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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Comments

[Jenna]

I am finding that PIP carriers (FL) are REFUSING to pay lost wages even after the insured has complied with all requirements under policy. Insurance Company avoids all status requests, phone calls, etc. They wait many months and use PIP to pay bills, causing Insured's to suffer, lose their homes, etc. Is there any remedy other than a statutory letter & CRN? This is deliberate harm.

[Dennis Wall]

I am not aware of any. Anyone else have any thoughts on this issue? Any similar experience?
Thanks in advance.

[Elliot @ Reclaim PPI]

Interesting read.. does anyone know of similar posts like these?

[ppi reclaim]

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).
Jose

[Dennis Wall]

Yes, that is a direct quote from the post. It is also part of the statute interpreted by Florida's Third District Court of Appeal in this case.

Thank you.

Dennis Wall