25 Fla. L. Weekly Supp. 869b
Online Reference: FLWSUPP 2510DACOInsurance — Personal injury protection — Coverage — Medical expenses — Withdrawal of benefits — Valid report by physician licensed under same chapter as treating physician stating treatment was not reasonable, related, or medically necessary — Trial court erred in granting summary judgment in favor of provider where insurer presented report of chiropractic physician and there was factual issue as to identity of treating physician for the services at issue
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant, v. PRIORITY MEDICAL CENTERS, LLC, a/a/o Lisa Dacosta, Appellee. Circuit Court, 17th Judicial Circuit (Appellate) in and for Broward County. Case No. 15-009650 (AP) L.T. Case No. CONO 11-000005. October 23, 2017. Appeal from the County Court of the Seventeenth Judicial Circuit, Broward County, Steven P. DeLuca, Judge. Counsel: Kenneth P. Hazouri, deBeaubien. Simmons, Knight, Mantzaris & Neal, LLP, Orlando, for Appellant. Marlene S. Reiss, Marlene S. Reiss, P.A., Miami, for Appellee.
OPINION
(PER CURIAM.) State Farm Mutual Automobile Insurance Company (“State Farm”) appeals a final judgment in favor of Priority Medical Centers, LLC (“Priority Medical”) as to the identity of the treating physician. 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 proceedings below, Priority Medical filed suit to recover personal injury protection benefits from State Farm for breach of contract pursuant to an assignment from Lisa Dacosta (the “Insured”). On April 2, 2015, the summary judgment hearing was treated as summary disposition pursuant to Florida Small Claim Rule 7.135. State Farm moved for a continuance of the hearing to allow it to complete discovery, specifically, taking the deposition of Dr. Jonathan Tarrash, pursuant to the court’s order. The trial court denied the motion for a continuance and entered summary disposition in Priority Medical’s favor. On May 5, 2015, the trial court entered Final Judgment in favor of Priority Medical. This Court reviews the decision de novo. See State Farm Mut. Auto. Ins Co. v. Margate Pain & Rehabilitation, Inc., a/a/o Pierre Charlesca, CACE 14-009523 (Fla. 17th Cir. Ct. App. 2017) (applying a de novo standard of review to orders on motions for summary disposition).
Section 627.736(7)(a), Florida Statutes, provides that an insurer may not withdraw PIP benefits “unless the insurer first obtains a valid report by a Florida physician licensed under the same chapter as the treating physician” stating that the treatment is not reasonable, related, or medically necessary. See § 627.736(7)(a), Fla. Stat. After almost three months of treatment, State Farm requested that the Insured submit to a CME to determine if any further treatment was necessary. The CME was performed by Dr. Mathesie, a chiropractic physician licensed under chapter 460, Florida Statutes. See, § 627.736(1)(a), Fla.Stat. Whether Dr. Mathesie’s CME was a valid report under the statute and sufficient for State Farm to effectively withdraw benefits, turns on whether Dr. Mathesie is a “physician licensed under the same chapter as the treating physician . . . .” § 627.736(7)(a). Fla. Stat. (emphasis added).Without addressing the validity of the affidavits, or weighing their credibility, the facts in the record very clearly raise an issue as to the identity of the treating physician for the services at issue. As such, State Farm met its burden and the case should be reversed and remanded to the trial court.
Accordingly, the final judgment in favor of Priority Medical is hereby REVERSED, and this case is REMANDED to the trial court for further proceedings consistent with this Opinion. Further, Priority Medical’s Motion for Appellate Attorney’s Fees is hereby DENIED. (BIDWILL, RODRIGUEZ, and SINGHAL, JJ., concur.)
