12 Fla. L. Weekly Supp. 1171b
Insurance — Personal injury protection — Coverage — Medical expenses — Usual and customary charges — Fact that policy gives insurer the choice of independent sources to determine usual and customary charges does not preclude medical provider from disputing that source’s finding of what is usual and customary charge for services in geographic area — Insurer’s motion for summary judgment is denied where there is disputed issue of material fact as to reasonableness of provider’s charge, and it cannot be determined on summary disposition whether database accurately assesses reasonableness of charges
NORTHEAST FLORIDA NEUROLOGY CLINICS, INC., (as assignee of Lisa Walker), Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2003-SC-1129, Division CC-J. September 19, 2005. Eleni E. Derke, Judge. Counsel: Patrick J. Snyder, Jacksonville. David G. Candelaria, Farah & Farah, P.A., Jacksonville.
ORDER ON DEFENDANT’S MOTION FOR PARTIAL SUMMARY DISPOSITION
THIS CAUSE coming before the Court sub judice on “Defendant’s Motions for Partial Summary Disposition,” and after considering argument of counsel, Progressive’s Insurance Policy and relevant Florida Law, it is hereby
DONE AND ORDERED:
1. Defendant’s Motions for Partial Summary Judgment are denied because “reasonableness” is an imputed requirement in every contract. Simply because the language of the policy gives the Defendant the choice of independent sources, the policy does not preclude a service provider from disputing that source’s finding of what a “usual and customary” charge for services in the geographic area is. In fact, the insurance policy contemplates such a dispute in that it states “any dispute as to the usual and customary charge will be resolved between the service provider and us,” and this Court is providing the forum for that dispute. Therefore, there still being a genuine issue of material fact as to the reasonableness of Plaintiff’s medical charge, and since it cannot be determined on Summary Disposition whether the Mitchell Medical Decision Point Database accurately assesses the reasonableness of the Plaintiff’s Charges.
[Editor’s note: original slip did not contain a paragraph numbered 2.]
3. Defendant’s Motions for Summary Judgment are hereby DENIED.
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