18 Fla. L. Weekly Supp. 1174a
Online Reference: FLWSUPP 1811SIMO
Insurance — Personal injury protection — Coverage — Reasonable charges — Medicare fee schedule is not relevant to determination of reasonableness of charges under section 627.736(5)(a)1.
THE PERSONAL INJURY CLINIC (A/A/O ALEXIS SIMO), Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 10-3946 SP 21. February 10, 2011. Honorable Ana M. Pando, Judge. Counsel: Ryan Peterson, Patiño Law Firm, Hialeah, for Plaintiff. Alina O’Conner, Office of the General Counsel, for Defendant.
ORDER ON PLAINTIFF’S MOTION FORSUMMARY JUDGMENT ON REASONABLE,RELATED, AND NECESSARY
In this PIP case the Plaintiff moved for Summary Judgment that the bills were reasonable, related, and necessary. The Defendant has stipulated to relatedness and necessity. The Plaintiff argues that the Medicare Part B fee schedule is not relevant to a determination as to what is “reasonable”.
This Court agrees that Medicare Fee Schedule pricing, including the Participating Physician’s Fee Schedule related to Medicare Part B, is not relevant to a determination of what is “reasonable” under the categories enumerated in Fla. Stat. 627.736(5)(a)(1). See Atkins v. Allstate Ins. Co., 382 So.2d 1276 (Fla. 3d DCA 1980); and Physician’s Group LLC (a/a/o Alicia Buckner) v. Progressive, 16 Fla. L. Weekly Supp 961a (Fla. 12th Circ. Cty. Ct., 2009). Summary Judgment on reasonable, related, and necessary is granted. The only issue remaining in this case is whether the Defendant properly limited the reimbursement as stated in Fla. Stat. (5)(a)(2), and whether the Defendant could legally do so.
