United Automobile Insurance Company is praising a Florida-based ruling from the Third District Court of Appeals that confirms a person cannot sue his auto insurance company for failing to provide an explanation of benefits on personal injury protection claims.
According to a release from the company, which is a major vehicle insurer in Florida, United Auto had appealed a 2007 decision by a Miami-Dade county court judge to award $1 in nominal damages and $19,530 in attorney's fees to A 1st Healthcare Systems, Inc. In that case, the judge said that United Auto had failed to respond to the company's request for payment within 30 days. The same judge said the plaintiff was owed nothing for those medical bills because they totaled less than the deductible.
The appeals court disagreed with the county court and with a circuit court that had upheld the decision to award damages and fees. Appeals Court Judge Frank A. Sheperd wrote in a unanimous opinion that "it is clear there is neither a requirement nor a deadline for a personal injury protection insurer to respond to a request for payment."
Citing several other appeals court decisions and state law, the court wrote that a response is required only at the time of payment or rejection of a claim.
An auto insurance company can challenge a payment claim after the 30-day period, the court said, and the court has "never located in the statute any absolute deadline on such a challenge."
The appeals court went a step further and ruled that insureds cannot sue their insurance companies for not providing an explanation of benefits on a medical claim. "In fact, the statute only authorizes one cause of action: a cause of action for personal injury protection benefits," the appeals court wrote.
"The result of the court's opinion will likely be a decrease in frivolous lawsuits filed solely for the purpose of obtaining attorney's fees from the insurance company," said Thomas Hunker, staff attorney in the appellate division of the office of the general counsel of United Automobile Insurance Company. "It will also simplify the personal injury protection litigation process and get the focus back on whether the bills were due and owing."