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PIP Emergency Medical Condition

Definition and Diagnosis of Emergency Medical Condition

Emergency Medical Condition is defined 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 could reasonably be expected to result in serious jeopardy to patient health, and/or serious impairment to bodily functions, and/or serious dysfunction of any bodily organ or part." How do you know if a patient has an EMC? The definition of EMC is a guide, then look at the patient’s injuries. If you think the patient’s injuries are serious then the patient may have an EMC. The word “serious” is mentioned three times in the definition so the “seriousness” of the injury is important when diagnosing EMC.

Who Can Diagnose an Emergency Medical Condition?

The new PIP law says only an MD, DO, PA, ARNP, or Dentist can diagnose an EMC.. An insurance company can always offer a greater benefit to their insureds and this is a question you should ask before purchasing your policy. Allstate and Esurance policies offer greater coverage to their insureds by allowing chiropractors to diagnose an EMC.

What Should a Doctor Put in Their Report about Emergency Medical Condition?

The bare minimum that is required by the new PIP law (assuming the patient has an EMC) is to say “patient had/has an emergency medical condition.” The treating provider is recommended to add the definition of EMC to their report if they would like to but it is not required.

What if you do not believe there is an Emergency Medical Condition?

Our advise would be to remain silent. There is no need to state that the patient doesn’t have an EMC. Also, they may end up having an EMC later on down the road and that statement could have an enormous impact on the patient’s ability to obtain and pay for future care.

Can an IME doctor say there is no Emergency Medical Condition?

No. The PIP statute specifically says “a provider in subparagraph 1 and 2”. Those providers are all “treating” providers and an IME doctor is not a treating provider.