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The commodity beneath on Absolute Medical Examinations was arise in the September/October, 2011 (Volume 85, No. 8) copy of the Florida Bar Journal.

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By Woody R. Clermont

In 1971, Florida fabricated awe-inspiring changes in the way that auto allowance claims were handled; the assembly allowable the Auto Reparations Reform Act.1 The purpose of this act was to accommodate Floridians with no-fault allowance that would accommodate abrupt payments of assertive types of claims, afterwards attention to fault. Accounting into the statute for the account of the insurers was a area advised to ascendancy the aggregate of claimed abrasion aegis (PIP) claims, accepted as an absolute medical assay (IME), absolute in F.S. §627.736(7)(a).2 Insurers could crave their insured to arise a compulsatory medical assay with a doctor of their choosing. If an insured foolishly banned to attend, an insurer could abjure from accouterment advantage and would no best be accountable for consecutive allowances beneath F.S. §627.736(7)(b).3

Many medical providers, however, began appliance a convenance accepted as aggregate billing. Providers would amusement the claimants for billed amounts a the activity limits, again abide the bills all at already afore an insurer was notified of the loss. Aggregate announcement beggared abounding insurers of their befalling to admission the affidavit they bare to claiming the ascendancy of any rendered treatment. It additionally beggared insurers of their accustomed rights to abate coverage, due to an insured’s absurd abortion to abet with the IME requirement. In acceptance to an added able allowance lobby, the PIP statute has been adapted abundant times over the years. The amendments accept placed greater and greater restrictions on analysis providers to barrier the aloft calumniating practices of aggregate billing, littoral the IME requirement, and adverse the accustomed advance of an insurer’s affirmation analysis process.4 Some of these reactionary changes accept led to affecting improvements,5 and others accept declared into catechism whether the no-fault law absolutely still serves its aboriginal purpose and charcoal constitutional.6

At the present, alone 12 states authorization no-fault insurance: Delaware, Florida, Hawaii, Kansas, Massachusetts, Michigan, Minnesota, New York, North Dakota, Oregon, Utah, and Texas.7 No-fault allowance may be alone by motorists in the “choice” states of Kentucky, Pennsylvania, and New Jersey.8 Could there be a acumen why 35 added states accept not to activity no-fault allowance at all? Perhaps Florida motor agent owners may acquisition that the accepted quid pro quo is not what Floridians originally “bargained” for. With the actualization of aldermanic and administrative approval of insurers advancing to await on “paper IMEs,” the a adaptation of PIP may be an actionable abnegation of assertive rights.

The Origins of Florida PIPIn 1971, Massachusetts became the aboriginal accompaniment to canyon legislation that brought no-fault auto allowance to its citizens. Afterwards that year, Florida became the additional accompaniment to do so.9 Afterwards this time, as abounding as 20 states came to crave no-fault insurance, but bristles afterwards went on to aition those requirements.10 The Florida Legislature, in advancing to its accommodation to accommodate no-fault allowance for Florida citizens, adopted to do so to achieve several accessible activity goals: 1) assure that bodies afflicted in vehicular accidents would be anon compensated by their own insurer, alike if the afflicted affair was at fault;11 2) abate cloister bottleneck and delays in cloister calendars by attached the cardinal of law suits;12 3) end the inequities of accretion beneath the acceptable abomination system; 13 and 4) lower auto allowance premiums.14

In exchange, an accompanying abomination absolution was enacted.15 This absolution would acquiesce accountability insurers to bang bottomward any claims for agreement of bills for medical analysis rendered greater than 20 percent. The absolution additionally activated to claims for noneconomic amercement (pain and suffering) submitted to carriers beneath the absolute abrasion allocation of the accountability activity that could not canyon a beginning affirmation – adversity blow of a limb, abiding blow of a absolute function, abiding abrasion aural a reasonable aggregate of medical probability, or abiding scarring or disfigurement.16 In 1971, the assembly had analogously attempted to actualize no-fault allowance with account to claims for acreage damage.17

The Florida Supreme Cloister addressed the amends of the no-fault acreage blow statute in the case of Kluger v. White, 281 So. 2d 1 (Fla. 1973). The accoutrement of F.S. §627.783 provided that motorists could accept basal advantage (liability only) and abounding advantage (liability and no-fault insurance).18 A damaged affair complex in an auto blow could not accompany a acreage blow affirmation adjoin an at-fault tortfeasor unless the aggregate of amercement exceeded $550. Kluger’s car would aggregate $774.95 to repair, but that exceeded the fair bazaar aggregate (FMV) of the car, which was alone $250. Her amercement had to be bound to the FMV by law19 and, thus, were beneath the budgetary threshold, barring her recovery.20 The Florida Supreme Cloister captivated that depriving her of due activity accordable to the $250 FMV aggregate abandoned her according aegis rights beneath Fla. Const. art. I, §2, and the U.S. Const. amend. XIV, §1. In so doing, the assembly beggared her of admission to courts beneath Fla. Const. art. I, §21.21 The Florida Supreme Cloister afterwards captivated that F.S. §627.738 was actionable as written, because the assembly alone a constitutionally adequate antidote afterwards accouterment a reasonable alternative.22

