In United Automobile Ins. Co. v. A 1st Choice Healthcare Systems, the Court considered two interrelated questions: (1) whether there exists a firm deadline for the provision of an EOB to an insured (or his or her assignee) under §627.736(4)(b); and (2); if so, whether §627.736(4)(b); affords the insured (or assignee) a private right of action against his or her insurer for an insurer's failure to meet the deadline.

Thirteen months after receiving bills for treatment, United Auto responded to the payment request with a form explanation of benefits. United Auto refused payment because the bill(s) were not timely submitted in accordance with Fla. Stat. §627.736(5). Two years later A 1st Choice filed a two-count complaint. It sought damages for nonpayment of benefits and nominal damages for United Auto's failure to provide a timely explanation of benefits. After determining that the amount sought for the nonpayment of benefits fell within the insured's deductible, A 1st Choice voluntarily dismissed that count. The Trial Court then assessed one dollar in nominal damages and attorneys' fees against United Auto. The Circuit Court, sitting in its appellate capacity, per curiam affirmed the trial court's order. United Auto sought second tier certiorari review, which was granted.

On the first question, A 1st Choice argued that section 627.736(4)(b) must be read to require a personal injury protection insurer to respond to any request for payment of benefits under a personal injury protection policy of insurance within thirty days after receiving "written notice ... of a covered loss" and "the amount due of same." See §627.736(4)(b). The court rejected this argument, stating that the provider "misreads the statute." The court held:

Under the plain language of the statute, a response is required from the insurer only "[w]hen an insurer [either] pays a portion of a claim or rejects a claim." Id. Then, "at the time of the partial payment or rejection," id., "the insurer shall provide ... an itemized specification of each item that the insurer had reduced, omitted or declined to pay." Id. (emphasis added). In fact, carefully parsed, it is clear there is neither a requirement nor a deadline for a personal injury protection insurer to respond to a request for payment. (all emphases added by court)

The Court noted that "there is a cost-and, indeed, ever increasing risk-to a miscreant insurer who does not treat its customers properly" however, that cost is limited to the risk of paying attorney's fees and interest if the bill is ultimately found to be covered.

On the second issue, the Court expressly rejected any claim that a private cause of action existed, stating:

There is nothing in the text of section 627.736(4)(b) from which one can deduce that the legislature intended an insured have a private right of action against an insurer for failure to provide an EOB. In fact, the statute only authorizes one cause of action: a cause of action for personal injury protection benefits. See §627.736(11).

Based on these conclusions, the Third District granted second-tier certiorari and reversed the PCA opinion of the Circuit Court.

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