12 Fla. L. Weekly Supp. 271a
Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary expenses — Where both accident and treatment occurred during September 2001, policy on which claim is based could not have been classified as new or renewed on or after October 1, 2002 — Accordingly, court must examine verdict finding that motion x-ray was necessary relative to requirements for reimbursement of medical expenses prior to 2001 amendment that replaced common law standard of whether procedure was “reasonably necessary” with higher standard that procedure be “medically necessary” — Where fact finder determined that medical provider met burden on higher standard of “medically necessary,” appellate court can affirm verdict in light of correct lower standard of “reasonably necessary” as long as it too is supported by competent substantial evidence
STATE FARM MUTUAL AUTOMOBILE CO., Appellant, vs. DR. J. MARK RENFROE, D.C., d/b/a RENFROE SPINAL CENTER, Appellee. Circuit Court, 1st Judicial Circuit (Appellate) in and for Escambia County. Case No. 2003 AP 000064. L.C. Case No. 02-0193-SC, Division J. November 30, 2004. On appeal from County Court in and for Escambia County, Thomas E. Johnson, Judge. Counsel: Charles F. Beall, Jr., Pensacola, for Appellant. Eric Stevenson and David Lee Sellers, Pensacola, for Appellee.
QUASHED. 30 Fla. L. Weekly D2497a
ORDER AFFIRMING THE DECISION OF THE LOWER COURT AND GRANTING APPELLEE’S MOTION FOR ATTORNEY’S FEES
(Michael Jones, Judge.) THIS CAUSE is before the Court on the Appellant’s notice of appeal. After full consideration of the Appellant’s initial brief, the Appellee’s answer brief, both parties motions for attorney’s fees, the record of the proceedings below, all relevant case law, and the issues presented at oral argument, the trial court’s judgment is AFFIRMED and the Appellee’s Motion for Attorney’s Fees (filed November 3, 2003) is GRANTED.
FACTS AND PROCEDURAL HISTORY
On September 7, 2001, William Word was involved in a motor vehicle accident. As a result of injuries suffered during that accident, Word enlisted the services of the Plaintiff/Appellee Dr. Renfroe, a chiropractor. On September 17, 2001, Dr. Renfroe performed a “motion X-ray” procedure on Word to help determine the extent of his injuries, but Word’s insurance company, Defendant/Appellant State Farm refused to pay for this procedure, arguing that it was unnecessary.
Word assigned his rights to reimbursement under his policy with State Farm to Dr. Renfroe, who then brought the instant lawsuit. The jury in the lower proceedings was asked to determine whether the procedure fit the definition of “Medically Necessary” found in Fla. Stat. §627.732(2) (2001). Finding that it did, the jury returned a verdict in favor of Dr. Renfroe.
ANALYSIS
On appeal, both parties have submitted well-written briefs regarding the procedure and how it relates to the definition of “Medically Necessary” found in Fla. Stat. §627.732(2) (2001). That statute reads:
“Medically necessary” refers to a medical service or supply that a prudent physician would provide for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptom in a manner that is:
(a) In accordance with generally accepted standards of medical practice;
(b) Clinically appropriate in terms of type, frequency, extent, site, and duration; and
(c) Not primarily for the convenience of the patient, physician, or other health care provider.
The briefs of the parties were primarily concerned with arguing whether the procedure was “in accordance with the generally accepted standards of medical practice” as required by the statute. However, the 2001 amendment to Fla. Stat. §627.736(1)(a), which adopted the “medically necessary” definition, took effect October 1, 2001 — and only for “policies issued new or renewed on or after” that date. 2001 Fla. Laws ch. 271 (emphasis added). Since both the accident and treatment occurred during September of 2001, the policy on which this claim is based could not have been classified as “new or renewed on or after October 1, 2001.” Therefore, the Court must examine the verdict relative to the requirements for reimbursement of medical expenses prior to the 2001 amendment.
The legislation which predated the 2001 amendment obligated insurance companies to pay for “necessary” medical treatment. Fla. Stat. §627.736(1)(a) (2000). Prior to the legislature defining “medically necessary,” the applicable common law standard was whether the procedure was “reasonably necessary.” Derius v. Allstate Idem. Co., 723 So.2d 271 (Fla. 4th DCA 1998) is the leading case on the “reasonably necessary” standard. It provides:
Whether a given medical service is “necessary” under §627.736(1)(a) is a question of fact for the jury. . . . The current state of the law is that the issue of necessity in a PIP case is decided by factfinders on a case by case basis, depending on the specific evidence introduced at trial and the arguments of counsel. The absence of a specific statutory definition accords each judge or jury broad discretion in arriving at a decision. We do not think it is proper to require further definition of a term that the legislature has left as is for 27 years.
In the instant case, there is ample competent evidence to support the jury’s finding that the procedure was “necessary.” Both Dr. Schmitz and Dr. Cox opined that the procedure was reasonable and necessary. State Farm has correctly asserted that the 2001 amendment acted to create a higher standard for Plaintiffs in PIP actions by narrowing the scope of coverage of medical services and benefits. Therefore, in a case such as this, where a factfinder determines that the plaintiff has met his burden on the higher standard of “medically necessary”, the appellate court can affirm the verdict in light of the lower standard of “reasonably necessary” as long it too is supported by competent evidence. See White v. State, 446 So.2d 1031 (Fla. 1984).
Accordingly, it is ORDERED and ADJUDGED that:
1. The judgement and verdict for the Plaintiff is hereby AFFIRMED;
2. The Appellant’s Motion for Attorney’s Fees is hereby DENIED;
3. The Appellee’s Motion for Attorney’s Fees is hereby GRANTED; and
3. The Court retains jurisdiction to determine whether the amount of attorney’s fees requested by the appellee is reasonable.
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