14 Fla. L. Weekly Supp. 628a
Insurance — Personal injury protection — Coverage — Medical expenses — Failure to obtain reasonable proof within 30 days — Insurer is not barred from contesting reasonableness, relatedness or medical necessity of claim by failure to obtain peer review within 30 days
UNITED AUTOMOBILE INSURANCE CO., Appellant, vs. JESSICA SUZZANE TATE, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 06-193 AP. L.C. Case No. 04-8531 CC 05. May 9, 2007. An appeal from the County Court for Miami-Dade County, Wendell M. Graham, Judge. Counsel: Michael J. Neimand, United Automobile Insurance Company, for Appellant. Marlene Reiss, Stephens, Lynn, Klein, for Appellee.
(Before CINDY S. LEDERMAN, MARK KING LEBAN, and BEATRICE BUTCHKO, JJ.)
(LEDERMAN, J.) This is an appeal of the lower court’s entry of summary judgment in favor of Appellee, Jessica Tate. Ms. Tate, a United Auto insured, was injured in a car accident in September 2003. She sought PIP benefits under her policy with United Auto. Those benefits were denied and Ms. Tate filed suit in March 2004. A year later, in March 2005, United Auto obtained a peer review which concluded that only $855 of Ms. Tate’s total $4195 in medical bills was compensable. The peer review was filed in August 2005.
Ms. Tate filed a motion to strike the peer review arguing that it was untimely since it was obtained more than 30 days after United Auto received notice of loss. The lower court struck the peer review and in January 2006, Ms. Tate filed a motion for summary judgment. The motion was granted and United Auto filed the instant appeal.
The standard of review for summary judgment is de novo and requires this court to view the evidence in the light most favorable to the non-moving party. Sierra v. Shevin, 767 So. 2d 524, 525 (Fla. 3d DCA 2000). Summary judgment is proper if there exists no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Volusia County v. Aberdeen at Ormond Beach, L.P., 760 So. 2d 126, 130 (Fla. 2000).
The Florida PIP statute contains three components relevant here. First, PIP benefits are payable only if the medical services were reasonable, related and necessary to the insured’s injuries. Fla. Stat. § 627.736(1)(a) (2007). Second, when PIP claims are not paid by an insurer within 30 days of receipt of relevant bills and records, the claim becomes “overdue” unless the insurer has “reasonable proof” to establish that it is not responsible for payment. Fla. Stat. § 627.736(4)(b). Third, an insurer is subject to specific penalties for an “overdue” payment — namely, ten percent interest per year and attorneys’ fees. Fla. Stat. § 627.736(4)(c) and Fla. Stat. § 627.736(8) respectively. The Florida Supreme Court has commented on the interaction of these sections.
In United Auto. Ins. Co. v. Rodriguez, 808 So. 2d 82 (Fla. 2002), the insurer’s 30-day window passed and it had neither paid on the PIP claim nor obtained a medical report as to whether the bills were reasonable, related or necessary. When the insurer finally filed its medical report outside of the 30-day window, the insured moved for summary judgment on the grounds that the report was untimely and, as a result, that United Auto was precluded from arguing as to the reasonableness, relatedness or necessity of the bills. The lower court agreed. But the Florida Supreme Court held otherwise. The Court sided with United Auto holding that if payment of PIP claims is “overdue,” under Fla. Stat. § 627.736, the only penalties that may be levied against the insurer are ten percent interest and attorney’s fees. Rodriguez, 808 So. 2d at 84. The Court went on to state that in such a scenario, the insurer is not forever barred from contesting the claim. Id. at 84 and 88.
The facts in Rodriguez areanalogous to those here — United Auto did not obtain any reasonable proof as to the reasonableness, relatedness or necessity of the insureds’ medical treatment within the 30-day window of Fla. Stat. § 627.736(4)(b). As such, a similar result is required — United is not barred from contesting the reasonableness, relatedness or medical necessity of Ms. Tate’s PIP insurance claim simply because the claim was officially “overdue” from not having been paid within 30 days. As such, we reverse the final summary judgment entered by the trial court and remand the case for proceedings consistent with this opinion.
REVERSED and REMANDED. (LEBAN and BUTCHKO, JJ., concur.
