25 Fla. L. Weekly Supp. 125b
Online Reference: FLWSUPP 2501VASSInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Where affidavit filed by insurer in opposition to summary judgment on issue of reasonableness of charges is conclusory and not based on sufficient facts or data, and insurer stipulated to relatedness and medical necessity of treatment in its discovery responses, final summary judgment is entered in favor of medical provider
ADVANCED CHIROPRACTIC AND MEDICAL CENTER, CORP. (Vassell, Jodricka), Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. COCE 13-11189 (51). March 7, 2017. Kathleen McCarthy, Judge.
ORDER GRANTING PLAINTIFF’S AMENDEDMOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come before the Court on February 28, 2017 for hearing on the Plaintiff’s Amended Motion for Final Summary Judgment, which was re-set by the Court from February 9, 20171 and the Court having heard the argument of counsel, sufficiently reviewed the record before the Court and being otherwise sufficiently advised in the premises, makes the following findings and determinations:
1. Plaintiff provided ongoing chiropractic care and therapy services to Jodricka Vassell as a result of his February 1st, 2011 motor vehicle accident that included an initial examination charge, x-rays and therapies billed under various CPT Codes. At the hearing, the Plaintiff withdrew CPT Codes 97012 and 97140.2
2. The dates of services at issue are February 7, 2011 through March 10, 2011.
3. The Defendant paid every CPT Code submitted by the Plaintiff however reduced the charged amount to 200% of Medicare Part B and paid the services at 80%.
4. In support of Plaintiff’s position that the amounts charged by Advanced Chiropractic were reasonably priced, the Plaintiff relied upon the Affidavit of Pamela McDole who is the Plaintiff’s corporate representative and records custodian. In her affidavit, Ms. McDole set forth how the charges at Advanced Chiropractic were established, the fact that they had been paid by other insurance carriers throughout the years and attached to her affidavit were explanations of benefits from various insurers, including the Defendant in this case, United Automobile Insurance Company showing that her charges had been accepted at the full amount and paid for the same services and the same year the services were rendered in this case. The Court finds that the Plaintiff has met its prima facie showing that the charges in this case are reasonable.
5. In support of Plaintiff’s position that the services provided were related and medically necessary, the Plaintiff relied upon Defendant’s Verified Answers to Interrogatories where Defendant stipulated to related and medical necessity. See Verified Interrogatory Answers #11(a-d) filed by Plaintiff in Support of its Motion on December 21, 2016 and served by Defendant on February 27, 2015. The Plaintiff further relied upon the Affidavit of Dr. Valeria Valenzuela Zeiser, DC who attached all the patient’s medical records and opined that all the treatment was related and medically necessary.
6. The Defendant did not present any countervailing evidence to raise a genuine issue of material fact to Plaintiff’s showing that its charges are reasonable and further that the treatment was related and medically necessary.3
7. Even if the Court did consider Dr. Weinreb’s Affidavit, the Court finds that his opinions on the reasonableness of the Plaintiff’s charges are conclusory, not based upon sufficient facts or data and are merely his own prices. Further, some of his charges are above what United Automobile allowed in this case.
8. Further, even if the Court were to consider Dr. Weinreb’s opinions on relatedness and medical necessity of the treatment despite Defendant’s Verified Interrogatories along with his recommended allowance for charges, the Court would still find that the Plaintiff would be entitled to additional money owed in the amount of $142.93.
9. However, based on all the evidence presented, the Court finds that Defendant did not present any competent evidence to refute Plaintiff’s prima facia case that the treatment in this case was reasonably prince, related and medically necessary and finds that Plaintiff is entitled to a judgment in the amount of $1,019.79 plus statutory interest.
Accordingly based on the forgoing, it is hereby ORDERED AND ADJUDGED that Plaintiff’s Amended Motion for Final Summary Judgment be and the same is hereby GRANTED and the Plaintiff is entitled to recover $1,019.79 as additional monies owed plus statutory interest. The court notes that this case has been in litigation for 1349 days. There are no remaining issues and the Plaintiff is hereby directed to submit a Final Judgment in the amount of $1,019.79 plus statutory interest.
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1The Court Granted the Defendant’s Emergency Motion for Continuance on February 9, 2017 and the matter was rescheduled for February 29, 2017. The Court reserved ruling on whether additional depositions or any other material would be considered that was not already of record as of February 9, 2017 at 10:30 AM.
2There were no remaining affirmative defenses and injury, accident and coverage were not in dispute.
3At the February 27, 2017 hearing the court allowed the Defendant to be heard on its Motion for Reconsideration, Rehearing and Motion to Vacate the Court’s February 9, 2017 Order on Plaintiffs’ Amended Daubert Motion. The Motion was denied.
