17 Fla. L. Weekly Supp. 519a
Online Reference: FLWSUPP 1707ELIS
Insurance — Personal injury protection — Error to enter summary judgment in favor of medical provider where there were competing reports from insured’s physician and physician who performed independent medical examination regarding reasonableness, relatedness and necessity of medical bills — Further, whether benefits should have been withdrawn as of date of IME or as of date of cut-off letter is issue for jury
UNITED AUTOMOBILE INSURANCE COMPANY, (A Florida Corporation), Appellant, v. AUGUST CHIROPRACTIC d/b/a TRAUMA AND REHAB ASSOC. (A/A/O Joseph Elisco), Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 08-446 AP. L.T. Case No. 07-13585 CC 23 (4). March 24, 2010. On Appeal from a decision rendered by the Miami-Dade County Court, Myriam Lehr, Judge. Counsel: Michael J. Neimand, Office of the General Counsel of United Automobile Insurance Company/Trial Division, for Appellant. Marlene S. Reiss, Law Offices of Marlene S. Reiss, P.A., for Appellee.
(Before, DONNER, ROTHENBERG and GENDEN, JJ.)
(GENDEN, J.)This is a PIP claim brought against United Auto for the payment of medical bills by the insured’s assignee August Chiropractic. The lower Court entered Summary Judgment in favor of August, the Plaintiff below and the insurer, United Auto, has appealed.
On September 26, 2006, the insured was examined by a Dr. Hornfeld on behalf of United Auto. Dr. Hornfeld opined that no treatment subsequent to September 26, 2006 would be reasonable, related or necessary. A letter dated October 11, 2006 was sent to the insured withdrawing treatment and suspending benefits as of September 26, 2006. The trial court granted the Plaintiff’s Motion for Summary Judgment finding that the Plaintiff was entitled to have its bill paid through October 11, 2006, the date of the cut-off letter. The Defendant appealed arguing that the RRN is a question of fact to be decided by a jury in the face of the competing reports from the insured’s doctor and Dr. Hornfeld, the insurer’s doctor. In addition the insurer argues that their responsibility for bills is not governed by the October 11, 2006 date, but the September 26, 2006 “IME” date.
We agree with the Insurer that there were issues of fact precluding the entry of Summary Judgment namely, whether or not the bills were reasonable, related and necessary. We therefore, remand this case for the trial court for trial.
As to the issue of the cut-off date, this Court believes that a jury should be given the responsibility to determine whether or not the benefits should have been withdrawn on the date of IME and not be bound by the October 11, 2006 date. (DONNER and ROTHENBERG, JJ., concur.)
