New Source of EMC Litigation
Insurers are now backing off from hiring Peer Review doctors to challenge your EMC determinations. They are currently challenging the EMC on reasonable, related, and necessary grounds.
What does the mean for me?
These new challenges will NOT affect our game plan and our ability to recover your PIP Money. As I’ve always recommended, continue indicating in your SOAP NOTES the following:
Upon examination (List patient’s injuries/objective findings), it is my medical opinion (Patient’s Name) __________________ has suffered from an emergency medical condition. An emergency medical condition is defined pursuant to Florida Statutes 627.736 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.”
In every PIP suit, whether a fee schedule suit, an IME cut-off, or an EMC suit, we must prove all of the treatment was reasonable (charges, type treatment), medically necessary and related to the underlying motor vehicle accident. An affidavit from you specifying the charges were reasonable, treatment medically necessary and the relation of everything to the motor vehicle accident is sufficient to meet our requirements. YOU ARE NOT required to do anything else other than document your file. Do not worry if the insurance carrier writes you a letter asking for more documents. If the EMC language is included in the medical notes you send along with your bills, we will absolutely get you reimbursed.
DO NOT respond to an insurer’s request for more information concerning RRN. Please send us the letter or demand response prior to collecting documents for submission to the PIP insurer. PIP insurers will rely on those documents for the duration of the PIP Suit. Any document you send to the insurer can and will most likely be used to build their defense(s). The RRN-EMC situation is merely another hurdle that needs to be cleared. It is the insurers’ way of hiding behind a peer review doctors’ determination that an EMC was not present. Because the statute does not allow PIP insurance companies to utilize these doctors, they are simply crafting another way of holding payment until a determination is made by the court.
LaBovick PIP Litigation is always at the forefront of insurers’ “hide the ball” games. We are ready to litigate the new EMC defenses with our innovative PIP concepts/litigation strategies. You need an experienced team behind you to ensure quick reimbursement of your PIP dollars. Contact LaBovick Law Group to schedule an audit/file evaluation!