12 Fla. L. Weekly Supp. 171a
Insurance — Personal injury protection — Standing — Assignment is valid — Claim form — Countersignature — There was no requirement for insured to countersign HCFA forms where medical provider has accepted assignment of benefits — Coverage — Magnetic resonance imaging — Insurer is not relieved of liability for MRI by fact that amount of bill exceeds fee schedule — Summary judgment is granted in favor of provider on issues of whether insured was involved in automobile accident, has submitted valid notice of claim, and was covered on date of loss by valid policy issued by insurer; whether provider timely billed for MRI; and whether insurer failed to timely pay bill — Peer review report precludes summary judgment on issue of whether MRI was reasonable, related, and necessary
A-1 MOBILE MRI (Stefaine Serrano), Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 03-13672 COCE (49), General Civil Division. October 7, 2004. Kathleen D. Ireland, Judge. Counsel: Robert G. Nichols, Nichols Williams, P.A., Fort Lauderdale, for Plaintiff. Leandro Lissa, Office of the General Counsel, United Automobile Insurance Company, for Defendant.
ORDER REGARDING PLAINTIFF’S MOTION FOR PARTIAL SUMMARY DISPOSITION
THIS CAUSE having come on to be heard on Plaintiff’s Motion for Partial Summary Disposition, and the Court having reviewed the Motion, heard argument of Counsel for the Parties, and being otherwise advised in the Premises, it is hereupon,
ORDERED AND ADJUDGED that, based upon the admissible evidence produced by the Plaintiff, said Motion be, and the same is hereby GRANTED as to each of the following issues:
Issue I. WHETHER THE ASSIGNMENT OF RIGHTS AND BENEFITS ATTACHED TO THE COMPLAINT AS PLAINTIFF’S EXHIBIT A IS LEGALLY VALID?
Holding: The Assignment of Rights and Benefits, which is attached to the Complaint as Plaintiff’s Exhibit A, is legally valid and was provided to the Defendant.
Issue 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?
Holding: There is no requirement under Florida law that a HCFA Form be countersigned by an insured/patient when the medical provider has previously accepted an Assignment of Rights and Benefits from the insured/patient. The Plaintiff in this case had accepted a valid Assignment of Rights and Benefits, and therefore there was no requirement for the patient to countersign the MRI HICF at issue in this case.
Issue III. WHETHER THE AMOUNT OF PIP BENEFITS FOR THE MRI IN THIS CASE ARE PAYABLE ACCORDING TO A PRESET MRI FEE SCHEDULE?
Holding: A PIP insurer is not relieved of liability for a properly submitted MRI simply because the amount of a bill exceeds the amount listed on the applicable MRI Fee Schedule. Instead, the amount of PIP benefits to be paid for an MRI bill is limited by the amount listed on the fee schedule. Thus, in this case, the MRI bill (which was attached to the motion) is payable under the applicable MRI Fee Scheduled at no more than $881.00.
Issue IV. WHETHER THE HCFA BILL CONSTITUTES VALID NOTICE OF A CLAIM ?
Holding: The Court finds that Plaintiff’s MRI HICF at issue was provided to the Defendant in a timely manner and constitutes valid notice of a claim to the Defendant.
Issue V. WHETHER STEPHAINE SERRANO WAS INVOLVED IN AN AUTOMOBILE ACCIDENT ON JUNE 5, 2002?
Holding: Based upon the record evidence, the Court finds that Stephaine Serrano was involved in an auto accident on June 5, 2002.
Issue VI. WHETHER STEPHAINE SERRANO WAS COVERED BY A VALID POLICY OF INSURANCE ISSUED BY DEFENDANT AND IN EFFECT ON THE DATE OF LOSS?
Holding: Based upon the record evidence, the Court finds that Stephaine Serrano was covered by a valid policy of PIP insurance which was issued by the Defendant and was in effect on the date of loss (June 5, 2002).
Issue VIII WHETHER PLAINTIFF TIMELY BILLED THE SERVICES AT ISSUE AND WHETHER DEFENDANT FAILED TO TIMELY PAY THE BILL AT ISSUE?
Holding: Based upon the record evidence, the Court finds that the Plaintiff submitted the MRI bill in this case to the Defendant in a timely manner, and that thereafter, the Defendant did not pay said MRI bill.
The Plaintiff’s Motion for Partial Summary Judgment is DENIED as to Issue VII. The Peer Review Report authored by Dr. Don Morris, D.C., which was filed by Defendant on the date of this hearing, prevents the Court from entering summary judgment on the issue of whether the MRI performed on Stephaine Serrano by Plaintiff on 8/19/02, was reasonable, necessary.
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