22 Fla. L. Weekly Supp. 945b
Online Reference: FLWSUPP 2208FRAGInsurance — Personal injury protection — Coverage — Medical expenses — Related treatment — No merit to argument that relatedness of treatment is determined by benefit or necessity of treatment — Treatment for injuries arising from accident is related treatment irrespective of whether treatment continued past point at which it was no longer beneficial
MARSHALL BRONSTEIN, DC, a/a/o LEROY FRAGER, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 2007-35320CC23(06). March 11, 2015. Spencer Multack, Judge. Counsel: Kenneth Dorchak, for Plaintiff. Iftikhar Memon and Jacqueline Whittingham, for Defendant.
ORDER GRANTING SUMMARY JUDGMENTAS TO RELATEDNESS (POST 6/5/2007)
THIS CAUSE came before the Court on the “Plaintiff’s Motion to for Partial MSJ As to Relatedness,” pursuant to Rule 1.510 Florida Rules of Civil Procedure. On March 2, 2015, this Court held a hearing, where it received evidence and argument from both the Plaintiff and Defendant. The Court has further reviewed the court file, analyzed the arguments, and weighed the evidence received, which serves as the basis for this order.Facts
1. On December 10, 2007 the Plaintiff filed an action for damages for the Defendant’s failure to pay his medical bills under F.S. 627.736, the “Florida Motor Vehicle No-Fault Law.”
2. On January 31, 2008, the Defendant filed an Answer and Affirmative Defenses. Paragraph 4 of the Answer states that the, “Defendant denies that the bills at issue in this lawsuit are reasonable, related, or necessary.”
3. On June 15, 2009, the Plaintiff filed a Motion for Summary Judgment asserting that no genuine issue of material fact existed as to a number of issues including “relatedness.”
4. On September 10, 2009 Judge Don Cohn, the predecessor judge, granted the Plaintiff’s Motion for Summary Judgment as to the bills for treatment rendered from April 12, 2007 through June 5, 2007. Inherent in the ruling is that the medical bills from April 12, 2007 through June 5, 2007 were reasonable, related, and necessary.
5. On April 8, 2014, the Plaintiff filed a second Motion for Summary Judgment as to the issue of relatedness for the time period between June 5, 2007 and July 26, 2007. This motion relies on the deposition of the Defendant’s expert, Dr. Michael Weinreb, taken on January 15, 2014.
6. According to the deposition, Dr. Weinreb, cannot relate the Plaintiff’s treated injury to any source of trauma other than the crash on or about April 5, 2007. (P.82 L.11-13.) In fact, nowhere in the deposition is there any other explanation as to the source of trauma that led to the Plaintiff seeking medical treatment. Both parties had the opportunity to examine the expert on this issue and other issues.
7. The Defendant submitted evidence in the form of expert affidavits1 to support the position that as of June 5, 2007, treatment of the Plaintiff’s injury was no longer, “reasonable, related, or necessary.”Relatedness
The Plaintiff takes the position that the medical treatment between June 5, 2007 and July 27, 2007 (when the treatment ultimately concluded) continued to be “related” to the subject accident on April 5, 2007. The Defendant avers a contrary interpretation of the word “related” as it pertains to the medical treatment between these dates. As the Court understands, the Defendant is of the position that once the Plaintiff’s treatment continued beyond the point it was deemed no longer beneficial2, the treatment was no longer related to the initial trauma of the car crash.
The Defendant’s argument hinges on the symbiotic relationship between the necessity/benefit of treatment and the relatedness of that treatment to the initial trauma. At the hearing on March 2, 2015, the parties and the Court grappled with the meaning of “related” as it pertains to the medical treatment of the Plaintiff after June 5, 2007. This analysis follows.
First, F.S. 627.736 does not include a definition of the term “related” as it pertains to the treatment of the insured by a physician. In fact, the term “related” as used in the subject litigation only appears in the text of F.S. 627.736(7)(a):
An insurer may not withdraw payment of a treating physician without the consent of the injured person covered by the personal injury protection, unless the insurer first obtains a valid report by a Florida physician licensed under the same chapter as the treating physician whose treatment authorization is sought to be withdrawn, stating that treatment was not reasonable, related, or necessary.
As it reads, if the subject treatment of the insured is unreasonable, unrelated, or unnecessary, then payments of PIP benefits are not required under the law. This is a typical and heavily litigated area of the “No-Fault” statute. It is a logical conclusion that in order to collect PIP benefits it is necessary that the treatment of the insured be causally related to the automobile crash suffered by the insured. In order to confirm the relationship between the treatment and the crash, the Court looks to the plain meaning of F.S. 627.736.
Legislative intent, as always, is the polestar that guides a court’s inquiry under the Florida No-Fault Law. Where the wording of the Law is clear and amenable to a logical and reasonable interpretation, a court is without power to diverge from the intent of the Legislature as expressed in the plain language of the Law. United Auto v. Rodriguez, 808 So.2d 82 (Fla. 2001) [26 Fla. L. Weekly S747a]. See also, E.A.R. v. State, 4 So.3d 614 (Fla. 2009) [34 Fla. L. Weekly S120a]. A court primarily discerns legislative intent by looking to the plain text of the relevant statute. Id. A court gives a statute its plain meaning when the language of the statute is clear and unambiguous and conveys a definite meaning. Maddox v. State, 923 So.2d 442 (Fla. 2006) [31 Fla. L. Weekly S24a]. When the meaning of a statute is ambiguous, a court may turn to the rules of statutory interpretation and construction.
