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Monday, August 6, 2012

Florida No fault Emergency Medical Condition

What about the So-Called Emergency Medical Condition (EMC) requirement?

Dr. Alan Himmel

Florida No-Fault PIP law, now states that only emergency medical conditions have $10k in medical benefits and that the EMC must be diagnosed by a MD, DO, ANRP, or PA.

This could be defined as acute pain, but it seems that in order for the $10k in coverage to be applied, it must be the opinion of one of the above medical professionals, that the car accident injury, without immediate attention, will result in any of the following: 

(a) Serious Jeopardy to the patient health.

(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.

Pain is the body's way of saying that there is something wrong. Its the body's alarm system. However, it doesnt always lead to any of the above scenarios listed in a, b, and c. Or does it? One could make the argument that pain due to an accident which caused, say, a herniated vertebral disc, could result in neurological deficits and muscle weakness and atrophy. The question is whether the insurance companies will regard this as, (c) serious dysfunction of a body part. If a person can no longer walk they way he or she did, I would certainly think this would be serious.

This sure leaves a lot of power to an insurance company adjuster, to decide how to handle the claim, and most people expect the insurance carriers to fight every EMC claim tooth and nail.

Keep your eyes on this blog.  I will be posting articles regarding Emergency Medical Conditions.  

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