This is this week’s blog entry from the accident lawyer in Boca Raton (injury attorney Coral Gables, accident lawyer Doral, injury lawyer Weston, accident attorney Cooper City, accident lawyer Plantation, injury attorney Parkland, injury lawyer Boynton Beach).
As we have written about, under your insurance policy and Florida law (statute 627.736(7), a copy of which is posted below), you are required to go to your own insurance company’s physician to be examined. This is not for TREATMENT but instead for their doctor to determine whether the treatment you have received was reasonable and necessary and related to the accident and whether future treatment is necessary. These exams are referred to as an IME, an independent medical examination, or what the plaintiff bar prefers to call a CME or compulsory medical examination. If the doctor finds that future care is not needed (the benefits are discontinued), then the insurance company has a legal basis to NOT pay for any more care from your treating doctor (however note that the physician that discontinues benefits must be licensed from the same chapter as the treating doctor; in other words, for example, a chiropractor cutoff does not impact future medical doctor care and visa versa).
One option in this scenario is for a PIP suit to be filed against the insurance company seeking the benefits to be reinstated. This is most commonly done by the doctor filing such a suit. If reinstated, then the insurance company would generally be required to pay for such treatment, so long as the treatment is reasonable and necessary and related to the accident. These lawsuits do take some time and generally the patient would continue care while that lawsuit is pending. The patient would also have the option to simply pay for the chiropractic care, to pay for the care from their settlement later if such an agreement can be reached with the doctor, or possibly if the patient has health insurance with chiropractic benefits, then those bills could be paid through health insurance.
Please call Drucker Law Offices for a free consultation at (561) 483-9199 for Palm Beach County (Boca Raton Main office); (954) 755-2120 in Broward County (Coral Springs satellite office); or (305) 981-1561 in Miami-Dade County (Miami satellite office).
It is important to note that every case is unique and should be judged based on the specific facts of the case. The advice in this blog is intended to be general in nature and should not to be construed as specific advice for a case, as a minor difference in the facts of the case could change the result. Also, this is a law blog and the advise here is not medical in nature. Also, this blog is, as the web site suggests, based on Florida law and the laws of any other states or even another country could vary from Florida.
(7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON; REPORTS.—
(a) Whenever the mental or physical condition of an injured person covered by personal injury protection is material to any claim that has been or may be made for past or future personal injury protection insurance benefits, such person shall, upon the request of an insurer, submit to mental or physical examination by a physician or physicians. The costs of any examinations requested by an insurer shall be borne entirely by the insurer. Such examination shall be conducted within the municipality where the insured is receiving treatment, or in a location reasonably accessible to the insured, which, for purposes of this paragraph, means any location within the municipality in which the insured resides, or any location within 10 miles by road of the insured’s residence, provided such location is within the county in which the insured resides. If the examination is to be conducted in a location reasonably accessible to the insured, and if there is no qualified physician to conduct the examination in a location reasonably accessible to the insured, then such examination shall be conducted in an area of the closest proximity to the insured’s residence. Personal protection insurers are authorized to include reasonable provisions in personal injury protection insurance policies for mental and physical examination of those claiming personal injury protection insurance benefits. An insurer may not withdraw payment of a treating physician without the consent of the injured person covered by the personal injury protection, unless the insurer first obtains a valid report by a Florida physician licensed under the same chapter as the treating physician whose treatment authorization is sought to be withdrawn, stating that treatment was not reasonable, related, or necessary. A valid report is one that is prepared and signed by the physician examining the injured person or reviewing the treatment records of the injured person and is factually supported by the examination and treatment records if reviewed and that has not been modified by anyone other than the physician. The physician preparing the report must be in active practice, unless the physician is physically disabled. Active practice means that during the 3 years immediately preceding the date of the physical examination or review of the treatment records the physician must have devoted professional time to the active clinical practice of evaluation, diagnosis, or treatment of medical conditions or to the instruction of students in an accredited health professional school or accredited residency program or a clinical research program that is affiliated with an accredited health professional school or teaching hospital or accredited residency program. The physician preparing a report at the request of an insurer and physicians rendering expert opinions on behalf of persons claiming medical benefits for personal injury protection, or on behalf of an insured through an attorney or another entity, shall maintain, for at least 3 years, copies of all examination reports as medical records and shall maintain, for at least 3 years, records of all payments for the examinations and reports. Neither an insurer nor any person acting at the direction of or on behalf of an insurer may materially change an opinion in a report prepared under this paragraph or direct the physician preparing the report to change such opinion. The denial of a payment as the result of such a changed opinion constitutes a material misrepresentation under s. 626.9541(1)(i)2.; however, this provision does not preclude the insurer from calling to the attention of the physician errors of fact in the report based upon information in the claim file.
(b) If requested by the person examined, a party causing an examination to be made shall deliver to him or her a copy of every written report concerning the examination rendered by an examining physician, at least one of which reports must set out the examining physician’s findings and conclusions in detail. After such request and delivery, the party causing the examination to be made is entitled, upon request, to receive from the person examined every written report available to him or her or his or her representative concerning any examination, previously or thereafter made, of the same mental or physical condition. By requesting and obtaining a report of the examination so ordered, or by taking the deposition of the examiner, the person examined waives any privilege he or she may have, in relation to the claim for benefits, regarding the testimony of every other person who has examined, or may thereafter examine, him or her in respect to the same mental or physical condition. If a person unreasonably refuses to submit to an examination, the personal injury protection carrier is no longer liable for subsequent personal injury protection benefits.
