At one point, the state of Florida had no formal definition for an emergency medical condition or EMC. This ambiguity led to many situations where someone could be granted or denied the full PIP benefits seemingly at random, depending on who was providing care and where the care was provided.
The statutes governing how PIP worked were amended in 2011 to include a number of extra provisions. One important provision was that injured persons only had 14 days to seek medical care from the date of the accident (or, in some cases, the earliest date they should have reasonably known they were injured). Otherwise, they wouldn’t receive any benefits at all under the PIP system and had to instead pay out of pocket or rely on their personal health insurance policy.
Another important change was that legislators added a clearer definition of what constituted a medical emergency. Florida Statutes §627.732 defines it as follows:
“Emergency medical condition” means 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 any of the following:
(a) Serious jeopardy to patient health.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.
This definition provides some more-concrete guidelines but does not spell out what an EMC is, exactly. For example, one doctor might judge that a lack of care could have hypothetically caused “serious dysfunction of any bodily organ or part,” whereas another could predict that the patient would have been relatively fine.