In United Automobile Insurance Co. v. Garrido, a/a/o Rodriguez, ____ So.3d ____ (Fla. 3d DCA October 28, 2009), the 3rd once spoke on the circumstances under which a PIP insurer can withdraw future PIP benefits. According to the 3rd,
a ‘valid report,’ even where appropriately required under section 627.736(7)(a) [i.e. when withdrawing future benefits – as opposed to denying past bills], need not be predicated on either a physical examination conducted by the reporting physician or on a physical examination conducted on behalf of the insurance company.
The Court also confirmed once again, that a "valid report" is only necessary when a PIP insurer is withdrawing future PIP benefits, and is not needed where the PIP insurer is denying past bills.
[I]n cases such as this, where no payments have been made resulting in a total rejection of a provider’s bills, section 627.736(4) of the Florida Statutes applies. This provision permits an insurer to deny a PIP claim at any time, either before or after that claim becomes ‘overdue [because not paid within thirty days]’ provided is has ‘reasonable proof’ that it is not responsible for payment. And, while such proof may come in the form of a report described in section 627.736(7)(a), such a report is not necessary to deny a claim under section 627.736(4)(b).