Petition for Discovery – 627.736(6)

April 19, 2012

The basis for an insurer’s right to petition a court to enter an order permitting discovery of facts is Section (6) of the Florida No-Fault (PIP) Statute, 627.736. It is one of the investigative tools available to combat insurance fraud. As highlighted below, Section (6) requires a:

  1. Timely  “request” for information;
  2. “Reasonable basis” for the request as to why additional documentation is necessary;
  3. “Dispute” warranting a Petition for the “discovery of facts”; and
  4. “Good cause”, i.e. some affirmative evidence before court warranting further investigation

Specifically, Section 627.736(6)(b), Florida Statutes provides that a medical provider:

 “shall, if requested to do so by the insurer … furnish forthwith a written report of the history, condition, treatment, dates, and costs of such treatment … together with a sworn statement that the treatment or services rendered were reasonable and necessary … and permit inspection and copying of its records regarding such…treatment, dates and costs of treatment …If an insurer makes a written request for documentation or information under this paragraph within 30 days after having received notice of the amount of a covered loss under paragraph 4(a), the amount of partial amount which is the subject of the insurer’s inquiry shall become overdue if the insurer does not pay in accordance with paragraph 4(b) or within 10 days after the insurer’s receipt of the requested documentation or information, which ever occurs later … An insurer that requests documentation or information pertaining to reasonableness of charges or medical necessity under this paragraph without a reasonable basis for such requests as a general business practice is engaging in an unfair trade practice under the insurance code.”

Section 627.736(6)(c), Florida Statutes, further provides that:

“In the event of any dispute regarding an insurer’s right to discovery of facts about an injured person’s … treatment, or the dates and costs of such treatment, the insurer may petition a court of competent jurisdiction to enter an order permitting such discovery. The order may be made only a motion for good cause shown…Such a court may …order payments of costs and expenses of the proceeding, including reasonable fees for the appearance of attorneys at the proceeding, as justice requires”.

To see a recently entered Court order on a petition for discovery click here