25 Fla. L. Weekly Supp. 905a
Online Reference: FLWSUPP 2510AMADInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Relatedness and necessity of treatment — Medical provider’s motion for summary judgment as to relatedness and necessity of treatment is granted where insurer admitted in response to interrogatories that treatment was related and necessary and further admitted that bills were paid in accordance with policy terms, exclusions and limitations
FLORIDA WELLNESS & REHABILIATION CENTER, INC. a/a/o Jessica Amador, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 12-11880 SP 23 (04). August 9, 2017. Alexander S. Bokor, Judge. Counsel: Vincent Rutigliano, Rosenberg & Rosenberg, Hollywood, for Plaintiff. Luis Perez, for Defendant.
ORDER
This cause having come before the Court on Plaintiff’s Motion for Summary Judgment Regarding the Defendant’s Ability to Contest Relatedness and Necessity dated August 19, 2017, the Court having heard argument of the parties, and being otherwise advised in the premises it is hereby ORDERED AND ADJUDGED, as follows:
Plaintiff’s Motion for Summary Judgment Regarding the Defendant’s Ability to Contest Relatedness and Necessity dated August 19, 2017 is hereby Granted. The Plaintiff proffered the Defendant’s verified answers to interrogatories, explanations of review and policy in support of their motion. The Defendant’s answers to Plaintiff’s interrogatories, which constitute party admissions, demonstrate that the Defendant has admitted that the at-issue treatment is related and necessary. The Defendant, further, declined to assert that the at-issue treatment was not related and / or not necessary. While Defendant may contest relatedness and necessity after payment, the parties have now reached the summary judgment phase. By now, Defendant, if it chose to contest such issues, would have done so. It has not.
The Defendant’s interrogatory answers, regarding the basis for any denials and as to whether the at-issue treatment was related and necessary, also direct the Plaintiff to the Defendant’s explanations of review and assert that the at-issue treatment was paid pursuant to the terms, conditions, limitations and exclusions of the subject policy of insurance and 627.736. This Court has reviewed the explanations of review and found that each of the services that the Plaintiff billed for was paid based upon 200% of the Medicare Part B fee schedule or the worker’s compensation fee schedule. This Court has further reviewed the policy and Florida Statute 627.736 and finds that the payment of PIP benefits only occurs if the medical treatment is related and necessary. The only reasonable inference that can be drawn from the Defendant’s admission that the bills were paid pursuant to the terms, conditions, limitations and exclusions of the subject policy of insurance and 627.736, absent any other contrary evidence is that the at-issue treatment is related and necessary. The Defendant’s statement that they paid the at-issue medical bills in accordance with their policy and Florida Statute 627.736 is an additional admission that the instant treatment was related and necessary.
There is simply no evidence offered that Defendant seeks to challenge relatedness or necessity. The Court finds that the Plaintiff has set forth a prima facie case that the at-issue treatment is related and necessary. The Defendant has not filed any evidence that would dispute the prima facie case and therefore Plaintiff’s motion for summary judgment as to relatedness and necessity is GRANTED.