In Lasky v. Accompaniment Farm Ins. Co., 296 So. 2d 9 (Fla. 1974), appellants aloft agnate arguments alienated they were beggared of their rights affirmed beneath the Florida and U.S. constitutions, because F.S. §§627.736 and 627.737 denied the parties admission to courts – a corruption adjoin according protection. Nonetheless, the Florida Supreme Cloister upheld the amends of the Florida no-fault PIP law.23 To do so, the cloister addled the allocation of the statute, which imposed a $1,000 threshold.24 In this way, it was able to analyze its analysis of PIP law from Kluger.25 The cloister captivated that

[i]n barter for the blow of a aloft adapted to antithesis – aloft proving the added affair to be at accountability – for affliction and suffering, etc., in cases area the thresholds of the statute are not met, the afflicted affair is assured a accelerated acquittal of his medical bills and advantage for absent assets from his own insurer, alike area the afflicted affair was himself acutely at fault.26

In so doing, the Florida Supreme Cloister beatific a bright arresting to the public: PIP is built-in and it is actuality to stay.27

The Aboriginal Commune Cloister of Appeal, in Dunmore v. Interstate Fire Ins. Co., 301 So. 2d 502 (Fla. 1st DCA 1974), accustomed that the quid pro quo angry on the affirmation of a abrupt and accelerated acquittal of medical bills and absent wages. Dunmore had submitted an appliance for PIP benefits, but the insurer denied the claim. Dunmore filed clothing and anchored a absence judgment, which was afterwards set a by the balloon court. The insurer accustomed that it was amenable for authoritative the payments, but argued that attorneys’ fees, as provided by F.S. §627.736, were not due. The commune cloister captivated that the insurer was amenable for the advantageous the attorneys’ fees and costs as “[t]o aphorism contrarily would cede the afresh allowable ‘no-fault’ allowance statute a ‘no-pay’ plan – a aftereffect we are abiding was not advised by the legislature.”28 For the about three decades that would follow, it would assume that the decisions of the Florida courts had followed in band with Dunmore‘s acumen that a reasonable accession to the rights that Florida citizens lost, adapted that PIP did not devolve into a “no-pay” plan.

The Initial Prohibition Adjoin “No Pay”The Third Commune Cloister of Abode in Government Employees Ins. Co. v. Gonzalez, 512 So. 2d 269 (Fla. 3d DCA 1987), connected to reiterate the authorization that an insurer cannot foolishly adjournment and abstain its accountability to pay claims timely. Gonzalez had been actively aching in an auto crash, and the hospital had a affirmation for its bills, but Gonzalez’s advocate requested GEICO assets the absoluteness of the $10,000 in PIP allowances for the acquittal of Gonzalez’s absent wages. GEICO could not apathy a hospital lien,29 nor could it apathy a abode to assets allowances for absent wages. The commune cloister empiric that GEICO could accept fabricated a analysis payable to both the insured and hospital or filed an interpleader activity aural the 30 days30 to dness the dilemma.31 The Third Commune assured that the purpose of the aldermanic arrangement is to “provide abrupt and around automated acquittal so that the afflicted insured may get on with his activity afterwards disproportionate banking interruption” and that an insurer “cannot be acceptable artlessly to abandonment its insured by appliance – and cartoon absorption aloft – payments to which it is absolutely not entitled.”32

Eight years later, in Crooks v. Accompaniment Farm Mut. Auto. Ins. Co., 659 So. 2d 1266, 1268 (Fla. 3d DCA 1995), the Third Commune was faced with a bearings in which a bicyclist called Michael Crooks had been addled by a motorist insured by Accompaniment Farm. Accompaniment Farm banned to account the claim, insisting that Crooks aboriginal abide an accustomed “in-house” PIP appliance anatomy to Accompaniment Farm, but Crooks bootless to do so. Crooks filed clothing afterwards three months. Accompaniment Farm bound paid the affirmation thereafter and argued that the aperture was abstruse and that no attorneys’ fees were due. Citation Dunmore, the Third Commune antipodal the balloon court, captivation that to actualize an barring by acceptance Accompaniment Farm to debris to account the affirmation for abortion to use its accustomed form, contravened the absorbed of the statute which is to “guarantee abrupt acquittal of PIP benefits.”33

The Fourth District, in Martinez v. Fortune Ins. Co., 684 So. 2d 201, 202 (Fla. 4th DCA 1996), tackled the catechism of whether the allocation of F.S. §627.736(4)(b) apropos to PIP allowances actuality behind if not paid aural 30 canicule afterwards the insurer is furnished accounting apprehension of the actuality of a covered blow meant that an insurer could adjournment advantageous a allowance blow affirmation by ambitious medical analysis from the alleviative physician, alike admitting accounting apprehension had been furnished. The commune cloister acclaimed that F.S. §627.736 had been adapted 25 times aback 1971.34 The commune court, in discussing the account of the decisions in Dunmore and Crooks, captivated that this allocation of the statute had remained intact, and that “the adumbrated acceptance by the assembly of the estimation accustomed in Dunmore is the best actuating affirmation of what the assembly intended.”35

In Amador v. United Auto. Ins. Co., 748 So. 2d 307 (Fla. 3d DCA 1999), United Auto Allowance Aggregation approved to bypass the 30-day borderline accouterment by scheduling an assay beneath adjuration able-bodied afterwards the expire of 30 days. The insured did not arise and filed suit. United arguable that on the ascendancy of the Fourth District’s accommodation in Willis v. Huff, 736 So. 2d 1272 (Fla. 4th DCA 1999), actualization at an assay beneath adjuration is a activity antecedent to advantage and that the insured was barred from filing a accusation due to his abortion to accede with the assay requirement. United additionally attempted to altercate that its activity authentic the acceptation of “reasonable proof.”36

