Insurance Claims And Issues

Florida PIP Benefits Not Payable Held Not Overdue, No Penalties.

    PIP benefits are overdue when not paid according to Florida Statute Section 627.736(4)(b) including its time limit of 30 days.  Access the Florida PIP Statute here.  When overdue in Florida, PIP payments draw penalties:  simple interest and, if the Policyholder (or assignee) files a lawsuit for PIP payments, then also the Insured's/Assignee's attorney's fees.  Fla. Stat. § 627.736(4)(d) & (8).

    However, by the terms of the Florida PIP Statute, "any payment shall not be deemed overdue when the insurer has reasonable proof to establish that the insurer is not responsible for the payment."  Fla. Stat. § 627.736(4)(b).  "This paragraph does not preclude or limit the ability of the insurer to assert that the claim was unrelated, was not medically necessary, or was unreasonable or that the amount of the charge was in excess of that permitted under, or in violation of, subsection (5)."  Id.

    It has recently been held that the 30-day time limit of Section 627.736(4)(b) "does not apply to claims for unrelated, unreasonable, or unnecessary treatment."  Download United Auto. Insurance Co. v. Millennium Diagnostic Imaging Ctr., Inc. (Fla. 3d DCA Case No. 3D08-772, Opinion Filed May 6, 2009).  See attached slipsheet opinion at 7.  [Emphasis added.]  "Therefore, an insurer may challenge such treatment at any time, and is permitted to rely on a report, obtained pursuant to section 627.736(7)(a), even if the report is obtained more than thirty days after the claim was submitted.  The insurer, however, must keep in mind that if its challenge fails, it will be liable for interest and attorney's fees."  Id. at 8.  [Emphasis added.]

    All Florida Statutes, Cases, Administrative Agency Rules and Regulations, and other authorities are accessible on links through www.dennisjwall.com.

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"Review Insurance Policies Now" Says Orlando Newspaper.

   Good advice with related links in this newspaper article published in the Orlando Sentinel, February 22, 2008, by Greg Groeller, "Review Insurance Policies Now".  Every Policyholder and their Agents and Brokers holding every kind of Insurance Policy can benefit from following the good advice published by this linked newspaper article.

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Attorney's Fees and Florida PIP ... And Wait Till Next Year!

     Personal Injury Protection ("PIP") benefits are generally available under Automobile Insurance policies issued in the United States.  In Florida, PIP benefits were scheduled to permanently expire when the statute requiring them "sunset," or expired,  on September 30, 2007.    The Florida Legislature  passed a reauthorization of the Florida PIP statute on Friday, October 5, 2007--effective, however, on January 1, 2008.  It is difficult to find a link to this new statute which was passed three days ago at the time of this post.   Link  here  to the "enrolled" bill which appears to be a compromise Florida Senate and House Bill 13.

     New subsection (15) of Section 627.736 is of special interest.  It is found on page 85 of 89 pages on the attached link.  Subsection (15) regulates awards of attorney's fees.  In some cases, there will be no attorney's fees awarded at all under this new statute.

     Here is how it is written.  How it will work will depend on the Florida Courts.  Whenever a claimant files a lawsuit against the Insurance Company under Section 627.736 to recover PIP benefits allegedly due and owing under the Insurance Policy, the new provision purports to bar attorney's fees awards when there is a claim that "should have been brought in a prior civil action" but was not brought before, AND "the court determines" that to be the case. 

     The same new Subsection 627.736(15) also provides that "all claims related to the same health care provider for the same injured person shall be brought in one action," ordinarily.  In other words, at least one of the times when the Legislature was of the view that a PIP claim "should have been brought in a prior civil action," is whenever there was a previous claim for PIP benefits "related to the same health care provider for the same injured person".   Parenthetically, Section 627.736 did not convey a statutory definition of "health care provider" before or after the new provision was enacted.

     Whether there are any other times that a "court determines" that a lawsuit "is filed for a claim that should have been brought in a prior civil action," is of course also for the Courts to determine.

     In the interim, the Florida PIP statute was recently reenacted to take effect next year.

                                                      

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