PIP and EMC, handled without overreach: 14 days, $10,000, $2,500, and 1 referral.

PIP billing and the emergency medical condition determination are the two places a chiropractic accident practice can either protect a client's benefit or damage a claim. This page states how Car Accident Doctors Group handles both. The governing statute is section 627.736, Florida Statutes. This is general information from a medical office, not legal advice.

The 14-day window

Initial treatment must occur within 14 days of the accident for PIP benefits to apply. At referral, Janelle Deal confirms the date of loss and books the examination inside the window, same day when a slot is open, Saturday by request. If the client has already been to an emergency department, that visit satisfied the requirement and the follow-up care here is covered.

The $10,000 and the $2,500

PIP pays 80% of reasonable medical expenses and 60% of lost wages up to $10,000, less the policy deductible, when an emergency medical condition has been determined. Without that determination, medical benefits are limited to $2,500. The determination may be made by a physician (MD), an osteopathic physician (DO), a physician assistant or an advanced practice registered nurse. It may not be made by a chiropractic physician.

What this office does, and does not do

Dr. McNamara-Krauss does not make EMC determinations and this office will not sign one. When the initial examination or a re-examination shows findings that warrant the determination, the client is referred to an MD, DO, PA or APRN who can make it. The referral, its clinical rationale and the outcome are documented in the file. This protects the client's full benefit and keeps the chiropractic records inside chiropractic scope, which is what a reviewer expects.

Billing

Covered treatment is billed to the client's PIP carrier by the office. Janelle Deal has 30 years of experience in Florida PIP claims; she handles the carrier paperwork, tracks the benefit, and tells your office where it stands. Payment terms beyond PIP are discussed with her case by case before the first visit so that the client and your office know them in advance.

What the file shows

Date of loss and date of initial treatment. Examination findings that support the diagnosis. Treatment rendered, by region, at every visit. The EMC referral, when made, and its result. Imaging referrals and reports. Re-examinations against the baseline. A narrative on request. All from one system, sent as one PDF. The documentation page lists each document.