4 Fla. L. Weekly Supp. 510a
Insurance — Personal injury protection — After the fact finding that diagnostic neurological tests were of no use or value in treatment of insured did not support trial court’s conclusion that diagnostic tests did not constitute necessary medical service — Paper review unaccompanied by physical examination not sufficient basis for recommendation that benefits for chiropractic treatment be terminated — After the fact determination that insured received no benefit from last visit with chiropractor does not absolve insurer from liability for expense where last visit was medically necessary
WENDY WILLIAMSON, Appellant, vs. FORTUNE INSURANCE COMPANY, Appellee. 17th Judicial Circuit in and for Broward County, Appellate Division. Case No. 95-4767 (02). L.T. Case No. 94-2670 (60). December 12, 1996. Leonard L. Stafford, Judge.
AMENDED FINAL ORDER
THIS CAUSE, having come before the Court on Appellant, Wendy Williamson’s Appeal from the Final Judgment entered by the County Court on March 16, 1995. The Court having heard argument of counsel, and being fully advised on the premises, hereby finds:
Appellant was injured in an automobile accident on November 10, 1993, and as a result suffered personal injuries which required medical treatment. Appellant was an insured of the defendant/appellee at the time of the subject accident. Appellant submitted the required applications for the benefits and appellee paid certain medical expenses to treating physicians. However, appellee denied payment with regard to certain diagnostic neurological testing ($2390), as well as the final visit to Dr. Seufert. Dr. Seufert was Appellant’s treating chiropractor.
Appellant brought suit against appellee, Fortune Insurance Company seeking recovery of personal injury protection (PIP) benefits alleging that Fortune had wrongfully discontinued payment of PIP benefits for the $195 chiropractic visit and the $2390 of neurological testing. Fortune initially paid PIP benefits for Williamson’s chiropractic treatment. Subsequently, as a result of a paper review evaluation by Dr. Reiter, Fortune denied future payment to Dr. Seufert. Also, Fortune denied payment for the neurological testing based on the result of an independent medical evaluation performed by Dr. Fixel, a board certified orthopedic surgeon.
At trial, appellant presented testimony from Dr. Seufert the chiropractor who treated her for her injuries caused by the accident. Dr. Fixel testified on behalf of Fortune Insurance Company. Dr. Reiter testified only by deposition. The trial court entered judgment in favor of Fortune Insurance Company. The trial court stated that there is no documentation to show that the diagnostic tests were of use or value in the treatment of the patient. Wendy Williamson appeals from the trial court decision denying her payment of the $195 chiropractic visit, and the $2390 of neurological testing.
Section 627.736, Florida Statutes, provides that “every insurance policy complying with the security requirements of Sec. 627.733 shall provide personal injury protection to… persons operating the insured motor vehicle… to a limit of $10,000 for loss sustained by any such person as a result of bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle…”
The insurer must pay “eighty percent of all reasonable expenses for necessary medical, surgical, X-ray, dental, and rehabilitative services” and “sixty percent of any loss of gross income and loss of earning capacity per individual from inability to work proximately caused by the injury sustained by the injured person…”
“The policy of the courts of Florida when construing provisions of the Florida No-Fault Act has always been to construe the act liberally in favor of the insured.” See, Farmer v. Protective Cas. Ins. Co., 530 So.2d 356 (Fla. 2d DCA 1988), citing, Palma v. State Farm Fire & Casualty Co., 489 So.2d 147 (Fla. 4th DCA 1986).
While the record contains evidence which supports the trial court’s finding that the neurological testing were of no use or value in the treatment of the patient, such evidence does not support the trial judge’s conclusion that the use of the diagnostic tests did not constitute a necessary medical service under the No-Fault Act.
The No-Fault Act was intended to broaden insurance coverage while at the same time reasonably limiting the amount of damages which could be claimed. The broad scope of the medical services covered by the No-Fault Act is highlighted by the inclusion of benefits for remedial treatment and services for an injured person who relies upon the spiritual means through prayer alone for healing in accordance with his religious beliefs. See, Palma v. State Farm Fire & Cas. Co., 489 So.2d 147 (Fla. 4th DCA 1986).
An after-the-fact determination that the diagnostic tests were of no value does not absolve Fortune Insurance Company from liability under its insurance policy for this expense. Sec. 627.736. Appellant’s treating chiropractor found it necessary to refer appellant for diagnostic testing because of the accident, and appellant’s prior complaint of pain. The diagnostic testing was a reasonable expense incurred for necessary medical services.
In this Court’s view, it was necessary for Dr. Reiter to conduct a physical examination of appellant prior to issuing his opinion. A paper review of appellant was not a sufficient basis to recommend termination of her benefits with Dr. Seufert. The legislative intent of Sec. 627.736(7)(a) indicates that the last sentence referring to the physician’s report was placed in the same paragraph and should be read in the context of Section 7(a) requiring an actual mental or physical examination and should not be taken out of context of 7(a).
The primary goal to statutory interpretation is to determine the purpose of the legislature. See, Palma v. State Farm Fire & Cas. Co., 489 So.2d 147 (Fla. 4th DCA 1986), citing, Tyson v. Lanier, 156 So.2d 833 (Fla. 1963).
Although appellant may not have received any benefit from her last visit with Dr. Seufert, the visit was still a medical necessary expense. An after-the-fact determination does not absolve appellee from liability under its insurance policy for this expense. In this court’s view, determining a patient’s level of impairment was necessary in order to evaluate the patient’s future treatment.
Accordingly, it is hereby:
ORDERED AND ADJUDGED, the Final Judgment of the Trial Court is REVERSED and Final Judgment be entered in Favor of Plaintiff. This cause is REMANDED to the trial court for further proceedings consistent with this opinion.
Jurisdiction is reserved on the issue of appellate fees and costs to be awarded by this Court.
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