12 Fla. L. Weekly Supp. 375a
Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Where insurer failed to establish it had reasonable proof it was not responsible for payment of medical bills within 30 days of receipt and has failed to establish that charges were not reasonable, related and necessary or that medical providers did not comply with any conditions precedent, summary judgment is granted as to all medical expenses except $450 waived by provider upon court’s finding that peer review raises genuine issue of material fact regarding those expenses
ASCLEPIUS MEDICAL, INC. and FINLAY DIAGNOSTIC CENTER, INC., a/a/o Susana Faure, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami Dade County. Case No. 04-228 CC 25(1). January 18, 2005. Mark King Leban, Judge. Counsel: Kevin W. Whitehead, Downs, Brill, Whitehead, P.A., Coral Gables. Sebastian M. Lissa.
ORDER and FINAL JUDGMENT
THIS CAUSE having come to be heard on Plaintiff’s, ASCLEPIUS MEDICAL, INC. and FINLAY DIAGNOSTIC CENTER, INC., a/a/o Susana Faure’s, Motion for Summary Judgment, after due notice to all parties, the Court having heard argument of counsel on December 29th, 2004, and having been otherwise fully advised in the premises, it is,
ORDERED AND ADJUDGED:
1. The Plaintiff’s Motion for Summary Judgment is GRANTED. After reviewing the court file, including deposition transcripts, pleadings, and filed affidavits, and hearing argument of counsel, there does not appear to exist any genuine issues of material facts, thereby entitling the Plaintiff to Final Summary Judgment as a matter of law.
2. The Plaintiffs sued the Defendant for medical expenses in the following amounts: Asclepius Medical, Inc., d/o/s April 29, 2003 through August 20, 2003 in the amount of $8,700.00 and Finlay Diagnostic Center, Inc., d/o/s April 30, 2003 in the amount of $450.00.
3. The Plaintiff’s Motion for Summary Judgment is GRANTED on all issues, including the Defendant’s affirmative defenses except for $450.00 in medical expenses incurred by Asclepius Medical, Inc. This Court considers the Peer Review filed in opposition to the Plaintiff’s Motion for Summary Judgment over the Plaintiff’s objection, and finds that there exists a genuine issue of material fact regarding $450.00 in medical expenses. The Plaintiff has agreed to waive these charges for purposes of submitting a final judgment which will not include these charges.
4. Pursuant to the policy of insurance and Florida Statutes §627.736(1)(a), the Defendant is responsible for payment of 80% of the related, reasonable and medically necessary bills incurred by Asclepius Medical, Inc. and Finlay Diagnostic Center, Inc. as a result of the subject accident.
5. Further, pursuant to §627.736(4)(b) and (c), the Defendant has thirty (30) days to establish reasonable proof it is not responsible for payment of the medical bills, otherwise the medical bills are overdue if not paid within thirty (30) days from receipt, plus 10% interest.
6. In order for the insurer to suspend PIP medical benefits, it must comply with §627.736(7). If the insurer fails to obtain a report for a physician in the same licensing chapter as the treating physician, it cannot suspend benefits pursuant to Florida Statutes § 627.736(7).
7. The Defendant failed to establish it had reasonable proof it was not responsible for payment of the subject medical bills received by the Defendant within thirty (30) days pursuant to Florida Statutes § 627.736(4)(b), and failed to obtain a report from a physician in the same licensing chapter as one of the treating physicians stating no further treatment was medically necessary as required by § 627.736(7).
8. All outstanding medical bills except for $450.00 remain due and owing plus 10% interest from 30 days after receipt of each bill up to and including the present date.
9. The Defendant failed to establish that these charges are not reasonable, related or necessary or the Plaintiffs have not complied with any conditions precedent.
10. Because there does not exist any questions of material fact regarding the related, reasonable and necessary medical expenses incurred by the Plaintiffs for these dates of service, and the Defendant’s failure to pay the Plaintiffs’ medical bills at full 80% pursuant to the terms of the policy and § 627.736, this Court must grant the Plaintiff’s Motion for Summary Judgment for these medical expenses.
11. This Court finds that the Plaintiffs are entitled to attorney’s fees and costs pursuant to §§ 627.736 and 627.428 as the prevailing party, and reserves jurisdiction to enter a Final Judgment on attorney’s fees and costs accordingly.
12. Wherefore, this Court orders that the Plaintiff, ASCLEPIUS MEDICAL, INC., hereby recover from the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, 3909 N.E. 163rd Street, North Miami Beach, FL 33160, the principal sum of FOUR THOUSAND SIX HUNDRED DOLLARS ($4,600.00) plus interest in the amount of FOUR HUNDRED FIFTY EIGHT DOLLARS AND EIGHT CENTS ($458.08), for a total amount of FIVE THOUSAND FIFTY EIGHT DOLLARS AND EIGHT CENTS ($5,058.08), for which let execution issue. This judgment shall bear interest at the rate of 7% per year from date of entry until satisfied. The draft shall be made payable to ASCLEPIUS MEDICAL, INC. and delivered to Kevin W. Whitehead, Esq. at 255 University Drive, Coral Gables, FL 33134.
13. Wherefore, this Court orders that the Plaintiff, FINLAY DIAGNOSTIC CENTER, INC., hereby recover from the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, 3909 N.E. 163rd Street, North Miami Beach, FL 33160, the principal sum of THREE HUNDRED SIXTY DOLLARS ($360.00) plus interest in the amount of THIRTY FIVE DOLLARS AND EIGHTY TWO CENTS ($35.82), for a total amount of THREE HUNDRED NINETY FIVE DOLLARS AND EIGHTY TWO CENTS ($395.82), for which let execution issue. This judgment shall bear interest at the rate of 7% per year from date of entry until satisfied. The draft shall be made payable to FINLAY DIAGNOSTIC CENTER, INC. and delivered to Kevin W. Whitehead, Esq. at 255 University Drive, Coral Gables, FL 33134.
14. This Court reserves jurisdiction to award attorney’s fees and costs in favor of the Plaintiffs, and enter a Final Judgment for Attorney’s Fees and Costs accordingly.
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