27 Fla. L. Weekly Supp. 1008a
Online Reference: FLWSUPP 2712YAGMInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness, relatedness and necessity of charges — Summary judgment — Opposing affidavit filed by insurer precluded summary judgment in favor of medical provider on issues of reasonableness, relatedness and necessity of charges where affidavit created genuine issue of material fact on all issues raised — Further support for reversal is found in trial court’s expressed confusion over what issues and evidence were before court, which was not clarified
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant, v. FLORIDA CHIROPRACTIC & SPORTS REHAB CENTER, a/a/o Tyler Yagman, Appellee. Circuit Court, 17th Judicial Circuit (Appellate) in and for Broward County. Case No. CACE17-014383 (AP). L.T. Case No. COSO13-005588 (61). December 10, 2019. Appeal from the County Court for the Seventeenth Judicial Circuit, Broward County; Arlene S. Backman, Judge. Counsel: DeeAnn J. McLemore, Banker, Lopez, Gassler, P.A., St. Petersburg, for Appellant. Brian M. Rodier, Rodier & Rodier, P.A., Hallandale, for Appellee.
OPINION
(HENNING, J.) State Farm Mutual Automobile Insurance Company (“State Farm”) appeals a final judgment in favor of Florida Chiropractic & Sports Rehab Center (“Florida Chiropractic”). 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.
Tyler Yagman was injured in an automobile accident on October 27, 2008. He first presented to Florida Chiropractic Sports & Rehab Center (“Florida Chiropractic”) for treatment for his injuries on November 26, 2008. It should be noted that he was involved in another automobile accident on November 25, 2008. Florida Chiropractic later submitted a bill for payment for services rendered to State Farm Mutual Automobile Insurance Company (“State Farm”), which paid a reduced amount. For this reason, Florida Chiropractic filed suit against State Farm to recover personal injury protection (PIP) benefits, claiming breach of contract pursuant to an assignment of benefits by Tyler Yagman. Thereafter, Florida Chiropractic filed a motion for summary judgment regarding the reasonableness, relatedness, and medical necessity of the two charges in dispute. After a hearing, the county court granted summary judgment in favor of Florida Chiropractic. Final Judgment was also entered in favor of Florida Chiropractic. This appeal followed.
Under Florida law, the movant for summary judgment has the initial burden of demonstrating the nonexistence of any genuine issue of material fact. Landers v. Milton, 370 So. 2d 368, 370 (Fla. 1979). In support of its summary judgment motion, Florida Chiropractic relied on the affidavit of Dr. Matthew Cooper to demonstrate the reasonableness, relatedness, and medical necessity of its treatments and charges. State Farm relied upon the affidavit of Dr. Matthew Mathesie to challenge the motion. In his affidavit, after citing specific examples and reasons, Dr. Mathesie opined that treatment was not medically necessary; was not consistent with generally accepted principles of medical practice; was not done in a manner that was clinically appropriate in terms of type, frequency, extent, site, and/or duration; and was rendered without regard to the convenience of the patient, treating physician, or healthcare provider. In addition, Dr. Mathesie stated that, based upon his review of the medical records, the insured did not receive services for numerous CPT codes billed.
In this Court’s de novo review of the evidence presented to the lower court, we find that the Mathesie affidavit clearly created genuine issues of material fact precluding the granting of summary judgment on any issues raised.
Further support for reversal is that during the hearing, the trial judge candidly admitted to being confused over what issues were before the court for determination and what evidence was actually considered for the ruling. Without seeking true clarification or taking the matter under consideration for ruling at a later time, the Court after changing its ruling more than once, ultimately granted Summary Judgment for Florida Chiropractic on all issues.
Accordingly, the Final Judgment in favor of Appellee is hereby REVERSED, and this case is REMANDED to the county court for further proceedings consistent with this Opinion. Appellant’s Motion for Attorneys’ Fees is hereby conditionally GRANTED as to appellate attorney’s fees, contingent on the county court’s determination that Appellant’s proposal for settlement complies with the requirements of law and Appellant ultimately prevailing in the case. Further, Appellee’s Motion for Attorney Fees is hereby DENIED. (SINGHAL and LEDEE, JJ., concur in result only.)
