25 Fla. L. Weekly Supp. 873a
Online Reference: FLWSUPP 2510NUNEInsurance — Personal injury protection — Coverage — Medical expenses — Trial court did not err in granting provider’s motions for summary judgment as to reasonableness of its charges — Evidence presented in support of motions was legally sufficient to shift burden to insurer, and insurer did not carry its burden of showing genuine issue of material fact or triable issue — Trial court erred in granting summary judgment in favor of provider as to relatedness and medical necessity of services rendered — Insurer did not waive right to raise these issues by making partial payment of benefits prior to commencement of lawsuit
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant, v. ADVANCED CHIROPRACTIC AND MEDICAL CENTER CORPORATION, a/a/o Emma Nuñez, Appellee. Circuit Court, 17th Judicial Circuit (Appellate) in and for Broward County. Case No. CACE15-003680 (AP). L.T. Case No. COCE13-011006. October 23, 2017. Appeal from the County Court of the Seventeenth Judicial Circuit, Broward County, Martin R. Dishowitz, Judge. Counsel: Nancy W. Gregoire, Birnbaum, Lippman & Gregoire, PLLC, Fort Lauderdale, for Appellant. Robert J. Hauser, Pankauski Law Firm, PLLC, West Palm Beach, for Appellee
OPINION
(PER CURIAM.) State Farm Mutual Automobile Insurance Company (“State Farm”) appeals a final judgment in favor of Advanced Chiropractic & Medical Center Corporation (“Advanced Chiropractic”) as to the issues of the reasonableness of the charges and the relatedness and medical necessity of the services. Having carefully considered the briefs, the record, and the applicable law, this Court dispenses with oral argument and the final judgment is hereby REVERSED as set forth below:
In the underlying case, Advanced Chiropractic filed suit to recover personal injury protection benefits from State Farm for breach of contract pursuant to an assignment of benefits from Emma Nuñez (the “Insured”). The trial court determined the issues upon Advanced Chiropractic’s motions for summary judgment. This Court reviews that decision de novo. Moustafa v. Omega Ins. Co., 201 So. 3d 710, 714 (Fla. 4th DCA 2016) [41 Fla. L. Weekly D2064a]. Entry of summary judgment “is appropriate only where there are no genuine issues of material fact and the movant is entitled to judgment as a matter of law.” Yaralli v. Am. Reprographics Co., LLC, 165 So.3d 785, 787 (Fla. 4th DCA 2015) [40 Fla. L. Weekly D1240a].
This Court finds that the trial court did not err in granting Advanced Chiropractic’s motion for summary judgment as to the reasonableness of Advanced Chiropractic’s charges. Florida courts have long resolved the issue of reasonableness at summary judgment. See generally State Farm Mut. Auto. Ins. Co. v. Figler Family Chiropractic, P.A., 189 So. 3d 970 (Fla. 4th DCA 2016) [41 Fla. L. Weekly D805b] (affirming the trial court’s granting of summary judgment on the issues of reasonableness, medical necessity, and relatedness). After a careful review, this Court finds that Advanced Chiropractic’s evidence was legally sufficient to shift the burden to State Farm. State Farm did not carry its burden to show a genuine issue of material fact as to the reasonableness of Advanced Chiropractic’s charges. Therefore, the trial court’s order granting Advanced Chiropractic’s motion as to reasonableness of Advanced Chiropractic’s charges is affirmed.
However, the trial court did err in granting Advanced Chiropractic’s motion as to the relatedness and medical necessity of the services rendered. State Farm was denied the opportunity to demonstrate that a genuine issue of material fact existed as to the relatedness and necessity of the services. The trial court determined that State Farm waived its relatedness and necessity defense by paying the claim based on the ruling in Glenn V. Quintana, D.C., P.A. v. State Farm Mutual Automobile Insurance Company. See 19 Fla. L. Weekly Supp. 882a (Fla. 11th Cir. Ct. July 11, 2012) (holding that the legislature did not intend for insurers to be able to retroactively deny previously paid bills when drafting section 627.736(4)(b), Florida Statutes). However, the trial court’s reliance on Quintana is misplaced. Section 627.736(4)(b), Florida Statutes, states that “this paragraph does not preclude or limit the ability of the insurer to assert that the claim was unrelated, was not medically necessary, or was unreasonable . . . . Such assertion[s] may be made at any time, including after payment of the claim . . . .” § 627.736(4)(b), Fla. Stat. Additionally, the Fourth District Court of Appeal has ruled that an insurance company may defend a suit by claiming the service was not medically necessary or that the amount was not reasonable, even after a claim has been denied or reduced. Northwoods Sports Med. & Physical Rehab., Inc. v. Daniel N., 137 So. 3d 1049, 1057 (Fla. 4th DCA 2014) [39 Fla. L. Weekly D491a] (citing United Auto. Ins. Co. v. Rodriguez, 808 So. 2d 82, 87 (Fla. 2001) [26 Fla. L. Weekly S747a]). Therefore, the trial court’s order granting Advanced Chiropractic’s motion for summary judgment as to the relatedness and medical necessity of the services rendered is reversed.
Accordingly, the final judgment in favor of Advanced Chiropractic is hereby REVERSED, and this cases is REMANDED to the trial court for further proceedings consistent with this Opinion. Advanced Chiropractic’s Motion for Appellate Attorney’s Fees is hereby GRANTED, as to the appellate attorney’s fees related to defending the trial court’s order granting Advanced Chiropractic’s motion as to the reasonableness of Advanced Chiropractic’s charges, contingent upon Advanced Chiropractic ultimately prevailing in the case. State Farm’s Motion for Appellate Attorney’s Fees is hereby GRANTED, as to the appellate attorney’s fees related to obtaining a reversal of the trial court’s order granting Advanced Chiropractic’s motion as to the relatedness and medical necessity of the services rendered, conditioned on State Farm prevailing in the trial court and the trial court’s determination that State Farm’s proposal for settlement complies with the requirements of the law. (BIDWILL, RODRIGUEZ, and SINGHAL, JJ., concur.)
