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Wednesday, March 6, 2013

Emergency Medical Condition: A Gaping Hole In The New Florida PIP NO-FAULT Bill, HB119


The following excerpt is DIRECTLY from Florida HB119, the 2012 FLORIDA PIP Legislation.

So, how do you interpret this statement, directly from the bill, lines 750-754?

750 4.  Reimbursement for services and care provided in 
751 subparagraph 1. or subparagraph 2. is limited to $2,500 if any 
752 provider listed in subparagraph 1. or subparagraph 2. determines 
753 that the injured person did not have an emergency medical 
754 condition.

Here is the link to the whole bill.  Its a PDF:

Read the excerpt, and read it again.

Its states that the benefits are limited to $2500 if an [MD, DO, PA, ARNP] determines it is NOT an emergency medical condition.

So, I ask you to read it again.  I am not going to try and explain it, since I am not a lawyer.

But, it seems that according to this statement, there must be a doctor who states it is NOT an EMC, otherwise the coverage defaults to the original $10,000.

Do you see this?  This doesn't seem to be what the insurance companies intended, but it looks like when you get a bunch of politicians who haphazardly write a bill to get it through, there could be some mistakes, and this seems like a big one.  Do you think they will "revisit" the subject during this year's legislation?  Possibly.  There have already been some word that they want to tweak the bill to possibly tighten it up a bit.  They cannot have holes in the bill like this.  If you are running an auto insurance company, this is not good, and you are not happy.

So, any opinions on this?

Dr.Alan Himmel

1 comment:

  1. You are right! There is some debate among PIP lawyers that the new law is still $10,000 in coverage UNLESS a treating provider says "no emergency medical condition". Even though I believe that coverage is still $10,000 and only goes down to $2,500 when a treating provider says "no emergency medical condition", I still think it is the safer route to send the patient to an MD/DO for an evaluation until we know how the Florida court system will interpret the law (which could be a few years).

    My recommendation to the MD/DO who examines the patient is that
    -if they have an EMC then write it down in your report
    -if they don't have an EMC then remain silent and perhaps the patient can still get the $10,000 in coverage