11/20/2023 0 Comments Emc insurance claimsIn other words, no confirming statement, no PIP benefits. This and other recent court decisions have set the stage that, in the court’s eyes, a medical provider must declare in their medical records that an EMC has been established. The court also clearly affirmed that the intent of the EMC provision in Florida’s PIP statute is to reduce the occurrence of PIP insurance fraud by claimants. The court found in favor of the insurance company. The defendant, Progressive Select Insurance Company, interpreted the statute to mean that a qualified medical provider must declare affirmatively that yes, an emergency medical condition does exist in order for an injured person to be eligible for the full benefit of $10,000. Even though the plaintiff did not have an EMC, she argued that she should still be entitled to the full benefit of $10,000. In the plaintiff’s case, the physician never made a determination about her medical condition one way or the other. The plaintiff’s interpretation of the law was that a person is limited to $2,500 only if the physician states that there is no emergency medical condition. The plaintiff sued the insurer for breach of contract because the insurer did not pay her full Florida PIP benefits of $10,000. The case involved two parties’ different perceptions of the EMC provision. District Court for the Southern District of Florida ruled in a case about this very thing. What happens if you had a medical evaluation within the 14 days after an accident, and there is no EMC determination by the medical practitioner? No mention at all of EMC? Interesting Court Case Argues the Meaning of EMC These tests are often the basis for concluding that the individual sustained an EMC.Ĭall 855-Kramer-Now (85). This is largely because medical evaluations such as imaging tests (MRI) and other diagnostic procedures and can take longer than 14 days. PIP law requires that someone injured in a Florida car accident must be seen by a qualified medical practitioner within 14 days following the accident.īeing treated medically within this time enables the injured person to receive PIP coverage of at least the minimum $2500 coverage.įlorida PIP law does not specify when an emergency medical condition should be established therefore, an EMC does not have to be declared within these 14 days. In essence: to receive the full insurance award of $10,000, your medical record must establish that an Emergency Medical Condition is present.Īs car accident attorneys who work with PIP insurance cases daily, our counsel may involve advising doctors how to clearly prepare this statement to avoid any doubt by the courts and possible resistance by insurance adjusters. This is another grey area of PIP law that our attorneys can guide you through. There is no specific language required under current law. No, there is no form for medical personnel to complete. Is There an EMC Form the Doctor Fills Out? Reimbursement for medical care and treatment is limited to $2,500 if a provider determines that the injured person did not have an emergency medical condition.Any EMC coverage must be specifically related to the diagnosed conditions. Reimbursement for medical care and treatment is awarded up to $10,000 if a qualified medical provider has determined that the injured person had an emergency medical condition.§627.736 provides two basic scenarios about EMC coverage under PIP: Emergency Medical Condition or Not: How Much PIP Coverage Do I Get?Ī separate statute, Fla. The medical provider making this call must be a qualified physician, osteopathic physician, dentist, physician’s assistant, or advanced registered nurse practitioner. Who Is Qualified to Determine if You Have an EMC? Speak with an experienced Florida attorney at our firm today.Ĭall 855-Kramer-Now (85). Therefore, knowing what type of injuries or medical trauma will be classified as an Emergency Medical Condition (EMC) is at best imprecise and open to the interpretation of medical professionals and the court. There is no list of injuries that meet these conditions, only a guideline by which qualified medical personnel can identify when an EMC event takes place. That is the extent of the statute definition of EMC. Serious dysfunction of any bodily organ or part.When hospitals, doctors and medical staff need to decide whether someone’s car accident injury qualifies as an Emergency Medical Condition (EMC), what criteria do they follow? What types of injuries are they looking for?įlorida PIP Statute §627.732 states it this way:Īn “emergency medical condition” is defined as a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention would reasonably be expected to result in any of the following:
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |