injured victims to seek medical care within 14 days of a car accident in order to receive Personal Injury Protection (PIP) benefits. PIP is a form of car insurance that covers some of your medical expenses and other damages such as lost wages and death benefits.

The act of presenting to a law enforcement officer an electronic device displaying proof of insurance in an electronic format does not constitute consent for the officer to access any information on the device other than the displayed proof of insurance.

The 2022 Florida Statutes (including 2022 Special Session A and 2023 Special Session B) (1) Any statement or description made by or on behalf of an insured or annuitant in an application for an insurance policy or annuity contract, or in negotiations for a policy or contract, is a representation and not a warranty.

Insurance Companies Use 627.736(6)(b) Requests as a Delay Tactic. In a typical Florida PIP claim, the medical provider must submit their bill to the insurance company within 35 days from the date of service. Thereafter, the insurer has 30 days to make their investigation and pay the claim.

The treating physician completes this form and the report provides specific medical information including date of accident, diagnosis, prognosis, the disability period(s), and the extent of any permanent disability. This form must be signed by the treating physician.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232