13 Fla. L. Weekly Supp. 361a
Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Reasonable, related and necessary treatment — Where medical provider’s affidavit attests that MRI services were reasonable, related and necessary as result of injuries incurred in accident, and insurer did not file opposing affidavit, provider is entitled to payment of charges pursuant to MRI fee schedule — Fact that HCFA form submitted to insurer sets forth amount greater than fee schedule is not defense to payment of charges — No merit to claim that insured is not entitled to coverage under PIP policy covering vehicle she occupied at time of accident because she was entitled to PIP coverage under policy covering vehicle owned by grandmother with whom she resides where grandmother filed unopposed affidavit stating that insured is not listed on her PIP policy
GOLDEN GLADES OPEN MRI AND IMAGING CENTER, L.C. (a/a/o Tenisha Marshall), Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Dade County. Case No. 02-20832 SP 23 (2). January 9, 2006. Caryn C. Schwartz, Judge. Counsel: Kenneth J. Dorchak, North Miami, and Michael Brodi, for Plaintiff. Chastity Perez, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FOR FINAL SUMMARY JUDGMENT AND FINAL JUDGMENT
THIS CAUSE having come before the Court on January 9, 2006 on the Plaintiff’s Motion for Final Summary Judgment, after hearing argument of the parties and being fully advised of the premises thereof, the Court finds as follows:
1. That the insured Tenisha Marshall was involved in an automobile accident on January 9, 2002.
2. On June 21, 2002 the Plaintiff rendered MRI services to Tenisha Marshall. That the Plaintiff received from Tenisha Marshall assignment of benefits.
4. Upon the sworn affidavit of Dr. Wallace Williamson, M.D., the Court finds that the MRI was requested by Dr. Williamson, M.D. and that the MRI services were reasonable, related and necessary as a result of the accident and injuries incurred thereby by Tenisha Marshall. See United Automobile Insurance Company v. Julio Cesar Mendoza, 11 Fla. L. Weekly Supp. 299a, Dade Court Circuit Court Appellate Div., wherein the Court reaffirmed that under Section 627.736(7)(a) a medical report stating that the treatment was not reasonable, related or necessary is a condition precedent to withdrawing payment. See also United Automobile Insurance Company v. Neurology Association Group Two, Inc (a/a/o Nicholas Cabello), 11 Fla. L. Weekly Supp. 204b, Dade County Circuit Court Appellate Division; See Also United Automobile Insurance Company v. Professional Medical Group (a/a/o Sol Angel Hurtado), Dade County Circuit Court Appellate Division, opinion dated August 3, 2004 [11 Fla. L. Weekly Supp. 877a].
6. The Defendant has not filed an affidavit in opposition to that of Dr. Williamson’s.
7. That Plaintiff’s charges are payable at the MRI fee schedule set forth in Section 627.736(5)(b)(5), Fla. Stat., for CPT codes 72148. Based on the uncontroverted evidence that the Plaintiff is an accredited MRI facility, the Plaintiff is entitled to 200% of 2001 Medicare Part B. (2 X $645.49 = $1,290.98) ($1,290.98 X 80% = $1,032.78)
The Court finds that the fact that the HCFA form submitted to the Defendant sets forth an amount greater that the fee schedule does not provide a defense to payment. See United Automobile Insurance Company v. Presgar Medical Imaging, (a/a/o Dexter Hepburn), Dade County Circuit Court Appellate Division, Case # 04-061 AP, Opinion dated October 5, 2004.
8. Plaintiff is entitled to a summary judgment on the defense that there was no coverage available to Tenisha Marshall due to the fact that she allegedly lived with her grandmother Martha Marshall who is alleged to have owned a vehicle under which Tenisha Marshall was entitled to PIP coverage. The Plaintiff has filed the un-rebutted affidavit of Martha Marshall wherein she stated that Tenisha Marshall was not listed on the policy which covered the vehicle which she owned. As a result Tenisha Marshall would not be entitled coverage under the policy applicable to the vehicle owed by Tenisha Marshall. Accordingly, Tenisha Marshall is entitled to claim PIP coverage under the policy issued by the Defendant which provided coverage for the vehicle which Tenisha Marshall was occupying at the time of the accident. See Farley v. Gateway Insurance Company, 302 So.2d 177 (Fla. 2nd DCA 1974).
The Court notes that the defense of EUO no-show had previously been stricken by the Court at the commencement of trial in this matter held on September 26, 2005.
The Court finding that there remains no issue of material fact to be resolved in this matter, based upon the foregoing it is hereby:
ORDERED AND ADJUDGED that Plaintiff’s Motion for Final Summary Judgment is Granted.
IT IS HEREBY ORDERED AND ADJUDGED that a final judgment is hereby entered in favor of the Plaintiff, GOLDEN GLADES OPEN MRI AND IMAGING CENTER, L.C. (as assignee of Tenisha Marshall of 1 N.E. 167th Street, North Miami Beach, FL 33162, and the Plaintiff shall recover from the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, FEI # 65-0415688, the amount of $1,032.78, as outstanding PIP benefits, and the amount of $218.66 (1104 days from January 1, 2003 through January 9, 2006) as statutory interest, for a total judgment against the Defendant in the amount of $1,251.44 which amount shall bear interest at the rate of 7% per annum and for which let execution issue.
IT IS FURTHER ORDERED AND ADJUDGED that the Court finds that the Plaintiff is entitled to an award of reasonable attorney’s fees and costs and shall reserve jurisdiction over this matter for purposes of determining the amount of such fees and costs.
