What is a 6B request?
Insurance companies are always looking for loopholes to deny payment for medically necessary medical treatment. Florida Statutes Section 627.376 (6)(b) is a loophole that was created by the Florida Legislature.
A (6)(b) request allows the defendant to ask for documentation and information regarding the history, condition, treatment and cost of treatment of the services provided by the medical provider to the patient/claimant.
The (6)(b) section is an investigatory tool for the insurer. The insurer is permitted to request additional documentation to make a decision as to whether or not payment should be made on a claim. The medical provider must send the requested documentation so long as the inquiry is reasonable/valid. The Florida county and small claims courts have been liberal in their approach to (6)(B) requests. So long as the request can lead to some form of admissible evidence in a PIP suit, the request will most likely be granted by our Honorable Judges in Florida.
Why is this request important for medical providers?
The (6)(b) request will stop the “clock” on a PIP lawsuit until 10 days after the insurance company or their attorney(s) have received the documentation and information requested. An insurer must make the request within 30 days of receiving “notice of the amount of a covered loss.” A demand letter will suffice as notice of the amount of a covered loss. If the insurer does receive the requested information and fails to pay, the lawsuit is ripe for filing!
However, a (6)(b) request can either make or break a case. If you, as the medical provider, fail to produce the requested documentation to the insurer, the lawsuit is considered premature. A premature lawsuit is no lawsuit at all. The judge on your suit will dismiss your case due to your failure to provide the requested documentation/information. Examples of documents/information include patient ledgers, suppliers’ invoices, medical records, copies of medical licenses, etc. These document/informational requests have been held valid by our judges in Florida.
It is extremely important to discuss the informational request received in a response to the demand letter, or a request in an Explanation of Review, with your attorney. If you are not represented, you absolutely would be exercising due diligence by contacting an experienced PIP litigation attorney. Certain wording may need to be redacted prior to sending the documents to the insurance company. Moreover, the document requested may not be the actual document that you have to necessarily provide.