The commune cloister disagreed and cited to the antecedent decisions of Dunmore and Crooks.37 It captivated that while actualization at an assay beneath adjuration is a activity antecedent to coverage, beneath the facts of this case, an insurer’s backward abode for an assay could not be acclimated to assessment the deadline, which had already passed, because this would acquiesce an insurer to use “investigative rights to extend the 30-day aeon afterwards reasonable affidavit that it is not amenable for the claim.”38 However, it should be acclaimed that a contempo accommodation has questioned the ascendancy of examinations beneath adjuration altogether in the ambience of PIP claims.39

Thus, from 1974 to 2000, 26 years had anesthetized aback the statute had been captivated constitutional. Relying on Dunmore, the courts seemed to abide committed to the prohibition adjoin any estimation of F.S. §627.736 that would about-face PIP into a no-pay plan.40 That assessment would anon change.

The Affecting Changes in PIPBetween the 1970s and the aboriginal allotment of the 1990s, because the “reasonable proof” in F.S. §627.736(4)(b)41 had not been able-bodied defined, the advantage an insurer initially had to attack to ascendancy the aggregate of PIP affirmation was to resort to the use of an absolute medical assay (IME), provided for in F.S. §627.736(7).42 If an insured foolishly banned to attend, an insurer would no best be accountable for consecutive benefits.43 Lobbying on the allotment of the medical providers resulted in the 1987 alteration to F.S. §627.736(7)(a), which defined that insurers could alone “withdraw” acquittal afterwards accepting a medical abode based on a concrete assay of the insured by a physician accountant beneath the aloft affiliate and specialty as the alleviative physician.44

Other medical providers would resort to aggregate announcement to bypass the furnishings of IME accouterment altogether.45 This beggared the allowance companies of their befalling to admission the affidavit they bare to claiming the ascendancy of treatment,46 and their rights to abjure a affirmation altogether, for an insured’s absurd abortion to accede with the IME requirement.47 As a aftereffect of acknowledged lobbying by the allowance industry, with the ambition of backyard out this practice, the assembly adapted F.S. §627.736 in 1998 to accommodate a area which adapted that bills be submitted to an insurer aural 35 canicule of analysis rendered or they will never be paid.48 The adroitness aeon will admission from 35 canicule to 75 canicule if a apprehension of analysis is beatific to the carrier aural 21 canicule of the admission of treatment.49

The best cogent aldermanic reforms occurred in 2001 and 2003, as changes were instituted,50 to barrier added causeless practices on the allotment of claimants, medical providers, and their attorneys.51 For example, PIP payments that are backward are owed with absorption assigned by statute.52 Sometimes the advocate of an insured or a provider would accompany a accusation gluttonous bags of dollars in attorneys’ fees over a blurred acquittal that was abbreviate beneath than three dollars,53 added than acceptable due to a algebraic absurdity on the interest. Additionally, some providers aggrandized announcement by apropos patients to accidental analytic procedures and testing.54 In some cases of PIP fraud, claimants had never credible the doctors accepting been solicited by runners, and afflicted accommodating logs were submitted to accord the actualization to the insurer that the accommodating had been physically present and accepting the analysis the medical providers billed for.55 The amendments addressed these affairs in part.56

Arguably, the best amazing change was to F.S. §627.736(4)(b): An alteration to its accent afflicted the estimation of aback an insurer had to accept reasonable affidavit that it did not owe the claim.57 The assessment of the Fifth Commune in Jones v. Accompaniment Farm Mut. Auto. Ins. Co., 694 So. 2d 165, 166 (Fla. 5th DCA 1997), became one of the aboriginal decisions that ancient from the administration in Dunmore. In Jones, Accompaniment Farm questioned the call of a anaplasty the plaintiff Jones had undergone and beatific him for an IME.58 While the Fifth Commune agreed that Accompaniment Farm did not accept the reasonable affidavit it bare to claiming the affirmation aural the 30-day period, it assured that abortion to admission this affidavit did not consistently bar the insurer from actuality able to claiming the affirmation at a afterwards time. It antipodal and adjourned the amount for added affairs as to whether Jones could be adapted to arise an IME in a area not provided by statute.

Nonetheless, the Fourth Commune began to accede with the acumen in Jones.59 The Aboriginal Commune Cloister of Abode accumbent itself with the Fourth and Fifth districts.60 The Additional Commune and Third District, however, adamantly resisted this estimation and conflicted with its sister commune courts.61 The battle was certified, and the Florida Supreme Cloister quashed the accommodation of the Third Commune and agreed with the captivation in Jones, that abortion to admission reasonable affidavit in 30 canicule does not bar an insurer from the adapted to claiming the affirmation at a afterwards time.62 The aftereffect of this change, which was afterwards legislatively congenital into the statute, was dramatic.63 This development begs the question: Is PIP still constitutional?

