27 Fla. L. Weekly Supp. 127a
Online Reference: FLWSUPP 2702ENCAInsurance — Personal injury protection — Coverage — Medical expenses — Trial court erred in finding that insurer could not contest relatedness and necessity of claim because it had partially paid claim — Trial court also erred in rejecting affidavit regarding reasonableness of charges as conclusory
UNITED AUTOMOBILE INSURANCE CO., Appellant, v. COUNTY LINE CHIROPRACTIC CENTER a/a/o Eddyth Encarnacion, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 16-455 AP. L.T. Case No. 2011-009134 SP 23. March 25, 2019. On Appeal from the County Court in and for Miami-Dade County, Caryn C. Schwartz, Judge. Counsel: Michael J. Neimand, for Appellant. G. Bart Billbrough, and Michael P. Brodi, for Appellee.
OPINION
(Before PEDRO P. ECHARTE, JR., ALBERTO MILIAN, and MONICA GORDO, JJ.)
(ECHARTE, J.) This is a PIP case in which a medical provider is suing an insurer for paying less than the full amount billed for treatment of injuries allegedly sustained in a motor-vehicle accident. The trial court refused to consider the insurer’s affidavit regarding relatedness and necessity, finding that because the insurer had partially paid the claim, it could not contest the relatedness and necessity of the claim. The trial court also found that the affidavit concerning reasonableness, submitted by the insurer, was insufficient. Therefore, it granted summary judgment in favor of the medical provider. We reverse.
The clear and unambiguous language of Florida Statute section 627.736(4)(b) allows an insurer to assert that a claim is unrelated or not medically necessary at any time, even after payment. See § 627.736(4)(b), Fla. Stat. (2009); State Farm Mut. Auto. Ins. Co. v. Roberto Rivera-Morales, M.D., a/a/o Joseph, 26 Fla. L. Weekly Supp. 454a (Fla. 11th Cir. Ct. July 17, 2018); State Farm Mut. Auto. Ins. Co. v. Health & Wellness Assocs., Inc. a/a/o Scott, 25 Fla. L. Weekly Supp. 220a (Fla. 11th Cir. Ct. May 24, 2017). Accordingly, the trial court erred in refusing to consider the insurer’s affidavit concerning relatedness and necessity.
Furthermore, upon our de novo review of the insurer’s reasonableness affidavit, we determine it complies with the requirements of Florida Rule of Civil Procedure 1.501(e), and that it is not conclusory or otherwise improper. Therefore, the trial court erred in rejecting it.
Accordingly, the summary judgment and final judgment entered below are hereby REVERSED. (MILIAN and GORDO, JJ., concur.)
