GEICO insurance office. Photo: Jonathan Weiss/Shutterstock.com.

A dispute over insurance coverage for post-car crash physical therapy is playing out in Miami-Dade Circuit Court, where a medical center has accused Maryland-based Geico General Insurance Co. of systematically refusing to cover legitimate personal injury protection claims.

Miami Greenberg Traurig attorney Stephanie Peral represents plaintiff Florida Spine and Joint Institute in Coral Springs, which says it was stonewalled after patients assigned their policy benefits to the center, which sought reimbursement for PIP benefits.

Florida's PIP statute, also known as "no-fault car insurance," provides coverage to all drivers injured in a crash, regardless of who was to blame.

But the no-fault system is on shaky ground. The Florida House of Representatives is poised to vote on a proposal, HB 771, which seeks a repeal over allegations that increased fraud has caused insurance rates to rise.

Related story: No-Fault Auto Insurance Repeal on Road to Florida House Floor

The plaintiff alleges Geico used its denial letters as a negotiating tactic, aimed at lowering costs or avoiding the claims outright. The insurer is accused of defaming Florida Spine and Joint Institute by writing to its patients to say it suspected the center had fraudulently billed them, without providing any evidence.

"Geico has a reasonable belief that a fraudulent insurance act under Sections 626.989 or 817.234, Fla. Stat., has been committed with respect to the claim," one of the letters read. "Geico is therefore investigating the claim for suspected fraud. Accordingly, no payment will be issued on the claim at this time pursuant to Section 627.736(4)(i), Fla. Stat."

The complaint says Geico gave multiple unsubstantiated reasons for denying coverage, including allegations that the center had charged too much, that its medical directors weren't properly fulfilling their duties or that the company's billing time codes didn't match its hours of operation.

According to the lawsuit, Geico did offer to pay the claims if the medical center waived any interest.

Geico did not immediately respond to a request for comment.

CEO of Florida Spine and Joint Institute Ryan Fulcher said his company "will not allow Geico to interfere with important and necessary medical care" for its patients.

"We hope this lawsuit will quickly result in Geico finally providing its policyholders with the insurance benefits they were promised," Fulcher said in an email.

The complaint accuses the defendant of tortious interference and defamation, and seeks a declaratory judgment forcing Geico to pay for the denied claims.

Miami-Dade Circuit Judge William Thomas will preside over the case.

Read the complaint:

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