10 Fla. L. Weekly Supp. 790a
Insurance — Personal injury protection — Whether agreement between medical provider and entity which performed MRI continues to be illegal fee-splitting as previously found in district court case was not proper defense to insured’s claim against insurer for cost of MRI where insured had nothing to do with allegedly illegal contract, and medical provider and entity that performed MRI were not brought into action as third-party defendants — Summary judgment in favor of insured is affirmed in light of insurer’s agreement that amount sought by insured was reasonable charge for medically necessary MRI
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant, vs. DIANA L. BARCUS, Appellee. Circuit Court, 18th Judicial Circuit (Appellate) in and for Seminole County. Case No. 02-37. L.T. Case No. 00-CC-2529-20. August 22, 2003. Appeal from County Court, Seminole County, Honorable Donald L. Marblestone. Counsel: Robert A. Kingsford, Maitland, for Appellant. Charles J. Kane, Boca Raton; and Steven L. Barcus, Altamonte Springs, for Appellee.
[County court order at 9 Fla. L. Weekly Supp. 414a.]
(ALLEY, J.) Appellant, State Farm Mutual Automobile Insurance Company asks this Court to reverse the lower court’s summary judgment in favor of Appellee, Diana L. Barcus. Because of the posture of this case, the Court finds that summary judgment on behalf of Barcus was appropriate and the lower court’s decision is affirmed.
After Barcus was involved in an automobile accident in late 1998, she had an MRI performed at the direction of her referring physician at Medical Management Group of Orlando, Inc. (hereinafter “MMGO”). At the time MMGO had an agreement with Premier Advanced Imaging (hereinafter “Premier”) whereby Premier conducted Barcus’ MRI.1 MMGO then billed State Farm $1250 for the procedure. State Farm agreed that the MRI was medically necessary and that the amount billed was reasonable. However, State Farm refused to pay for the MRI because it claimed that the agreement MMGO had with Premier was an illegal fee splitting scheme under Fla. Stat. § 817.505 (2002)2 and Federated National Insurance Co. v. Physicians Charter Services, 788 So.2d 403 (Fla. 3d DCA 2001). State Farm further argues that the fees were not for a lawfully rendered medical service under Fla. Stat. § 627.736 (2002). Additionally, State Farm relied on Medical Management Group of Orlando, Inc. v. State Farm Mutual Automobile Insurance Company, 811 So.2d 705 (Fla. 5th DCA 2002), in which the Fifth District Court of Appeal found that State Farm did not have to pay for an MRI billed by MMGO because MMGO did not provide “medically necessary medical . . . services” pursuant to Fla. Stat. § 627.736(1)(a).
Whether MMGO’s agreement with Premier continues to be illegal and enforceable, as it was in the case before the Fifth District Court of Appeal, was not a proper defense to Barcus’ claim for payment because she had nothing to do with the contract State Farm was alleging was illegal. Had State Farm wanted to plead this issue, it should have added MMGO and Premier as third-party defendants so that MMGO could raise possible defenses to the claim of illegality and Premier could have asserted any claims it may have for its portion of the bill. Because these two parties were never brought into this action nor was their contractual agreement ever submitted to the lower court for consideration, the trial court had no jurisdiction to determine the nature of their relationship and whether it was illegal under Florida law. Consequently, this Court cannot assess these issues either.
With the posture of the case as it is, the trial court had no choice but to enter summary judgment in favor of Barcus because State Farm agreed that the $1250 was a reasonable charge for a medically necessary MRl. See Fla. Stat. 627.736 (2002). Accordingly, the lower court’s order granting summary judgment to Appellee Barcus is AFFIRMED.
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1As noted below neither the trial court nor this Court can be entirely sure that this was the relationship between MMGO and Premier at the time Barcus’ MRI was performed. The only record evidence of the relationship between MMGO and Premier was from assertions made by the attorneys involved in this case and by State Farm employees in depositions.
2Appellee notes in the Answer Brief that the amendment to Fla. Stat. § 627.736(5)(b)1 which sets forth that an insurance company does not have to pay a “broker” for services rendered to an insured was not enacted until after MMGO performed the MRI for Barcus. However, this statute is only one of several under which State Farm claims it does not have to pay the claim. Additionally, whether State Farm’s claim that MMGO violated these statutes was not considered by this Court in reaching this decision.
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