11 Fla. L. Weekly Supp. 936b
Insurance — Personal injury protection — Standing — Assignment is valid and enforceable — Claim form — Countersignature — Insured is not required to countersign HCFA forms as condition precedent to insurer paying PIP benefits — Magnetic resonance imaging — Amount billed for MRI in excess of preset fee schedule does not relieve insurer from paying reimbursable amount — HCFA bill is valid notice of claim — Provider is entitled to summary disposition on issue of whether insured was involved in automobile accident where insured’s affidavit states he was involved in accident, and insurer has presented no evidence to reveal genuine issue of fact — Application — Misrepresentation — Materiality — No merit to claim that insured committed material misrepresentation where insurer has presented no evidence that additional premium would have been applicable to insured
A-1 MOBILE MRI, INC., (Michael Emekekwue), Plaintiff(s), vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant(s). County Court, 17th Judicial Circuit in and for Broward County. Case No. 03-13697 COCE (56). May 7, 2004. Linda R. Pratt, Judge. Counsel: Amir Fleischer. Julie Terry.
Affirmed with respect to two issues raised on appeal.
ORDER GRANTING PLAINTIFF’S MOTION FOR SUMMARY DISPOSITION
THIS CAUSE having come on to be heard before me on Plaintiff’s Motion for Summary Disposition under Fla. Sm. Cl. R. 7.135, and the Court having heard the argument of counsel and being otherwise fully advised in the premises, it is:
ORDERED AND ADJUDGED that said Motion for Summary Disposition and the same is hereby GRANTED in part. The pleadings on file and record evidence submitted herewith demonstrates conclusively that no genuine issue of material fact exists as to the following issues in this lawsuit:
I. WHETHER THE ASSIGNMENT OF RIGHTS AND BENEFITS ATTACHED TO THE COMPLAINT AS PLAINTIFF’S EXHIBIT A IS LEGALLY VALID.
The court finds the assignment to be valid and enforceable, as supported by affidavits of the claimant, Michael Emekekwue and Plaintiff’s corporate representative, Angel Soto. Therefore, no triable issue of fact remains as to the validity of said Assignment.
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.
The court finds as a matter of law that Fla. Stat. 627.736(5)(a) does not require an insured to countersign a HCFA form as a condition precedent to an insurance company paying PIP benefits. Therefore, no triable issue of fact exists and Plaintiff is entitled to summary disposition.
III. WHETHER THE AMOUNT OF PIP BENEFITS FOR THE MRI ARE PAYABLE ACCORDING TO A PRESET MRI FEE SCHEDULE.
The court finds as a matter of law that any amount billed in excess of the preset fee schedule does not relieve an insurer from paying the reimbursable amount. The court holds that this is not a valid defense and Plaintiff is entitled to summary disposition on this issue. The reimbursable fee schedule amount is not an issue for jury determination and is not an issue for trial. The court shall determine any reimbursable amount due to Plaintiff.
IV. WHETHER THE HCFA BILL CONSTITUTES VALID NOTICE OF A CLAIM.
The court finds as a matter of law that the HCFA bill submitted by Plaintiff, A-1 MOBILE MRI, INC. constitutes a valid notice of a claim. Defendant has presented no evidence to reveal a genuine issue of fact as to this issue. Plaintiff is entitled to summary disposition.
V. WHETHER CLAIMANT MICHAEL EMEKEKWUE WAS INVOLVED IN AN AUTOMOBILE ACCIDENT ON APRIL 9, 2002.
The court finds that no genuine issue of fact exists as to this issue. Plaintiff presented Mr. Emekekwue’s affidavit wherein he states he was involved in an automobile accident on April 9, 2002. Defendant has presented no evidence to refute the fact that claimant was involved in said accident. Plaintiff is entitled to summary disposition.
VI. WHETHER MICHAEL EMEKEKWUE WAS COVERED BY A VALID POLICY OF INSURANCE ISSUE BY DEFENDANT WHICH WAS IN FULL FORCE AND EFFECT AT THE TIME OF THE LOSS.
The court finds that no genuine, material issue of fact exists as to this issue. The court finds no merit in Defendant’s contention that Mr. Emekekwue committed a material misrepresentation at policy inception. A misrepresentation is only material if it creates an additional premium. Defendant has presented no record evidence or law that an additional premium would or could be applicable to Mr. Emekekwue. Plaintiff is entitled to summary disposition.
IT IS ADJUDGED that the only triable issue is whether the medical treatment rendered by A-1 MOBILE MRI, INC. to Michael Emekekwue was medically necessary and related to the motor vehicle accident of April 9, 2002.
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