In United Automobile Insurance Company v. Metro Injury & Rehab Center, ___ So.3d ___ (Fla. 3rd DCA July 29, 2009), the PIP insurer withdrew PIP benefits based on a peer review of the treating doctor’s records. Those records contained information concerning physical examination(s) which the treating physician performed on the insured. The county court granted summary judgment against the PIP insurer, and the circuit court, sitting in its appellate capacity, affirmed, holding that "[a] report based only upon a review of the records of the insured’s treating physician is not a valid report within the meaning of section 627.736(7)(a)." The court reasoned that the statute required the reviewing physician to perform a physical examination of the insured.
The 3rd agreed that a physical examination of the patient was a necessary ingredient of "valid report," but held that
the physician preparing the report does not have to personally examine the insured. He or she may base the report on another physician’s examination whether an IME or an examination conducted by the treating physician.
It is unclear whether other DCA’s will follow this reasoning. Other DCA’s may require that the examiantion be performed by the CME physician, or someone at his direction. We shall see.