May a peer report be performed after the 30-day claims determination period?

The District Court of Appeal, Third Division answered this question in the affirmative.

In the matter of Millennium Diagnostic Imaging Ctr., Inc. v. United Auto Ins. Co., 975 So. 2d 1149 (Fla. 3d DCA 2009), the Court held the following:

The language in section 627.736(4)(b) pertains to PIP benefits that are “due” under the policy. If a medical bill is submitted for treatment that is not reasonable, related, or necessary, there can possibly be no benefits “due” under the policy, and therefore, that claim cannot be deemed “overdue.” Section 627.736(4)(b) provides that the insurer can assert, “at any time, including . . . after the 30-day time period for payment,” that “the claim was unrelated, was not medically necessary, or was unreasonable.”

Based on the unambiguous language of section 627.736(4)(b) and applicable case law, we answer the certified question, as phrased by the trial court, in the affirmative, and conclude that the thirty-day time period set forth in section 627.736(4)(b) does not apply to claims for unrelated, unreasonable, or unnecessary treatment. 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.

Oh I forgot to add that I was referencing Florida law. Compare, Bronx Expert Radiology, P.C. v. New York Cent. Mut. Fire Ins. Co. 24 Misc.3d 134(A)(App. Term 1st Dept. 2009); Dilon Medical Supply Corp. v. New York Cent. Mut. Ins. Co., 18 Misc.3d 128(A)(App. Term 2d Dept. 2007).

Facebook
Twitter
Email
Print

One Response

Practice Areas

Our wide-ranging expertise will provide you with well-rounded legal counsel

At the Law Office of Jason Tenenbaum, our attorneys have the integrity and experience you need to best assist, advise, and support you through your legal challenge, every step of the way.

No Fault Defense
Practice Areas
No Fault Defense

Using cutting-edge technology and strategy to solve complicated problems.

Woman in the hospital with injured leg
Practice Areas
Personal Injury

We can fight for your pain and suffering, lost income, medical bills, and any future lost wages.

Upset woman in the front of the computer with bills
Practice Areas
Medical Malpractice

You have the right to bring a malpractice claim for your medical expenses, lost income and pain and suffering.

Card in the hand
Practice Areas
Consumer Protection

If you have been sued for an unpaid consumer loan, fallen behind on your credit card bills or similar.

Court room
Practice Areas
Commercial Litigation

We can help when you are faced with commercial litigation issues.

We dedicate ourselves to important values

We work hard to fight for your individual case and rights, while providing superior legal services on a timely, effective, and efficient basis. 

Need Help With Your Case?

Proin rhoncus metus aliquet blandit ad placerat sociosqu erat vel letius scelerisque taciti pulvinar.

Got Questions?

Proin rhoncus metus aliquet blandit ad placerat sociosqu erat vel letius scelerisque taciti pulvinar.