The Emergency Medical Condition (EMC)

The “Emergency Medical Condition” – meet this statutory requirement or risk being limited to $2,500 in Florida PIP benefits.

In the personal injury world, it is important for injured claimants to utilize their full $10,000 PIP benefits, which is most commonly used to pay providers up to 80% of allowable charges for qualified medical treatment rendered after a motor vehicle accident.[1] Without full use of a claimants PIP medical benefits, the claimant may be left with unresolved and/or outstanding medical bills, or may be forced to use his/her private health insurance (if applicable), which can become problematic for a myriad of reasons.

However, prior to triggering full coverage, §627.736, Fla. Stat., requires that a claimant be determined to have an Emergency Medical Condition (EMC)[2]. This determination cannot be rendered by any medical professional, however. § 627.736, Fla. Stat., designates specific medical professionals that are authorized to render this determination, including a “physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced practice registered nurse licensed under chapter 464”.[3] Notably, a chiropractor is not included in this list. Failure to obtain an EMC designation is detrimental and results in PIP benefits being limited to $2,500.00.

Additionally, not all medical treatment rendered subsequent to a motor vehicle accident qualifies for payment[4]. Both massage and acupuncture, as more specifically defined under §627.736(1)(a)(5), are not authorized to receive medical payments under the current PIP statute, even though some clients argue that they receive the most relief from these types of treatment. Therefore, it is important to consult with a personal injury attorney that is familiar with the Florida PIP Statute, its application, and its importance, as soon as possible. Not only must treatment occur within 14 days after a motor vehicle accident, but an Emergency Medical Condition must be rendered by a designated medical professional, and treatment must be of the type specified under Florida’s PIP Statute.

[1] NOTE: There are other circumstances that may qualify for PIP payments, including, but not limited to, loss of income.

[2] NOTE: This is but one requirement imposed by Florida law, which must be met prior to receiving full PIP benefits. There are other requirements/restrictions.

[3] §627.736(1)(a)(3)

[4] Please review §627.736(1)(a)(1)-(2) for an exhaustive list of qualified medical treatment.

Leave a Reply

Your email address will not be published. Required fields are marked *