§ 31-11-81. Definitions

As used in this article, the term:

1. “Emergency condition” means any physical or mental condition of a recent onset and severity, including but not limited to severe pain, regardless of the initial, interim, final, or other diagnoses that are given, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could result in:
   1. Placing the patient’s health in serious jeopardy;
   2. Serious impairment to bodily functions; or
   3. Serious dysfunction of any bodily organ or part.
2. “Emergency medical provider” means any provider of emergency medical transportation licensed or permitted by the Department of Public Health, any hospital licensed or permitted by the Department of Community Health, any hospital based service, or any physician licensed by the Georgia Composite Medical Board who provides emergency services.
3. “Emergency services” means emergency medical transportation or health care services provided in a hospital emergency facility to evaluate and treat any emergency condition.
4. “Prospective authorization” means contacting for approval or authorization to evaluate and treat a patient any insurer, health maintenance organization, hospital medical service corporation, or health benefit plan, a representative of which is not physically present in the hospital’s emergency department at the time such patient presents for emergency services.

History. Code 1981, § 31-11-81 , enacted by Ga. L. 1996, p. 668, § 1; Ga. L. 2006, p. 652, § 1/HB 1257; Ga. L. 2008, p. 12, § 2-28/SB 433; Ga. L. 2009, p. 453, § 1-4/HB 228; Ga. L. 2009, p. 859, § 2/HB 509; Ga. L. 2011, p. 705, § 5-17/HB 214; Ga. L. 2022, p. 598, § 2/HB 1324.

The 2022 amendment, effective July 1, 2022, in paragraph (1), substituted “physical or mental condition” for “medical condition” near the beginning and in- serted “regardless of the initial, interim, final, or other diagnoses that are given,” in the middle.

Editor’s notes.

Ga. L. 2022, p. 598, § 1/HB 1324, not codified by the General Assembly, provides: “The General Assembly finds that:

“(1) This state recognizes a ‘prudent layperson’ standard with regard to the need for emergency care;

“(2) Insurance companies operating in this state are required to adhere to that standard;

“(3) Patients in this state have had emergency medical claims denied due to insurers’ failure to adhere to the prudent layperson standard as intended;

“(4) The federal court system has recognized that this standard is not intended to look to the diagnosis that a patient receives. Rather, the only relevant considerations are the patient’s symptoms and whether a prudent layperson would think that emergency medical attention is necessary based on those symptoms;

“(5) This legislative body has intended and continues to intend that the prudent layperson standard be applied in the same manner;

“(6) In order to better protect Georgians seeking emergency care, legislation is needed not to change the meaning but to clarify the intended application of the prudent layperson standard in this state; and

“(7) Nothing in this Act is intended to be applicable to healthcare plans which are subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et seq.”

Law reviews.

For article on the 2011 amendment of this Code section, see 28 Ga. St. U.L. Rev. 147 (2011).