PIP EMC and 14 Day Rule
The 14 day rule and the EMC rule
The Law on the 14 Day Rule:
(a) Medical benefits.—Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital, and nursing services if the individual receives initial services and care pursuant to subparagraph 1. within 14 days after the motor vehicle accident.
Subparagraph 1 includes care received by a chiropractor, MD, DO, hospital,
urgent care center, EMT, and dentist.
If a patient comes to you after the 14 days you have three options:
(1) you can take the case as an LOP if the patient wasn’t at fault
(2) you can bill health insurance if possible
(3) you can bill PIP and let me file a PIP suit. Right now I’ve filed several of these cases and settled some. I’m arguing that it is unconstitutional to deny care to a patient who pays for PIP and their symptoms didn’t manifest until after the first 14 days.
ATTENTION CHIROPRACTORS: Do not send the patient to the hospital/urgent care because you think the PIP law requires them to see an MD/DO/PA within 14 days. You are confusing two different areas of the law.
(1) The first part of the law says that the patient needs to be seen by a DC, MD, etc within 14 days.
(2) The second part of the law says that a patient needs an EMC if they want $10,000 in PIP coverage. There is no requirement that an EMC be done within 14 days! The law on EMC is below. It clearly says if the “injured person had an EMC” then they get $10,000. There is no time limit related to an EMC.
YOU DO NOT NEED AN EMERGENCY MEDICAL CONDITION OPINION WITHIN 14 DAYS.
THERE IS NO TIME LIMIT TO GET THE EMERGENCY MEDICAL CONDITION OPINION.
THE PATIENT CAN GET THE EMERGENCY MEDICAL CONDITION OPINION AT ANY TIME! EVEN AFTER 14 DAYS!