USAA
USAA has adopted the (6)(B) request as a means of doing business. USAA generally requests you send them an EMC report pursuant to Florida Statutes Section 627.736(6)(b) prior to receiving the full $10,000.00 under the respective policy. Unfortunately, you have to comply with their request. However, there is a great opportunity to earn more money. USAA will have to pay for the benefits owed to you, for the costs of copying records, sending documents, and for clerical work. Thus, you will receive double payment for your troubles!
Here’s the kicker, USAA is usually sneaky with their (6)(B) language. You may receive a demand response or a letter indicating bills cannot be paid because USAA has not received a particular document. However, you may find small print indicating a request was effectuated pursuant to 627.736(6)(b) somewhere nestled below the reimbursement explanation. If that is the case, you have to comply with what they are requesting. Contact Labovick immediately, do not delay. The more you delay the more you sit around waiting for a check!
STATE FARM
State Farm is more liberal with these requests. State Farm usually asks for supplier invoices for durable medical equipment or medical records to support certain treatments. Unless they specify (6)(B) we recommend you simply send over the requisite information and allow us to demand payment. Without utilizing (6)(B) there is no 10-day waiting period. We can go ahead and get your check ASAP utilizing our innovative tactics. Call us immediately!
PROGRESSIVE/GEICO/OTHER INSURERS
Generally, Progressive utilizes (6)(B) requests in the same manner as does USAA. Other insurers are looking for EMC reports. However, if your office has already added EMC notes into your SOAP Notes/Daily records, YOU absolutely do not need to send anything in addition to those SOAP notes. Progressive may ask for an EMC report, and fail to list (6)(B). Again, the 10-day freeze does not come into play in this situation. (6)(B) language is a must!!!
PROGRESSIVE-LICENSING ISSUES, VERY IMPORTANT
As you may know, the PIP statute was revised in 2012. A new licensing portion of the statute was created. The statute allows chiropractors, MDs, DO’s, etc. to circumvent the ACHA licensing process (Called “Wholly Owned Entities). Other providers, i.e. Physical Therapists, have to comply with ACHA licensing guidelines along with additional licenses. Certain insurers are requesting pre-suit records prior to sending out payment.
PROGRESSIVE:
Progressive is likewise utilizing (6)(B) as a harassing tactic for clinic information pre-suit. They’re asking for the following information:
The clinic director is:
- Who owns the Clinic
- Who shares in the losses/profits
- Who is the authorized bank signor
- Who is mentioned on the lease, etc.
PROGRESSIVE CANNOT DO THIS!!!!!!!!!!!!!!!!!!!! 6(b) discusses the information and facts about an insured patient a PIP insurer is entitled to receive, i.e. a treatment report. Clinic licensing IS NOT contained within the subject matter of (6)(B) and is certainly NOT obtainable by the insurer pre-suit. While they can receive medical notes, THE INSURER CANNOT PERFORM A FISHING EXPEDITION FOR YOUR INTERNAL BUSINESS RECORDS PRE-SUIT.
See 40 Fla. L. Weekly D1447a SHANDS JACKSONVILLE MEDICAL CENTER, INC., v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, (1st DCA, June 22, 2015).
REMEMBER THE BELOW TO PROPERLY RESPOND TO A (6)(B) REQUEST:
- You SHOULD NOT, I repeat, SHOULD NOT, attempt to respond to their request UNTIL you speak to our office.
- You should not attach more than requested.
- Make sure USAA specifically indicates 627.736(6)(b). If they simply state you failed to include something with your bills, they cannot later argue they utilized a (6)(b) request. Thus, you can send the file our way and we can demand/file a suit.
- USAA HAS 10 DAYS to respond to your (6)(b) REQUEST response to consider payment. Meaning10 days from the date they actually receive the documents you provide in response to their request.
- YOU DO NOT need to send additional paperwork if a specific request is nott made.
- We cannot file suit until the (6)(B) process has been completed.
- Do not worry, we have ALL the necessary forms and documents to ensure all costs are covered and benefits are paid appropriately.
WHY YOU SHOULD NOT SEND ANYTHING WITHOUT CALLING US
The insurer may request an EMC report. That same insurer is only citing a $2,500.00 cut-off because they have not received your office’s notes about an EMC. However, you send the insurer additional notes and treatment was rendered for both the accident and a personal condition. Now, the insurer cuts off treatment citing the additional medical records as its basis.
The above situation is absolutely avoidable; please, contact us prior to responding. DO NOT SEND MORE THAN what is required. Moreover, we can weed out what is not needed to sufficiently comply with the insurer’s request.
WHY LABOVICK
Because we value our clients. Our litigation tactics ensure expeditious recovery of monies you are owed! We utilize innovative approaches to answering (6)(B) requests as well as litigating your suits. We offer free audits and we offer free monthly reports. Our reports are highly detailed as we use our own proprietary software to complete them. Do not delay, call our litigation team to ensure maximum monetary recovery!
