LEGAL GUIDE
Written by attorney David Phillip Folkenflik | Jan 20, 2013

What's an "Emergency Medical Condition" Under Florida's Amended PIP Law?

Under the amended Florida PIP (No-Fault) auto insurance statute, if a Medical Doctor (MD), Osteopathic Physician (DO), or dentist (or Nurse Practitioner, or Physician Assistant) determines that you have anEmergency Medical Condition(EMC), you are entitled to up to $10,000 in PIP benefits for medical expenses and lost wages, if not, your benefits are limited to $2500, total.

So, what is an "EMC"? Pursuant to Florida Statutes Section 627.732:

“Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following: (a) Serious jeopardy to patient health. (b) Serious impairment to bodily functions. (c) Serious dysfunction of any bodily organ or part.

Before the law was recently amended, under Florida automobile insurance laws, everyone injured in a motor vehicle accident had PIP auto insurance coverage up to $10,000 to pay for medical bills (and lost wages). That has changed. Now, if are determined to have an EMC, you are entitled to "up to" $10,000 in benefits. However, if it is determined you did not have an EMC, your insurance medical benefits are limited to $2500, maximum. So, this is really significant.

Unfortunately, the statute is, in my opinion, very poorly written. As such, there are several important questions that are left open to later court or legislative interpretation on the EMC issue such as:

  1. When does the EMC determination need to be made? Does it have to be made soon after the injury, or can it be made months or even years later?

  2. What happens if no doctor specifically determines you did or didn't suffer an EMC? I would argue that this would entitle you to the full $10,000 in benefits, but that question remains.

  3. Is a determination of EMC made by a medical doctor, or D.O., stronger for legal purposes than one made by a nurse practitioner, or by a physician assistant?

  4. Will an EMC determination made by an M.D., or D.O. be stronger than a determination of "no EMC" by a chiropractor?

(Note that a Chiropractic Physician (DC), is not able, under the new law, to make the determination that the injured person did suffer an EMC , but, interestingly, and somewhat nonsensically, a DC is allowed to make the determination that "the injured person did not have an [EMC]".)

  1. Will an EMC determination made close in time to the accident be stronger than one made months or years later?

In any event, it is my opinion that the amended statute is likely to lead to more payment denials by insurance companies, and more litigation by claimants.

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