12 Fla. L. Weekly Supp. 589a
Insurance — Personal injury protection — Coverage — Medical expenses — Summary judgment is granted as to issues of insured’s involvement in accident and coverage by valid policy where medical provider provided record evidence meeting its burden of proof, and insurer failed to come come forward with contrary evidence — Ruling is reserved on issue of whether MRI was reasonable, necessary and related until after hearing to determine why two peer review reports are materially different — By agreement of parties, summary judgment is granted on issues of timeliness of billing and insurer’s payment and whether denial of benefits was properly based on alleged failure to give timely notice of accident
ROBERT L. KAGAN, M.D., P.A. (Claude Youte), Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 04-249 COCE (49). March 15, 2005. Kathleen Ireland, Judge. Counsel: Robert G. Nichols, Nichols Williams, P.A., Fort Lauderdale, for Plaintiff. Yvette Blackwell, for Defendant.
ORDER RE: PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGEMENT
THIS CAUSE, coming on to be heard upon the Plaintiff’s Motion for Partial Summary Judgment, and the Court having read the relevant pleadings, and having heard argument from counsel for the parties during a hearing on the matter, it is, therefore,
ORDERED AND ADJUDGED that the Plaintiff’s Motion for Partial Summary Judgment is granted as follows:
ISSUE I: WHETHER CLAUDE YOUTE WAS INVOLVED IN AN AUTO ACCIDENT ON 12/18/01?
RULING: The Plaintiff provided record evidence that the claimant, Claude Youte, was involved in an automobile accident on 12/18/01. Therefore, Plaintiff has met its burden of proof, but the Defendant has failed to come forward with any contrary evidence to dispute whether there was an accident on 12/18/01. The Court therefore grants summary judgment as to Issue I.
ISSUE II: WHETHER CLAUDE YOUTE WAS COVERED BY A VALID POLICY OF INSURANCE ISSUED BY DEFENDANT AND IN EFFECT ON THE DATE OF LOSS?
RULING: The Plaintiff provided record evidence that the claimant, Claude Youte, was covered by a valid policy of insurance issued by the Defendant, United Auto Insurance Company, on the date of the accident. Therefore, Plaintiff has met its burden of proof, but the Defendant has failed to come forward with any contrary evidence to dispute whether there was such a policy in place on the date of the accident. The Court therefore grants summary judgment as to Issue II.
ISSUE III: WHETHER THE MRI PERFORMED ON CLAUDE YOUTE BY PLAINTIFF ON 5/7/02, WAS REASONABLE, NECESSARY AND RELATED TO THE AUTOMOBILE ACCIDENT OF 12/18/01?
RULING: The Court reserves ruling on this issue until after an evidentiary hearing to determine why the 7/1/04 Peer Review Report of Dr. Glen Siegel, D.C., who was retained by United Auto Insurance Company to evaluate the MRI in this case, was materially different than Dr. Siegel’s same Peer Review Report issued on 3/2/05.
ISSUE IV: WHETHER PLAINTIFF TIMELY BILLED THE SERVICES AT ISSUE AND WHETHER DEFENDANT FAILED TO TIMELY PAY THE BILL AT ISSUE?
RULING: Per the agreement of the parties, summary judgment is granted as to Issue IV.
ISSUE V: WHETHER THE DENIAL OF BENEFITS WAS PROPERLY BASED ON AN ALLEGATION THAT THE INSURED HAD NOT PROVIDED TIMELY NOTICE OF THE ACCIDENT AT ISSUE?
RULING: Per the agreement of the parties, summary judgment is granted as to Issue V.
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