12 Fla. L. Weekly Supp. 983a
Insurance — Personal injury protection — Coverage — Denial — Unreasonable, unrelated or unnecessary expenses — Failure to obtain reasonable proof within 30 days — Where insurer’s failure to pay PIP benefits or provide explanation of benefits explaining reason for denial of payment within 30 days of receipt of notice of claim shows insurer did not have reasonable proof to deny payment within 30-day statutory period, insurer is precluded from asserting defense that treatment was not reasonable, related or necessary
MILLER CHIROPRACTIC & MEDICAL CENTERS, INC., (As Assignee of Martine Beaubrun), Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Small Claims Division. Case No. 04-CC-011847-SC, Division I. August 3, 2005. Charlotte W. Anderson, Judge. Counsel: Timothy Patrick, Timothy A. Patrick, P.A., Tampa. Peter Aare.
AMENDED ORDER GRANTING PLAINTIFF’S MOTION FOR FINAL SUMMARY JUDGMENT
THIS CAUSE having come before the Court on July 14, 2005, for hearing on Plaintiff’s Motion for Final Summary Judgment, the court having heard arguments of counsel for both parties, and the Court being otherwise fully advised in the premises, the Court makes the following finds of fact and law, and rules as follows:
1. Plaintiff’s assignor, Martine Beaubrun, was injured in a motor vehicle accident on or about November 21, 2003.
2. As a result of alleged injuries sustained in the accident, Martine Beaubrun incurred medical bills for treatment rendered by the Plaintiff from December 2, 2003 to February 12, 2004. The total amount of the charges was $6,850, eighty percent (80%) of which is $5,480.
3. This action was filed by the Plaintiff to recover the amount of “overdue” Personal Injury Protection (PIP) benefits (i.e., $5,480).
4. On January 4, 2005, the Plaintiff took the deposition of Defendant’s litigation adjuster. The adjuster stated that United Automobile did not pay the PIP benefits within thirty (30) days after receiving the Notices of Claim, nor did it send an explanation of benefits providing the reason that the payment of benefits was denied within thirty (30) days.
5. The failure to pay PIP benefits or provide an explanation why benefits were not paid within thirty (30) days after receiving the Notices of Claim shows that the defendant did not have reasonable proof to deny payment of the bills within the thirty (30) day statutory period.
6. Because the insurer failed to pay PIP benefits for the medical bills submitted, without having a report of a physician licensed under the same chapter as the provider stating that treatment was not necessary, reasonable or related, or other reasonable proof within the thirty (30) day statutory period showing that it was not responsible for the payments, the insurer was precluded from subsequently relying on Florida Statute §627.736(4)(b) and attempting to assert defenses to this action.
7. The Defendant is thus compelled to render payments for the aforementioned medical bills immediately.
8. The Florida Motor vehicle No-Fault law allows insureds to receive medical treatment, while providing insurers with a right of action to pursue recovery of payments for medical bills that were paid within thirty (30) days after receiving the Notices of Claim and for which the insured can subsequently provide reasonable proof that it was not responsible for paying for such medical bills.
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