27 Fla. L. Weekly Supp. 129c
Online Reference: FLWSUPP 2702HEALInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Trial court erred in entering summary judgment where insurer raised genuine issue of material fact as to reasonableness of charges and relatedness and necessity of services — Insurer may challenge reasonableness, relatedness and necessity at any time
STATE FARM FIRE & CASUALTY COMPANY, Appellant(s), v. MARTINEZ HEALTH, INC., Appellee(s). Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 2016-000315-AP-01. L.T. Case No. 2012-025694-SP-05. April 18, 2019. An Appeal from the County Court for Miami-Dade County, Wendell Graham, Judge. Counsel: Nancy Gregoire, and Carloes Carmone, Jr., for appellant(s). Richard E. Doherty, for appellee(s).
(Before CRISTINA MIRANDA, ALAN FINE, RENATHA FRANCIS, JJ.)
(PER CURIAM.) REVERSED.
As an initial matter it appears to be a settled issue, at least in the Eleventh Circuit, that Sec. 627.736(4)(b)(6), Fla. Stat. means what it says:
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 or that the amount of the charge was in excess of that permitted under, or in violation of, subsection (5). Such assertion may be made at any time, including after payment of the claim or after the 30-day period for payment set forth in this paragraph.
Coral Gables Chiropractic PLLC v. United Automobile Ins. Co., 199 So.3d 292 (Fla. 3d DCA 2016) [41 Fla. L. Weekly D687a].
Therefore, upon consideration of the affidavits and other materials submitted by Appellee in opposition to the Appellant’s motion for summary judgment, in the light most favorable to Appellee, it is clear that Appellant raised a genuine issue of material fact on the relatedness and medical necessity of the services and the reasonableness of the charges. Accordingly, summary judgment should not have been granted. Tropical Glass & Const. Co. v. Gitlin, 13 So.3d 156 (Fla. 3d DCA 2009) [34 Fla. L. Weekly D1163a].
This matter is remanded to the County Court for further proceedings consistent with this opinion.