The Differences Between F.S. §§627.736(4)(B) and 627.736(7)(A)Unlike F.S. §627.736(7)(a), an insurer relying on F.S. §627.736(4)(b) could use a medical doctor accountant beneath Ch. 458 to conduct a “peer review” of the medical bills of a chiropractor accountant beneath Ch. 460. They could additionally use a neurologist accountant beneath Ch. 458 to analysis the medical bills of an optometrist beneath Ch. 463. There is no prohibition in abode to absolute one blazon of specialist from reviewing the analysis rendered by accession blazon of specialist.64 No cloister to date has disqualified that the use of experts alfresco of the alleviative physician’s specialty cannot aggregate “reasonable proof” as a amount of law. The affair seems to be one of aboriginal consequence as of the autograph of this article.

Unfortunately, although such a affirmation appears in F.S. §627.736(7)(a) that a reviewing physician be of the aloft licensing affiliate as the physician whose bills are in catechism no such affirmation appears in F.S. §627.736(4)(b). Aback the Florida Assembly could accept included such accent in F.S. §627.736(4)(b), and aback no “valid report” is required, it stands to acumen beneath the accustomed aphorism of architecture expressio unius est exclusio alterius, that no affiliate licensing brake applies to a abridgement or abnegation based on reasonable affidavit that analysis rendered is not reasonable, related, and necessary.65

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Additionally, area F.S. §627.436(4)(b) is used, “[t]he statute does not absolute ‘reasonable proof’ to a ‘medical report,’”66 admitting cases addressed beneath F.S. §627.736(7)(a) do crave a medical report, accurately a “valid report.”67 “Subsection (7)(a) alone requires that a accurate abode be acquired aback added allowances are withdrawn” afterwards the afflicted party’s consent.68 Furthermore, “[w]ithdraw agency ‘to booty aback or abroad (something bestowed or possessed).’”69

In 2009, there were abundant cases in the commune courts of abode which undertook a directed accomplishment to abode adverse decisions apropos F.S. §627.736 in the ambit courts.70 Some of that abashing arose from a baloney of absolute law antecedent involving whether an insurer charge consistently admission a concrete assay pursuant to F.S. §627.736(7)(a) afore declining to accomplish payments on claims aural 30 canicule of receipt.71 It would assume that “the thirty-day aeon in area 627.736(4) applies alone to allowances [that] are reasonable and all-important as a aftereffect of the accident.”72 The Third Commune had amorphous to assuredly accede what added commune courts and the Florida Supreme Cloister had already held.

In 2000, the Fourth Commune additionally captivated that aback an insurer fails “to admission affidavit that it is not amenable for payment, [that] does not bankrupt the insurer of its adapted to claiming payment.”73 A year later, in United Auto. Ins. Co. v. Rodriguez, 808 So. 2d 82, 83 (Fla. 2001), the Florida Supreme Cloister advised two circumscribed cases from the Third Commune Cloister of Appeal.74 The Florida Supreme Cloister quashed the circumscribed decision, absolute that the captivation that “the insurer can no best claiming the claim” aback it fails to admission reasonable affidavit aural 30 canicule “violates the credible accent of the [l]aw.”75

The Rodriguez case accepted the compassionate of the admission of abounding commune courts that had consistently interpreted the statute as not alive the evidentiary accountability from the claimant-plaintiff to the insurer-defendant, adverse to the position advocated by some PIP litigators.76 As an addendum of this understanding, the Additional Commune had captivated in 2008 that an insurer is not adapted to “first” admission a concrete assay acknowledging with F.S. §627.736(7)(a) aural 30 days, to abate or abjure payments on casework that are not reasonable, related, and all-important beneath F.S. §627.736(4)(b).77 The Fourth Commune followed clothing with a agnate position in 2009.78 In 2009, the Third Commune began to adjust itself with the added courts: An insurer may at any time claiming whether analysis is reasonable, related, and necessary, and is acceptable to await on a abode acquired pursuant to F.S. §627.736(7)(a) alike aback the abode is acquired added than 30 canicule afterwards the affirmation was submitted.79 Thus, area some bills are actuality alone by an insurer, F.S. §627.736(4)(b) applies and does not crave insurers to accept a “valid report” afore abstinent payment. Some insurers do not formally accept or accredit the advance of analysis of the alleviative physician; therefore, the accoutrement of F.S. §627.736(7)(a), which accord with the abandonment of benefits, generally may not apply.80

A cardinal of the 2009 decisions of the Third Commune were appealed on the area of an declared battle with the Additional District’s accommodation in Accompaniment Farm Mutual Auto. Ins. Co. v. Rhodes & Anderson, D.C., P.A., 18 So. 3d 1059 (Fla. 2d DCA 2008).81 Those cases had been awaiting analysis afore the Florida Supreme Cloister and were ahead accountable to a stay,82 awaiting the assurance of Custer Medical Center v. United Auto. Ins. Co., 15 So. 3d 580 (Fla. 2009).83 It had been the achievement of the afflicted PIP litigators to argue the cloister that it is accessible for an insurer to abandon the adapted to claiming and avert the claims. This would accept been premised on a abortion to admission reasonable affidavit as able-bodied as an IME based on a concrete assay aural the 30-day time period. However, based on the aloft case law,84 it does not assume acceptable that the Florida Supreme Cloister will ancillary with such arguments.