As to the relatedness between the crash and treatment, F.S. 627.736(1) clearly states that,
An insurance policy complying with the security requirements of s. 627.733 must provide personal injury protection to the named insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in the motor vehicle, and other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle, subject to subsection (2) and paragraph (4)(e), to a limit of $10,000 in medical and disability benefits and $5,000 in death benefits resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle (emphasis added).
Furthermore, 627.736(4)(d)(1) states that,
The insurer of the owner of a motor vehicle shall pay personal injury protection benefits for accidental bodily injury sustained in this state by the owner while occupying a motor vehicle, or while not an occupant of a self-propelled vehicle (emphasis added) if the injury is caused by physical contact with a motor vehicle.
For additional confirmation as to the meaning of “related” the Court looks to the jury instructions proscribed by the Florida Supreme Court on this very issue. The instruction reads as follows:413.4 ISSUES ON CLAIM
a. Issues generally:
(Plaintiff) seeks personal injury benefits from (defendant) for [a medical service] [medical services]. (Plaintiff) is entitled to [recover benefits] [receive payment] if the service[s] [is] [are] related to the accident, the service[s] [is] [are] medically necessary, and the charge[s] for the service [s] [is] [are] reasonable.
Therefore, on this claim for personal injury benefits, you must decide the following:
The first issue is whether the service is related to the automobile accident of (date). If you decide that a service is not related to the accident, you should not award damages for that service. If you decide that one or more services are related to the accident, you must then decide a second issue.
In re STANDARD JURY INSTRUCTIONS IN CIVIL CASES-REPORT NO. 09-01 35, So.3d 666 (Fla. 2010.)
The jury instruction contemplates the debate over the term “relatedness” and offers the following guidance,Note 4
No definition of “related” is provided in this instruction. Causation can be a complex issue in a PIP case. Generally, to invoke this insurance coverage a bodily injury must “arise out of the ownership, maintenance, or use of a motor vehicle.” See F.S. 768.736(1) (2003); Lumbermens Mutual Casualty Co. v. Castagna, 368 So.2d 348 (Fla.1979). The medical treatment covered by the insurance policy is the treatment that is related to the bodily injury arising out of the ownership, maintenance, or use of the motor vehicle. The committee has been advised that most practitioners prefer to use the term, “related,” as a simple method to explain causation (emphasis added) to the jury. The committee does not therefore intend for an instruction similar to F.S. 401.12 to be given in a PIP case as an explanation of causation.
Additionally, traditional tort concepts of causation are to be considered part of the personal injury protection statute. Causation is the necessary link that connects a plaintiff’s injuries to the physical contact and brings them within the statute. Underwriters Guarantee Ins. V. Gregory 582 So.2d 11 (Fla. 3d 1991).
The party opposing a motion for summary judgment must present evidence, not simply legal argument, demonstrating the existence of a disputed issue of material fact. Where a movant for summary judgment offers sufficient evidence to support its claim of the nonexistence of material fact, the opposing party must demonstrate the existence of disputed issues of fact either by presenting evidence of countervailing facts or justifiable inferences from the facts presented. If the opposing party fails to present such evidence, summary judgment may be entered in favor of the moving party. Woodruff v. GEICO, 669 So.2d 1114 (Fla. 1st DCA 1996) [21 Fla. L. Weekly D684a]. See, Fleming v. Peoples First Financial S & L Assoc., 667 So.2d 273 (Fla. 1st DCA 1995) [20 Fla. L. Weekly D2066a]; DeMesine v. Stephenson, 498 So.2d 673 (Fla. 1st DCA 1986).
With the stated authority before us, it is evident from a plain reading of the statute and jury instructions that the term “related” represents a causal connection between the treated injury and the automobile accident. There does not appear to be any authority that would support the Defendant’s argument that “relatedness” hinges on the benefit or necessity of treatment. Clearly, if the treatment is not related to the automobile accident then the necessity and reasonableness are moot issues. However, the argument does not succeed in the reverse. The terms “related” and “necessary” are not mutually exclusive and must be analyzed independent of one another. The individual analysis of the terms “reasonable,” “related,” and, “necessary,” are required of the jury and required of the Court. In order to refute relatedness, United Auto would have to present actual and/or factual evidence which would purport to more or less show that the injuries and subsequent medical treatment did not arise out of the subject accident. See Sevila Weston v. UAIC, 11660AP, 12-127AP (Fla. 11th Cir. 2013) [21 Fla. L. Weekly Supp. 306b]. The Defendant’s position is simply not supported by the law as it is currently written and does not create an issue of material fact where there is none.
Therefore, based on the above authority, prior ruling of this Court, and evidence submitted by the parties, the Plaintiff’s motion for summary judgment as to relatedness after June 5, 2007 is GRANTED.
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1Dr. Michael Weinreb’s affidavit and peer review of February 26, 2015 and Dr. Michael Mansdorf’s affidavit of August 31, 2009.
2June 5, 2007
