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Florida Third DCA rules that PIP insurer was equitably estopped from claiming that medical provider’s late submission of charges precluded payment; Court finds that insurer’s notice to insured that it was denying coverage was the cause of the late submission

On June 16, 2021, in United Automobile Insurance Company v. Chiropractic Clinics of South Florida, No. 3D21-111, the Florida Third DCA affirmed a final judgment in favor of a medical provider in a case involving a dispute between the medical provider and an insurance company over whether treatment was compensable under a PIP policy or was disqualified because the bill was not submitted to the insurer within 35 days of treatment as required under Fla. Stat. § 627.735 (c). The medical provider alleged that the bill had not been submitted within the 35-day time period because the insured had been erroneously notified by the PIP insurer that he did not have coverage and had passed that information along to the medical provider. The medical provider relied upon a provision in the statute which states that if the insured fails to furnish the provider with the correct name and address of the insured's PIP insurer, the provider has 35 days from the date the provider obtains the correct information to furnish the insurer with a statement of the charges. The insurer countered that this provision only applies if the medical provider submits a denial letter from the “incorrect insurer” or a proof of mailing to the incorrect insurer when the submission for payment is made, which apparently was not done in this case. Without explicitly addressing the fact that the defendant insurer was not in fact the “incorrect insurer” in the first place, thereby arguably rendering the provision relied upon by the insurer completely irrelevant. The Third DCA concluded that the insurer was in any event equitably estopped from relying on a defense of untimely submission because the insurer was itself responsible for the untimely submission.

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