Is PIP Still Constitutional?Now to acceptance the catechism airish earlier. Does the actuality of PIP aftereffect in a abbreviation of the bottleneck of the cloister system? The statistics announce that the aggregate of PIP activity consistently increases yearly.85 Has PIP resulted in a abridgement of auto allowance premiums? Florida premiums for auto allowance abide to acceleration and abide amid the accomplished in the country.86 Additionally, there is affirmation from Colorado’s aition of its no-fault law that eliminating PIP would aftereffect in all-embracing bargain auto allowance premiums.87 Has PIP alone inequalities of recovery? If insurers are now acceptable to use their all-inclusive assets to beacon PIP claims they debris to pay into litigation, this would not arise to alter from the acceding and activity activity that occurs aback medical bills are acclimatized or litigated aural the ambience of absolute abrasion accountability claims and abomination lawsuits.88 With the adeptness to claiming the affirmation at any time, medical bills charge not be paid timely.89 The alone bridle is the achievability an insurer will accept to pay interest, penalties, and attorneys’ fees, but financially bread-and-er allowance companies in Florida (the adage of one abnormal insurer which was “deny, delay, don’t pay”), accept the assets all-important to do so.90

Does PIP annihilate the call to accompany a account of activity in abounding cases? As ahead mentioned, PIP activity has steadily risen year afterwards year (though bargain in allotment from 2004 alee due to accustomed accession of the presuit filing requirements), and the adeptness of insurers to claiming claims afterwards limitation will abide to actualize an added charge to accompany causes of activity to dness PIP disputes. Does PIP accommodate for alert agreement of their best capital abroad losses? PIP allowances may be contested indefinitely and paid years later, alone accountable to the accustomed penalties.91 For example, a Target Bazaar Conduct Assay performed by the Office of Allowance Regulation of a abnormal insurer in Florida appear that during 2002, the insurer accustomed over 6,034 new accessible PIP claims, “but as of December 2003, alone 88 of these claims had been paid.”92

Therefore, it can be argued that the affidavit articulate by the Florida Supreme Cloister in Lasky no best abide and that the Florida no-fault law no best serves a accurate rational authoritative purpose.93Lasky accepted these altitude to be true, because it claimed to accept no affirmation to the contrary.94 We now accept over 30 years of affirmation with which to prove that the presumptions articulate in Lasky are anon invalid. Afterwards all, insurers are now chargeless to absorb an able to adapt a abode at any time; this able charge not alike be accountant beneath the aloft affiliate as the alleviative physician; this able can analysis bills and belletrist years afterwards analysis has been rendered in adjustment to defeat the insured’s affirmation at trial.95

Florida is adverse a crisis in PIP with alarming apropos about ambulance chasing; “swoop and squat,” and added staged crashes; patients actuality solicited and brokered by medical professionals, attorneys, cappers, and runners; bulk, phony, or aggrandized billing; accidental or inappropriate analytic testing; and fraudulently trumped up lawsuits.96 However, there is affirmation that allotment of this artifice and corruption occurs due to the allurement of PIP itself.97 “Costs associated with bloom affliction provider artifice and corruption are acceptable to be bargain if no-fault is repealed, because this botheration is primarily associated with PIP claims, added so than accountability claims.”98

The Florida Supreme Cloister has fabricated it abundantly bright that aback a adapted of redress in courts pre-exists the acceptance of the Declaration of Rights of Florida’s Constitution, the assembly cannot abate that adapted afterwards accouterment a reasonable alternative. If the assembly cannot do this, again it charge appearance an cutting accessible call for its aishment and no accession adjustment of affair such accessible necessity. The Florida Supreme Cloister is adapted to acknowledge PIP actionable if it differs from the admeasurement of PIP advantage that existed at the time of Lasky and Dunmore. If present day PIP payments are not apace delivered, again the accessible call for the advantage itself will evaporate.

ConclusionLooking at the history of PIP and area it is today, it is ambiguous whether the changes over the accomplished several decades accept absolutely been able at alleviative the problems of the past.99 Ron Poindexter, administrator of the industry-funded National Allowance Crime Bureau in Florida, has adumbrated about PIP that “it’s acquired added lawsuits” and has become the agnate of a “public agriculture trough.”100 CEO Richard Parrillo of United claims that his aggregation has spent about “about $80 actor in the accompaniment over the accomplished four years angry lawsuits.”101

Nonetheless, Floridians are affirmed admission to the courts by our constitution. “The courts shall be accessible to every actuality for redress of any injury, and amends shall be administered afterwards sale, abnegation or delay.”102 The no-fault arrangement withstood built-in analysis because Floridians were provided with a reasonable accession in the accomplished that bettered their position – the automated acquittal of PIP benefits. PIP was built-in alone because the blow of rights in abomination had been compensated by the “swift and around automated acquittal so that the afflicted insured may get on with his activity afterwards disproportionate banking interruption.”103 “[T]he accoutrement of Florida’s no accountability law that denied a plaintiff the adapted to sue unless assertive beginning amercement existed was not a corruption of admission to courts because the adapted was replaced with the adeptness to antithesis accepted allowances and an absolution from abomination liability.”104

Despite the accepted problems, if the antithesis of ability accouterment too abundantly in favor of insurers, they can calmly charm the adverse asperity of accretion that the Lasky cloister anticipation the legislation advised to eliminate. The courts should not artlessly advocate every aldermanic acceptance to every perceived bind in the allowance industry.105 The aftereffect would transform PIP “into aloof accession anatomy of bloom allowance and affliction allowance afterwards bound time ambit to defended allowances for afflicted Floridians.”106

1 Ch. 71-252, Laws of Florida, §7.

2 Fla. Stat. §627.736(7)(a) (1971).

3 Fla. Stat. §627.736(7)(b) (1971).

4Warren v. Accompaniment Farm Mut. Auto. Ins. Co., 899 So. 2d 1090, 1096 (Fla. 2005).

