11 Fla. L. Weekly Supp. 1112b
Insurance — Personal injury protection — MRI — Assignment executed by insured in favor of plaintiff was legally valid and sufficient to confer standing — Florida law does not require patient to countersign legally assigned invoice, bill or health insurance claim form as condition precedent to payment of claim — Bill for MRI is not invalid merely because amount charged exceeds amount of applicable MRI Fee Schedule — MRI was reasonable and necessary diagnostic test which was related to injuries sustained in motor vehicle accident, and bill for MRI was submitted to insurer within 30 days of MRI — Plaintiff’s motion for summary judgment granted
A-1 MOBILE MRI (Edwin Hurtado), Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County, Civil Division. Case No. 03-13705 COCE (56). August 23, 2004. Linda R. Pratt, Judge. Counsel: Robert G. Nichols, Nichols Williams, P.A., Fort Lauderdale, for Plaintiff. Wendy Brewster-Maroun, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FOR SUMMARY DISPOSITION & FINAL JUDGMENT
THIS CAUSE came before this Court upon the Plaintiff’s Motion for Summary Disposition filed on June 9, 2004. The Court finds that the motion was properly noticed, and all parties were present for the hearing on the matter. The Court has carefully considered the motions and pleadings filed by the parties as well as the argument by the attorneys during the hearing.
ISSUES
A-1 Mobile MRI, Inc. (hereinafter “the Plaintiff”) has filed a PIP suit alleging that PIP benefits, based upon an MRI that Plaintiff rendered to the insured/claimant, Edwin Hurtado, (hereinafter, “the insured”) were improperly withheld by United Automobile Insurance Company (hereinafter “the Defendant”). The Plaintiff’s Motion for Summary Disposition presented the following issues for this Court’s determination. Each issue was fully argued by the attorneys during the hearing.
I. WHETHER THE ASSIGNMENT OF RIGHTS AND BENEFITS ATTACHED TO THE COMPLAINT AS PLAINTIFF’S EXHIBIT A IS LEGALLY VALID?
II. WHETHER THE FLORIDA PIP LAW REQUIRES HCFA FORMS TO BE COUNTERSIGNED BY AN INSURED WHEN THE MEDICAL PROVIDER HAS ACCEPTED AN ASSIGNMENT OF RIGHTS AND BENEFITS?
III. WHETHER THE AMOUNT OF PIP BENEFITS FOR THE MRI IN THIS CASE ARE PAYABLE ACCORDING TO A PRESET MRI FEE SCHEDULE?
IV. WHETHER THE HCFA BILL CONSTITUTES VALID NOTICE OF A CLAIM?
V. WHETHER EDWIN HURTADO WAS INVOLVED IN AN AUTOMOBILE ACCIDENT ON MAY 30, 2002?
VI. WHETHER EDWIN HURTADO WAS COVERED BY A VALID POLICY OF INSURANCE ISSUED BY DEFENDANT AND IN EFFECT ON THE DATE OF LOSS?
VII. WHETHER THE MRI PERFORMED ON EDWIN HURTADO BY PLAINTIFF ON OCTOBER 21, 2002, WAS REASONABLE, NECESSARY AND RELATED TO THE AUTOMOBILE ACCIDENT OF MAY 30, 2002?
VIII. WHETHER PLAINTIFF TIMELY BILLED THE SERVICES AT ISSUE AND WHETHER DEFENDANT FAILED TO TIMELY PAY THE BILL AT ISSUE?
The Plaintiff attached the following exhibits to said motion:
Exhibit A: Affidavit of Angel Soto (with attached Exhibits);
Exhibit B: Affidavit of Edwin Hurtado (with attached Exhibits);
Exhibit C: Affidavit of Dr. Kam Habibi (with attached Exhibits);
Exhibit D: Partial Deposition of United Auto Adjuster Mary Vojtasek; and,
Exhibit E: Plaintiff’s Interrogatories and Defendant’s Sworn Responses.
Also filed in the Court file were the following:
(1) Deposition of the insured, Edwin Hurtado; and,
(2) Affidavit of Robert Deluca, Custodian of Records for Active Spine Center.
RULINGS
Based upon the unrefuted record evidence, the Court makes the following rulings:
Issue I: WHETHER THE ASSIGNMENT OF RIGHT SAND BENEFITS IS LEGALLY VALID?
The Assignment of Rights and Benefits executed by the insured in favor of the Plaintiff (which is attached to the complaint) was legally valid and was provided to the Defendant in a timely manner. The assignment is sufficient to confer Plaintiff with standing in this action.
