21 Fla. L. Weekly Supp. 440b
Online Reference: FLWSUPP 2105CWILInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Where, in addition to fee schedules submitted by insurer to rebut medical provider’s prima facie case that charges at issue were reasonable, provider admitted that it accepted Medicare payments and that it accepted far less from other insurers for same services, jury had sufficient evidence to support finding that amount billed by provider was not reasonable — Motion for judgment notwithstanding verdict and motion for new trial are denied
QUANTUM IMAGING HOLDINGS LLC (a/a/o Charles Williams), Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 11-24150 COCE 53. January 24, 2014. Robert W. Lee, Judge. Counsel: Emilio Stillo, Davie, for Plaintiff. Thomas L. Hunker, Office of the General Counsel, United Automobile Insurance Company, Miami Gardens, for Defendant.
ORDER DENYING DEFENDANT’S MOTIONFOR JUDGMENT NOTWITHSTANDING THEVERDICT AND MOTION FOR NEW TRIAL
THIS CAUSE came before the Court on January 22, 2014, for hearing of the Plaintiff’s Motion for Judgment Notwithstanding the Verdict and Motion for New Trial, and the Court having reviewed the Motion, the entire Court file, and the relevant legal authorities; having heard argument; having made a thorough review of the matters filed of record; and having been sufficiently advised in the premises, the Court finds as follows:
The Plaintiff argues that insufficient competent evidence was presented to rebut Plaintiff’s prima facie case that the charge for the medical service at issue was reasonable. The only issue before the jury was the reasonableness of the Plaintiff’s pricing. The Court agrees that merely providing fee schedules, without more, is insufficient for an insurer to raise a dispute on the issue of reasonableness of price. The issue of the fee schedules was addressed recently by 17th Circuit Court sitting in its appellate capacity in the case of United Automobile Ins. Co. v. Health Diagnostics of Miami, LLC, Opinion, Case No. 12-841 CACE (Dec. 16, 2013). In this case, the appellate court affirmed a decision of the trial court entering summary disposition on the issue of reasonableness when the only defendant’s only evidence opposing the Plaintiff was the Medicare fee schedule:
THE COURT: [. . .] What do you have by way of any evidence that is suggesting that the amount charged in this case was not reasonable?
[DEFENSE COUNSEL]: Your honor, the reliance on the Medicare fee schedule. Our position is that the Medicare fee schedule is reasonable. And the jury would make the determination, basically the trier of fact would make a determination as to what’s reasonable, whether it’s the charge that’s submitted by the Plaintiff or the amount paid by the Defense [. . .].
THE COURT: Anything else?
[DEFENSE COUNSEL]: No, Your Honor.
Although the Health Diagnostics case proceeded to summary disposition under the Small Claims Rules rather than the Rules of Civil Procedure, the important point relevant to the instant case is that the appellate court apparently agreed that if the only evidence in opposition to Plaintiff on reasonableness is the Medicare fee schedule, such evidence standing alone is insufficient for a trier of fact to decide which fee is “reasonable.”
In the instant case, however, the jury had more than mere fee schedules to rely on. The Plaintiff admitted that it accepted Medicare payments. The Plaintiff also acknowledged specific amounts that it accepted from several other specific insurance companies far less for the same services provided in this case. The jury was specifically asked whether the Plaintiff’s charge was reasonable, and the jury answered, “No.” The Court concludes that the jury could reasonably conclude, as it apparently did, that the amount billed by the Plaintiff in this case was not reasonable. As for the remaining grounds argued in Plaintiff’s Motions, the Court finds them to be without merit. Accordingly, it is hereby
ORDERED AND ADJUDGED that the Plaintiff’s Motion for Judgment Notwithstanding the Verdict and Motion for New Trial are DENIED.
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