UNITED AUTOMOBILE INSURANCE COMPANY, PETITIONER.
v.
EDUARDO J. GARRIDO, D.C., P.A., RESPONDENT
AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.
United Automobile Insurance Company sought certiorari to overturn a Circuit Court Appellate Division decision that found the insurer waived its right to deny payment of untimely medical bills under Florida's Personal Injury Protection (PIP) statute. The court held that submitting untimely bills with timely bills or failing to check 'late billing' on an explanation of benefits does not constitute waiver of the statutory deadline requirement.
The court held that neither submitting untimely bills with timely bills to an independent medical examiner nor failing to check 'late billing' as a reason for denial constitutes a waiver of the insurer's statutory right to deny payment of late-filed bills under section 627.736(5)(c)(1).
[1] An insurer is not required to pay charges for treatment or services rendered more than 35 days before the postmark date or electronic transmission date of the statement,…
[2] Submitting untimely medical bills along with timely bills for a determination of medical necessity does not constitute a waiver of an insurer's right to deny payment for…
Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“unless the provider submits to the insurer a notice of initiation of treatment within twenty one days after its first examination or treatment of the claimant, "the insurer is not required to pay, charges for treatment or services rendered more than 35 days before the postmark date or electronic transmission date of the statement"”
Establishes the statutory requirement for timely submission of medical bills under section 627.736(5)(e)(1)
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceA medical provider submitted bills for treatment to United Automobile Insurance Company. Some of the bills were submitted more than 35 days after the …
The full statement of facts, procedural history, and disposition for this case are member content.
Join FLexlaw to unlock all legal intelligence© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.
Explore caselaw by topic → Browse Personal Injury Protection (Pip) Benefits cases and more on FLexlaw
WELLS, Judge.
United Automobile Insurance Company petitions for a writ of certiorari to quash a decision of the Circuit Court Appellate Division which concluded that the insurer waived its statutory right to assert that certain medical bills submitted for payment by the respondent medical provider were untimely under section 627.736(5)(c)(l) of the Florida Statutes. § 627.736(5)(e)(l), Fla. Stat. (2007) (providing that, unless the provider submits to the insurer a notice of initiation of treatment within twenty one days after its first examination or treatment of the claimant, “the insurer is not required to pay, charges for treatment or services rendered more than 35 days before the postmark date or electronic transmission date of the statement”). Under section 627.736(5)(c)(l), an insurer has no obligation to pay late-filed bills. See Coral Imaging Servs. v. Geico Indem. Ins. Co., 955 So. 2d 11 (Fla. 3d DCA 2006).
Neither submitting untimely bills along with timely bills to an independent medical examiner for a determination of medical necessity, nor failing to check “late billing” as a reason for denying payment of untimely bills on an explanation of benefits form, constitutes a waiver of this provision. We therefore grant the writ because the Appellate Division’s decision to the contrary amounts to a violation of a clearly established principle of law resulting in a miscarriage of justice. Because the ruling potentially affects large numbers of claimants and large numbers of claims processed by insurers under personal injury protection (“PIP”) coverage, exercise of certiorari jurisdiction is appropriate. See Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885 (Fla.2003); Progressive Express Ins. Co. v. McGrath Cmty. Chiropractic, 913 So. 2d 1281, 1286 (Fla. 2d DCA 2005) (“In measuring the seriousness of an error to determine whether second-tier certiorari is available, one consideration is whether the error is isolated in its effect or whether it is pervasive or widespread in its application to numerous other proceedings.” (quoting Dep’t of Highway Safety & Motor Vehicles v. Alliston, 813 So. 2d 141 (Fla. 2d DCA 2002))).
Writ granted; the decision below is quashed and the matter is remanded with directions to reverse the summary judgment entered in favor of the provider.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Authorities Cited
- Allstate Ins. Co. v. Keely Kaklamanos, 843 So. 2d 885 (Fla. 2003)
- Progressive Express Ins. Co. v. McGRATH Community Chiropractic, 913 So. 2d 1281 (Fla. 2d DCA 2005)
- Dep't of Hwy. Safety & Motor Vehicles v. Alliston, 813 So. 2d 141 (Fla. 2d DCA 2002)
- Coral Imaging Servs. v. GEICO Indem. Ins. Co., 955 So. 2d 11 (Fla. 3d DCA 2006)