13 Fla. L. Weekly Supp. 494b
Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Summary judgment is entered in favor of medical provider where affidavit of physician establishes that MRI was reasonable, related and necessary as result of accident, and medical provider has not filed anything in opposition to motion for summary judgment — Where provider is not accredited MRI facility, charges are payable at 175% of Medicare Part B fee schedule
OPEN MRI OF MIAMI-DADE, LTD., (a/s/o George Wilson), Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Dade County. Case No. 05-10501 SP 23 (1). February 2, 2006. Myriam Lehr, Judge. Counsel: Kenneth J. Dorchak, for Plaintiff. Darien Doe, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FOR FINAL SUMMARY JUDGMENT AND FINAL JUDGMENT
THIS CAUSE having come before the Court on February 2, 2006 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 George Wilson was involved in an automobile accident on December 18, 2002.
2. On the date of said accident the Defendant insured George Wilson for PIP insurance benefits.
3. On February 17, 2003 the Plaintiff rendered MRI services to George Wilson. That the Plaintiff received from George Wilson an assignment of benefits (CPT 72141).
4. Upon the sworn affidavit of Dr. Wallace Williamson, M.D. the Court finds that the MRI was reasonable, related and necessary as a result of the accident and injuries incurred thereby by George Wilson.
5. Upon receiving the bill from the Plaintiff, the Defendant failed to comply with the statutory requirements of Section 627.736(7), Fla. Stat., which imposes upon an insurer a burden of obtaining a valid report stating that the medical services was not reasonable, related or necessary.See United Automobile Insurance Company v. Julio Cesar Mendoza, 11 Fla. L. Weekly Supp. 299a, Dade County 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.
6. The Defendant has not filed anything in opposition to the Plaintiff’s Motion for Summary Judgement.
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 72141. Based on the uncontroverted evidence that Plaintiff was not an accredited MRI facility, the Plaintiff is entitled to 175% of 2001 Medicare Part B.
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, OPEN MRI OF MIAMI-DADE, LTD. (as assignee of George Wilson), of 19082 N.E. 29th Avenue, Aventura, Florida 33180, and the Plaintiff shall recover from the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, FEI # 65-0415688, the amount of $836.59, as outstanding PIP benefits, and the amount of $142.47 (1036 days from April 1, 2003 through February 2, 2006) as statutory interest, for a total judgment against the Defendant in the amount of $979.06 which amount shall bear interest at the rate of 9% 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.
