Emergency Medical Condition – What Is It and FAQ

If you have been in an accident in Wesley Chapel, and your injuries are severe, and if a lack of immediate medical care could put your well-being in jeopardy, you may have what is designated as an “Emergency Medical Condition,” or an EMC.

But how do you know if you have an EMC? That’s what we’re here for! Learn what could be considered an Emergency Medical Condition from our medical team at Impact Medical Wesley Chapel.

What is an Emergency Medical Condition?

Individuals who are diagnosed with an emergency medical condition (EMC) have injuries that are manifested by acute symptoms of “sufficient severity” and if they don’t receive immediate medical treatment, these injuries could result in serious health complications, impairment, or loss of bodily function.

An EMC:

Poses a serious threat to a patient’s health
Could cause serious impairment to bodily functions or,
Serious dysfunction of a body organ or part

Situations, where an EMC may be declared, include:

Bleeding that will not stop
Severe difficulty breathing
Change in mental status
Unconsciousness
Coughing or vomiting blood
Head or spine injury
Deep or large wounds
Severe injuries
Smoke inhalation
Seizures
Severe burns
Severe abdominal pain

How Does an EMC Affect Insurance Following an Accident?

In the state of Florida, when you are involved in a car accident, regardless of fault, your Personal Injury Protection (PIP) benefits will pay for your initial medical bills if you receive treatment within 14 days of your accident.

Your insurance company pays 80% of your initial medical bills up to the limits stated in your policy. If a doctor determines that you have an Emergency Medical Condition, you will be entitled to up to $10,000 in PIP benefits. Otherwise, your benefits are limited to $2,500.

Why Does PIP have a 14-Day Rule?

Florida’s 14-day PIP rule exists for two reasons. First, waiting to get medical attention could make your injury worse. The sooner you receive care, the sooner you can prevent complications and minimize injuries.

Second, proving that the accident was the cause of your injuries is critical to making your insurance claim. When you receive medical care right away, the link between your injuries and the car accident is clear and will be documented.

The 14-day rule exists to help accident victims get the treatment that they need while ensuring that the accident claims are accurate and valid.

Who Can Determine an EMC?

This EMC designation is up to the discretion of the medical provider who treats the individual following an accident. Only doctors, dentists, physician’s assistants, and registered nurse practitioners can determine an EMC.

If the medical professional does not believe that the person’s injuries are an EMC, then the individual will only be eligible for $2,500 in PIP benefits.

To make things quite complicated, there isn’t an EMC form that your physician can fill out and present to your insurance company. Instead, your medical record must state that you suffered an EMC as the result of your car accident.

How Should a Doctor Report an EMC?

The bare minimum that is required by PIP law is for the doctor to state in their medical report that their patient “had/has an emergency medical condition.” It is recommended that a treating medical provider adds the definition of an EMC to their report, but it is not required.

Don’t Wait, Get Treatment Today

If you have been in a car accident, no matter the severity of your injuries, you should seek medical care immediately to ensure that you are entitled to your PIP benefits under Florida Law. Our team of doctors, physical therapists, and chiropractors are here to help you heal and move forward following an accident.

Your road to recovery starts here. Call Impact Medical Wesley Chapel today; 813-701-5424!