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Tuesday, January 15, 2013

FL PIP "EMERGENCY MEDICAL CONDITION" (EMC) FORM

FLORIDA PIP "EMERGENCY MEDICAL CONDITION" (EMC) FORM

Dr. Alan Himmel

If you are looking for a Florida PIP medical condition form, there isn't one.




At least, not yet.

 As of today, which actually is Jan 15, 2013, (the deadline if you had your accident on Jan 1 and have not seen a doctor yet), the Florida department of insurance or the department of financial services have not issued a standard form.  Also, they have not even recommended to the insurance carriers that there should be a standard form.  Therefore, if you are a doctor who treats auto injury trauma patients, you wouldn't have any idea where to make the statement of an emergency medical condition or not.  Common sense would say that there should be a standard form or something should be written in the notes.  I had one insurance adjuster for Allstate tell me that it should be put on the claim form.  When I asked him where, he told me he did not know.  There are no extra boxes to designate emergency on a HCFA 1500 form, and there certainly are no extra boxes to write in how the injury fits the EMC definition as we have been reading it.  You can put in your diagnosis codes there, but that's all.

Hypothetically, it would be more realistic for the doctor to write in his chart note something like:

"I have examined this patient and have given the diagnosis of "brain concussion", with the symptoms of loss of balance, inability to concentrate, nausea, severe headache, etc., and have determined that this condition may cause serious jeopardy to the patient's health.  Thus, this patient has a severe injury which is an emergency medical condition."



This is probably the best bet at this point since there has been no instruction to the doctors about how this should be done.

Of course, any insurance company can tell you that your "emergency medical condition" is not severe enough.  Those insurance companies will disregard your doctor's EMC and limit you to 25% of the coverage you paid for, but that's another story.

This is only my opinion, and not advice.    I hope it helps.

Pembroke Pines Chiropractic
954-659-8600
305-979-5549