Mercury Insurance appealed a final judgment entered in favor of the provider, based on the trial court's finding that Mercury's request for verification that the provider was eligible for payment of PIP benefits was not a request for information within the scope of §627.736(6)(b) and thus did not toll Mercury's obligation to pay the provider's bills.

The provider submitted to the insurer a properly completed CMS 1500 for the treatment to the insured for accident related injuries. The physician's full name and license number were included on the form. In response, the insurer requested the provider to send a copy of a completed Office of Insurance Regulation approved form (OIR-B1-1809), to verify that Med Manage was in compliance with section 627.736(1)(a), Fla. Stat. (2008). The provider did not respond to the request, and instead submitted a demand letter. The insurer claimed that the demand letter was premature, as the provider had never complied with the (6)(b) request for information. The provider then filed suit.

The insurer moved for summary judgment, arguing that the bill was not overdue, because they had never complied with the request for information. The Trial Court denied the motion and entered judgment in favor of the provider. On appeal, the Circuit Court affirmed, finding that the documentation requested in this case was not within the scope of the statute. First, the court noted that (6)(b) requires a provider:

to furnish a written report of the history, condition, treatment, dates, and costs, of such treatment of the injured person and why the items identified by the insurer were reasonable in amount and medically necessary, together with a sworn statement that the treatment or services rendered were reasonable and necessary with respect to bodily injury sustained and identifying which portion of the expenses for such treatment or services was incurred as a result of such bodily injury, and produce his or her or its records regarding such history, condition, treatment, dates, and costs of treatment. (emphasis added by court)

The court refused to follow an earlier county court decision from Dade County, in which the court had concluded that a similar request went to "costs" under §627.736(6)(b), similar to the request in Kaminester v. State Farm Mut. Auto. Ins. Co., 775 So.2d 981 (Fla. 4th DCA 2000). Finding that Kaminester applied to entirely different documentation than that requested here, and that the information requested here did not go to "costs", the court rejected that reasoning.

The court concluded that the provider had provided written notice of the fact of a covered loss and the amount of same when it submitted the HCFA form. Since the insurer's request for information failed to request information as to the history, condition, treatment, dates, and costs of such treatment or whether the items were reasonable, necessary or related, the request was not within the scope of the statute. The provider thus did not need to respond to the request and the bills were overdue. The court further concluded that the treatment was lawfully provided, supervised, ordered, or prescribed by Dr. Burack, a licensed physician under Chapter 459, Fla. Stat.

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