12 Fla. L. Weekly Supp. 95a
Insurance — Personal injury protection — Coverage — Unreasonable, unrelated or unnecessary medical expenses — Peer review conducted years after disputed bills were received by insurer will not be considered in opposition to medical provider’s motion for summary judgment on reasonableness, relatedness, and necessity of services where insurer did not comply with condition precedent to procure valid physician’s report before withdrawing payment of benefits — Motion for summary judgment granted
PABLO MURSULI, MD a/a/o THELMA OROZCO, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 02-8195 CC 26. September 30, 2004. Cristina Pereyra-Shuminer, Judge. Counsel: Jose R. Iglesia, Jose R. Iglesia, P.A., Coral Gables. David Millheiser.
ORDER GRANTING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT ON REASONABLENESS, RELATION AND MEDICAL NECESSITY OF MEDICAL BILLS
THIS CAUSE having come to be heard on September 21, 2004, upon the PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT ON THE REASONABLENESS, RELATION AND MEDICAL NECESSITY OF MEDICAL BILLS, and the Court being fully advised in the premises, the Court finds that:
1. The Plaintiff filed a motion for summary judgment on the reasonableness, relation and medical necessity of the medical bills on May 3, 2004.
2. The Plaintiff filed its supporting affidavit of the treating physician on May 7, 2004.
3. The Defendant filed a peer review in opposition of the Plaintiff’s Motion for Summary Judgment on July 1, 2004.
4. The record indicates that the peer review was conducted on May 15, 2004, clearly years after the bills became due and owing. (The record indicates that the medical bills were received by United Automobile Insurance Company between May 26, 2002 and July 6, 2002.)
5. Section 627.736 requires the insurer of a motor vehicle to take some affirmative action to establish that it is not responsible for payment of medical bills within thirty (30) days of receiving notice of the fact of an accident and receipt of any medical bill. See Palmer v. Fortune Ins. Co., 776 So. 2d 1019, 1021 (Fla. 5th DCA 2001).
6. In the case of United Automobile Insurance Company v. Viles, 726 So.2d 320 (Fla. 3d DCA 1998), the Third District Court of Appeals ruled that it was a condition precedent pursuant to Section 627.736(7)(a) that an insurer first obtain a physician’s report in order for an insurance company to defend a suit for reduction, withdrawal, or denial of payments on the grounds of reasonableness, necessity, or relationship. The Court stated that there is a requirement in F.S. 637.736(7)(a) to procure a valid physicians report before an insurer can withdraw payment.
7. It is clear by the recent case of United Automobile Insurance Company v. Professional Medical Group a/a/o Sol Angel Hurtado, Case No. 03-085 AP, (11th Circ. Dade County, Florida, August 3, 2004) [11 Fla. L. Weekly Supp. 877a], that the 11th Circuit is adhering to the view stated in Viles, that under Florida Statute 627.736(7)(a) a medical report stating that the treatment was not reasonable, related or necessary is a condition precedent to withdrawing payment of PIP benefits.”
8. Thus, the peer review filed by the Defendant will not be considered by this court.
Based on the aforementioned reasons, it is HEREBY ORDERED AND ADJUDGED that:
That Plaintiff’s Motion for Summary Judgment on the Reasonableness, Relation and Medical Necessity is hereby granted.
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