PIP Insurer Only Needs a Written Medical Report Prior to Withdrawing Future Benefits, Not Prior For Denying Past Benefits
In United Automobile Insurance Company v. Garrido, a/a/o Alarcon, ____ So.3d ____ (Fla. 3rd DCA October 28, 2009), United Auto - a PIP insurer - denied payment for past services rendered by Dr. Garrido to the insured. United Auto did not first obtain a written report from a physician saying that the denied charges were not reasonable, necessary or related to the crash.
The 3rd held:
In United Automobile Insurance Co. v. Millennium Diagnostic Imaging Center, Inc., 12 So.3d 242, 246-47 (Fla. 3d DCA 2009), we held that an insurer may at any time challenge whether treatment is RRN, and is permitted to rely on a report obtained pursuant to section 627.736(7)(a) even when the report is obtained more than thirty days after the claim was submitted. Building on this conclusion, we explained in United Automobile Insurance Co. v. Santa Fe Medical Center, No. 3D08-547, 2009 WL 3188957 (Fla. 3d DCA October 7, 2009), that an insurer's obligation, pursuant to section 627.736(7)(a), to first obtain a medical report, applied only to withdrawal - as opposed to denial - of payment to a treating physician. Here, United denied payment. Accordingly, the 'first obtained' language of section 627.736(7)(a) is not controlling and the court erred in finding otherwise.
What does it all mean...For a PIP insurer to deny past bills, it can obtain a report/expert/opinion that the bills are not RRN at any time - presumably up until the insured files for summary judgment at which time the PIP insurer probably needs to come up with some evidence. For a PIP insurer to withdraw future treatment, the insurer must first obtain a written report from a physician pursuant to 627.736(7)(a). (Does that report need to based on a physical examination performed by the insurance company physician? Stay tuned, I'm blogging on that in exactly 1 minute).