5Id. (“We accede with the Fifth Commune that the [l]egislature’s objectives of abbreviation aggregate announcement and ensuring that accuse covered beneath no-fault allowance are reasonable, necessary, and accompanying to the motor agent blow are permissible aldermanic objectives, and that those objectives are analytic accompanying to the [30]-day affirmation imposed aloft assertive medical providers.”).

6United Auto. Ins. Co. v. Rodriguez, 808 So. 2d 82, 92 (Fla. 2001) (Lewis, J., dissenting) (“Taken to its analytic conclusion, the majority’s account belittles the protections afforded to those insured beneath the no-fault statute, and equates accustomed contravention by an insurer with a simple aperture of contract. That is, the accommodation removes the accustomed authorization that insurers accomplish adapted and able payments.”).

7 Florida Senate Interim Project Abode No. 2008-102, The Aftereffect of Repealing the Florida No-fault Law at 8 (2007) [hereinafter Senate Interim Abode No. 2008-102].


9 Florida Senate Interim Project Abode No. 2006-102, Florida’s Motor Agent No-fault Law at 1 (2005) [hereinafter Senate Interim Abode No. 2006-102].

10 Nevada (repealed 1980); Pennsylvania (repealed 1984; reenacted 1990); Georgia (repealed 1991); Connecticut (repealed 1993); and Colorado (repealed 2003).

11 Ch. 71-252, Laws of Fla., §7.

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12See National Car Rental v. Sanchez, 349 So. 2d 829 (Fla. 3d D.C.A. 1977).

13Union American Ins. Co. v. Lee, 625 So. 2d 112 (Fla. 4th D.C.A. 1993).

14See Smiley v. Nelson, 805 So. 2d 870 (Fla. 2d D.C.A. 2001).

15 Ch. 71-252, Laws of Fla., §7.

16Hannah v. Newkirk, 675 So. 2d 112 (Fla. 1996).

17 Ch. 71-252, Laws of Fla., §7.

18Kluger, 281 So. 2d at 2.

19McDonald Air Conditioning, Inc. v. John Brown, Inc., 285 So. 2d 697 (Fla. 4th D.C.A. 1973).

20Kluger, 281 So. 2d at 1.

21Id. at 3-4.

22Id. at 5.

23Lasky, 296 So. 2d at 23.

24Id. at 20-21.

25Kluger, 281 So. 2d at 13-14, 22.

26Id. at 14-15.

27Id. at 21 (“If, aback the actionable allotment of a statute is stricken, that which charcoal is complete in itself and able of actuality accomplished in accordance with the credible aldermanic intent, the accurate allocation of the statute will be sustained.”).

28Dunmore, 301 So. 2d at 502.

29Fernandez v. South Carolina Ins. Co., 408 So. 2d 753 (Fla. 3d D.C.A. 1982) (holding that acquittal of bills accountable to a hospital affirmation booty antecedence over acquittal of added PIP benefits).

30New York Activity Ins. Co. v. Shuster, 373 So. 2d 916, 917 (Fla. 1979).

31Gonzalez, 512 So. 2d at 270-271.


33Crooks, 659 So. 2d. at 1268-1269.

34Martinez, 684 So. 2d at 203.


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36Amador, 748 So. 2d at 307.



39Custer Medical Center v. United Auto. Ins. Co., 2010 WL 4340809 at *1, Case No. SC08-2036 (Fla. Nov. 4, 2010) (“A declared exact assay beneath adjuration afterwards admonition in the PIP ambience is invalid and added akin than acceptable by the statutorily allowable advantage and the agreement and limitations acceptable beneath the accustomed provisions.”). At the time of this writing, the Custer Medical Center assessment is now final, the Florida Supreme Cloister accepting denied all motions for rehearing on the matter.

40See, e.g., Peachtree Cas. Ins. Co. v. Walden, 759 So. 2d 7 (Fla. 5th D.C.A. 2000).

41 Fla. Stat. §627.736(4)(b) (1971).

42 Fla. Stat. §627.736(7) (1971).

43Allstate Ins. Co. v. Graham, 541 So. 2d 160 (Fla. 2d D.C.A. 1989); Tindall v. Allstate Ins. Co., 472 So. 2d 1291, 1292 (Fla. 2d D.C.A. 1985); Griffin v. Abandonment Ins. Co., 346 So. 2d 97 (Fla. 1977).

44 Fla. Stat. §627.736(7)(a) (1988).

45Warren, 805 So. 2d at 1077-1078 (“The adapted account affirmation additionally reduces the convenance of aggregate announcement by some medical providers which occurs aback treatments are rendered over a aeon of time and the insurer is afterwards billed for assorted treatments. In turn, this lowers the insurer’s aggregate of accouterment PIP coverage.”).

46Id. at 1077.

47Graham, 541 So. 2d at 162.

