The Fourth District issued a written opinion denying the provider's petition for second tier certiorari in this PIP claim arising from the denial of a single MRI performed in 2005. The insurer obtained a peer review of the treatment and billing records. The reviewing physician opined that the MRI was not reasonable, necessary or related. The MRI company filed suit and moved for summary judgment, arguing that the insurer could not contest the bill, because §627.736(7)(a) required the insurer to obtain a report from a qualified examining physician before withdrawing payment. The county court agreed and the circuit court reversed, concluding that the statute does not require an IME before payment can be denied.

The Fourth DCA specifically held that the circuit court had applied the correct law and afforded procedural due process, so that 2nd tier certiorari was not appropriate. The court nonetheless addressed the merits of whether a "valid report" under §627.736(7)(a) requires a physical examination. The court specifically concluded, in line with the Third District Court of Appeal, that "the "valid report" required by the statute does not require an insurer to order an IME before denying a claim for PIP benefits." The court concluded that language added to (7)(a) in 2001 which defined a "valid report" did not require a physical exam. The court stated, "the plain language of the statute permits a report to be based on review of treatment records." The court then reaffirmed their prior holding in Nationwide Mut. Fire Ins. Co. v. Se. Diagnostics, Inc., 766 So.2d 229 (Fla. 4th DCA 2000).

In a footnote, the court specifically noted that the question of whether the valid report requirement applied to a denial (as compared to a withdrawal/termination) was not presented in this case. State Farm had conceded that the valid report requirement applied. The footnote neither approves or disapproves of the opinions from other districts which have addressed that issue.

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