Issue II: WHETHER THE FLORIDA PIP LAW REQUIRESHCFA FORMS TO BE COUNTERSIGNED BY AN INSURED WHENTHE MEDICAL PROVIDER HAS ALREADY ACCEPTEDAN ASSIGNMENT OF RIGHTS AND BENEFITS?
Florida law does not require the patient to countersign a legally assigned invoice, bill or health insurance claim form as a condition precedent to the insurer paying the claim. In this case, the patient executed a valid assignment of benefits.
III: WHETHER THE AMOUNT OF PIP BENEFITS FOR THEMRI IN THIS CASE ARE PAYABLE ACCORDING TOA PRESET MRI FEE SCHEDULE?
F.S. 627.736(5)(b)(5) does not invalidate an MRI bill simply because the amount charged exceeds the amount of the applicable MRI Fee Schedule. Instead, the payment of PIP benefits for an MRI bill is limited to the amount of the MRI Fee Schedule. In this case, the MRI billed was CPT 72148 TC (as per the HICF attached to the Affidavit of Angel Soto, Exhibit A)which was performed in Dade County, Florida. Under the applicable MRI fee scheduled, the MRI was payable at: $976.00. Thus, the amount payable in this case is 80% of $976.00: $780.00.
IV: WHETHER THE HCFA (ATTACHED TO EXH. A)CONSTITUTES VALID NOTICE OF A CLAIM?
The Plaintiff’s HICF at issue in this case (which is attached to Exhibit A of the Plaintiff’s Motion) constitutes valid notice of a covered loss under F.S. 627.736.
ISSUE V. WHETHER THE INSURED, EDWIN HURTADO,WAS INVOLVED IN AN AUTOMOBILE ACCIDENTON FEBRUARY 1, 2002?
The unrefuted record evidence indicates that the insured, Edwin Hurtado, was involved in a motor vehicle accident on February 1, 2002, which is the subject of this suit.
ISSUE VI. WHETHER THE INSURED, EDWIN HURTADO,WAS COVERED BY A VALID POLICY OF INSURANCE ISSUEDBY DEFENDANT AND IN EFFECT ON THE DATE OF LOSS?
The unrefuted record evidence indicates that the insured, Edwin Hurtado, was covered by a policy of insurance, issued by the Defendant, which included PIP coverage for the subject injuries, at the time that the insured was involved in the motor vehicle accident on February 1, 2002, which is the subject of this suit.
ISSUE VII. WHETHER THE MRI PERFORMED ON THEINSURED, EDWIN HURTADO, BY PLAINTIFF ON APRIL 12, 2002,WAS REASONABLE, NECESSARY AND RELATED TO THEAUTOMOBILE ACCIDENT OF FEBRUARY 1, 2002?
The unrefuted record evidence that would be admissible at trial indicates that the subject MRI that was rendered to the insured on April 12, 2002 was a reasonable and necessary diagnostic test that was found to be related to the injuries sustained in the insured’s motor vehicle accident of February 1, 2002, which is the subject of this lawsuit. The Defendant would be unable to present any admissible evidence to dispute the Plaintiff’s evidence. Moreover, the Court finds no relevant conflict between the expert testimony presented by the Plaintiff (i.e., the Affidavit and Deposition of Dr. Kam Habibi) and any of the other record evidence. Therefore, the Court finds that because there is no admissible evidence to rebut the Plaintiff’s evidence, there is no issue to be presented to a jury regarding whether the subject MRI was reasonable, related and necessary, and summary disposition is therefore granted as to this issue.
ISSUE VIII. WHETHER PLAINTIFF TIMELY BILLED THE SERVICES AT ISSUE AND WHETHER DEFENDANT FAILED TO TIMELY PAY THE BILL AT ISSUE?
The unrefuted record evidence in this case indicates that the bill for the MRI in this case was submitted to the Defendant within 30 days of the date of the MRI, and that the Defendant has failed to make any payment of PIP benefits in response to said bill. The MRI bill was therefore submitted in a timely fashion.
There are no other issues to be resolved by the trier of fact in this case.
THEREFORE, it is ORDERED AND ADJUDGED that the Court hereby GRANTS the Plaintiff’s Motion for Summary Disposition, and enters final judgment for the Plaintiff in the amount of $780.00. The Court further retains jurisdiction regarding the issue of reasonable attorneys fees and costs for the Plaintiff. Defendant shall take nothing and go hence without day.
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