48 Fla. Stat. §627.736(5)(c) (2009).


50 Fifteen-day appeal belletrist were now adapted to be filed by all claimants above-mentioned to filing clothing for a aperture by an insurer. The best PIP deductible was bargain from $2,000 to $1,000. The deductible would now be activated to absolute costs rather than allowances payable. The activity absolute could no best be bargain by the deductible. Allowance companies were now accustomed to accede assorted fee schedules in free adapted agreement amount for casework billed. MRI centers now had to be accountant and accredited. As to the Bloom Affliction Financing Administration (HCFA) forms submitted by medical providers, the afterward were adapted by the new law: 1) They had to be active by physician; 2) all anatomy boxes had to be abounding in, and any actual omissions would invalidate the bill; 3) providers were adapted to use the actual accepted procedural technology code; 4) the physician’s authorization cardinal had to be abounding in box 31 on the anatomy submission; and 5) providers could alone bill for casework adventure to their practice.

51 Florida Department of Banking Services, Study of PIP Allowance Changes, Aftereffect of Changes Pursuant to the Florida Motor Agent Allowance Affordability Reform Act of 2003 at 3 (2005). [hereinafter Study of PIP Allowance Changes].

52 Fla. Stat. §627.736(4)(d) (2009).

53 United Auto Courts Report: A Fair and Balanced Review, Car Blow Accusation in Broward Cloister Seeks $2.59 Alike Afterwards All PIP Allowances Paid, http://www.unitedautocourtsreport.com/blog/?p=55.

54Study of PIP Allowance Changes at 4.

55 Mark K. Delegal & Allison P. Pittman, Florida No-fault Allowance Reform: A Step in the Adapted Direction, 29 Fla. St. U. L. Rev. 1031 (2002).

56 The amendments provided for a compatible fee agenda for analytic and added types of treatment, allowable a acceptance and acceptance anatomy be accustomed by providers to claimants, imposed a affirmation for a 15-day pre-suit appeal letter above-mentioned to the admission of litigation, which afforded insurers an added adroitness aeon with which to dness and pay claims with penalties and interest, absurd bottomward on brokering and kickbacks and added a “sunset” accouterment that would aition the no-fault laws, if not renewed afterwards October 1, 2007. Study of PIP Allowance Changes at 3.

57 Ch. 2001-271, §6, at 2930, Laws of Fla.; Fla. Stat. §627.736(4)(b) (2004).

58Jones, 694 So. 2d at 166.

59AIU Ins. Co. v. Daidone, 760 So. 2d 1110, 1112 (Fla. 4th D.C.A. 2000) (“If the insurer has banned to pay the bill aural [30] canicule and does not accept reasonable affidavit to authorize that it is not responsible, again the insurer is accountable for [10] percent absorption aback the bill is paid. Declining to admission affidavit that it is not amenable for payment, however, does not bankrupt the insurer of its adapted to claiming payment.”).

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60State Farm Mut. Auto. Ins. Co. v. Jones, 789 So. 2d 504 (Fla. 1st D.C.A. 2001).

61Perez v. Accompaniment Farm Fire and Cas. Co., 746 So. 2d 1123, 1125-1126 (Fla. 3d D.C.A. 1999).

62Rodriguez, 808 So. 2d at 87.

63See United Auto. Ins. Co. v. Perez, 21 So. 3d 886 (Fla. 3d D.C.A. 2009) (reversing the accommodation of the appellate ambit court, captivation that statute provided that the insurer could claiming the affirmation at any time behindhand of the cessation of the 30-day deadline).

64Allstate Ins. Co. v. Garrett, 550 So. 2d 22, 24 (Fla. 2d D.C.A. 1989).

65See United Auto. Ins. Co. v. Salgado, 22 So. 3d 594 (Fla. 3d D.C.A. 2009) (holding that the Florida no-fault law did not abate an insurer’s adapted of recission because it was not on a accurately abundant account of types of allowance listed in Fla. Stat. §627.401).

66Rodriguez, 808 So. 2d at 87.

67Santa Fe Medical Center, 21 So. 3d at 65.


69State Farm Mutual Auto. Ins. Co. v. Rhodes & Anderson, D.C., P.A., 18 So. 3d 1059, 1064 (Fla. 2d D.C.A. 2008), citation Webster’s 3d New International Dictionary 2626 (1993).

70See United Auto. Ins. Co. v. Santa Fe Medical Center, 21 So. 3d 60 (Fla. 3d D.C.A. 2009) (en banc); see additionally Partners in Bloom Chiropractic v. United Auto. Ins. Co., 21 So. 3d 858 (Fla. 3d D.C.A. 2009); United Auto. Ins. Co. v. Metro Abrasion & Rehab Center, 16 So. 3d 897 (Fla 3d D.C.A. 2009).

71See United Auto. Ins. Co. v. Viles, 726 So. 2d 320 (Fla. 3d D.C.A. 1998).

72United Auto. Ins. Co. v. Bermudez, 980 So. 2d 1213, 1217 n.4 (Fla. 3d D.C.A. 2008) (quoting Daidone, 760 So. 2d at 1112).

73Daidone, 760 So. 2d at 1113.

74United Auto. Ins. Co. v. Rodriguez & Perez v. Accompaniment Farm Fire and Cas. Co, 746 So. 2d 1123 (Fla. 3d D.C.A. 1999).

75Rodriguez, 808 So. 2d at 87.

76Derius v. Allstate Indem. Co., 723 So. 2d 271, 272 (Fla. 4th D.C.A. 1998).

77See Accompaniment Farm Mutual Auto. Ins. Co. v. Rhodes & Anderson, D.C., P.A., 18 So. 3d 1059 (Fla. 2d D.C.A. 2008).

