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Importance of an EMC in Florida for PIP coverage

UnderĀ Florida law, Florida motorists are required to have a minimum $10,000 in Personal Injury Protection (PIP) coverage as part of their auto insurance policy. Having PIP coverage does not always guarantee that the insurance company will pay out the full $10,000 in benefits. The law in Florida has become more complicated, making it harder for physicians to receive payment for treatment provided to car accident victims.

To be entitled to the full amount of PIP benefits patients must take the necessary steps to comply with the law. Florida Statute 627.736 requires that the patient be diagnosed with an Emergency Medical Condition just to stand a chance of being entitled to the full $10,000 in benefits. The statute defines an EMC in Florida 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: serious jeopardy to patient health, serious impairment of bodily function, or serious dysfunction of any bodily organ or part.

The type of physician that is allowed to diagnose an EMC in Florida is restricted under the law as well. A list of physicians in the statute includes Medical Doctors, Dentists, and several others. Chiropractors, however, are not included on the list. This does not necessarily mean that Chiropractors cannot be reimbursed for services by up to the full amount of PIP coverage. It does mean that without having an EMC diagnosed, a Chiropractor may be limited to $2,500 in benefits for treatment that is performed.

Many physicians that receive PIP benefits for treatment performed have operated under a reading of the statute that may not be accurate. The prevailing view seems to be that, absent a finding of an EMC, PIP benefits dispersed for treatment may not exceed $2,500. This is not necessarily true in many cases. A closer reading of the statute shows that lack of an EMC finding does not necessarily mean that benefits are capped. More accurately, when a physician finds that there is definitively no EMC in Florida, then benefits will be capped. So, it is crucial for Chiropractors and other physicians understand that may not have been capped due to and EMC not being found.

Many physicians have been underpaid on PIP claims due to a false reading of the current requirements for EMC in Florida. If any uncertainty exists regarding claims that you have been underpaid or denied for this reason, it is crucial that you contact an attorney that has experience dealing with PIP claims. An audit of your claims by an attorney from Florida Litigators, PLLC can many times result in litigation of claims they you should have been paid more on.