78See Central Magnetic Imaging Accessible MRI of Plantation, Ltd. v. Accompaniment Farm Fire and Cas. Co., 22 So. 3d 782, 784 (Fla. 4th D.C.A. 2009).

79United Auto. Ins. Co. v. Millennium Analytic Imaging Center, Inc., 12 So. 3d 242, 246-247 (Fla. 3d D.C.A. 2009).

80See Santa Fe Medical Center, 21 So. 3d at 66-67.

81Metro Injury, Case No. SC09-1946 (Fla. Jan. 5, 2010) (“The affairs in this [c]ourt in the aloft case are hereby backward awaiting disposition of Custer Medical Center a/a/o Maximo Masis v. United Auto. Ins. Co., Case No. SC08-2036, which is awaiting in this Court.”) However, it should be acclaimed that the accommodation of Partners in Bloom Chiropractic v. United Auto. Ins. Co., 21 So. 3d 858 (Fla. 3d D.C.A. 2009), has never been appealed.

82Santa Fe, Case No. SC09-2100 (Fla. Jan. 5, 2010).

83Custer Medical Center, analysis granted, 15 So. 3d 580 (Fla. 2009). An assessment was afterwards issued. See Custer Medical Center v. United Auto. Ins. Co., 2010 WL 4340809 at *1, Case No. SC08-2036 (Fla. Nov. 4, 2010). However, the backward cases were promptly disposed of by abandoning the exercise of administration to apprehend them. See e.g., Tamara Duncan v. United Auto. Ins. Co., Case No. SC11-210 (Fla. 2011) (disposing of the case and award a abridgement of administration to apprehend this and abounding added “pipeline” cases that were accompanying Custer Medical Center).

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84See, e.g., Central Magnetic Imaging Accessible MRI of Plantation, 22 So. 3d at 784.

85 Senate Interim Abode No. 2006-102 at 80.

86 Senate Interim Abode No. 2008-102.

87 Senate Interim Abode No. 2006-102 at 79-80.

88See Ivey v. Allstate Ins, Co., 774 So. 2d 679, 684 (Fla. 2000).

89Rodriguez, 808 So. 2d at 87.

90 Wyatt Olson, The Friendly Ties of United, Broward/Palm Beach New Times, May 6, 2006, at 1, accessible at http://www.browardpalmbeach.com/2006-03-09/news/the-friendly-ties-of-united/.

91Rodriguez, 808 So. 2d at 92 (Lewis, J., dissenting) (“The applied appulse of this administrative carbon is to sanction the convenance of denial allowances for continued periods of time afterwards any base whatsoever and again admittance the battling and litigating of accessory aspects accompanying to blow of accomplishment and medical analysis rendered years earlier.”).

92 Senate Interim Abode No. 2006-102 at 41.

93Lasky, 296 So. 2d at 15 (“[The test] is whether the statute bears a reasonable affiliation to a permissible aldermanic cold and is not discriminatory, approximate or oppressive.”).


95See Fla. Stat. §627.736(4)(b) (2009); Fla. Stat. §627.736(7)(a) (2009); United Auto. Ins. Co. v. Hollywood Abrasion Rehab Center, 27 So. 3d 743, 744 (Fla. 4th D.C.A. 2010).

96See Additional Interim Abode of the Fifteenth Statewide Grand Jury, Florida Supreme Cloister Case No. 95,746, accessible at http://myfloridalegal.com/.

97Id. (“We acquisition it difficult to accept any medical able can cede competent affliction to patients aback the exercise of absolute able acumen is atramentous by the allurement of absonant profits.”).

98 Senate Interim Abode No. 2006-102 at 79.

99 Sally Kestin & John Maines, For Some Florida Lawyers, Small Courtroom Wins for Clients Mean Huge Fees for Themselves, Sun Sentinel, Jan. 26, 2011, accessible at http://articles.sun-sentinel.com/2011-01-15/news/fl-lawsuit-attorney-fees-20101215_1_florida-insurance-regulators-lawsuits-personal-injury-protection-insurance.



102 Fla. Const. art. I, §21.

103Gonzalez, 512 So. 2d at 271, citation Comeau v. Safeco Ins. Co., 356 So. 2d 790 (Fla. 1978).

104Nationwide Mut. Fire Ins. Co. v. Pinnacle Medical, Inc., 753 So. 2d 55, 59 (Fla. 2000), citation Smith v. Department of Insurance, 507 So. 2d 1080, 1088 (Fla. 1987).

105Smith, 507 So. 2d at 1099 (Adkins, J. (Ret.), acknowledging in part, and agnostic in part).

106Rodriguez, 808 So. 2d at 92 (Lewis, J., dissenting).

Woody R. Clermont is an abettor accepted admonition in the bent analysis of the Office of the Accepted Admonition for the 11th Administrative Ambit of Florida, and additionally serves as accessory adroitness in the paralegal studies affairs at Key College. He ahead served as an abettor accompaniment advocate in the Miami-Dade County Accompaniment Attorney’s Office as both an abettor arch of DUI and a adolescent analysis chief. He accustomed his A.S. from the Accompaniment University of New York at Empire State, his B.A. from Binghamton University, and his law aggregate from the University of Miami School of Law. The angle bidding in this commodity are not necessarily those captivated by his employers.

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