6 Fla. L. Weekly Supp. 722a
Insurance — Personal injury protection — Insurer, as condition precedent to reducing medical charges and/or defending lawsuit for benefits, must first obtain report from a physician with the same level of licensure as the treating physician, stating that the charges are excessive — Question certified: In a claim for personal injury protection benefits disputing the amount charged by the treating physician, is it a condition precedent, pursuant to F.S. 627.732(7)(a), that the insurer first obtain a report from a physician licensed under the same chapter as the treating physician, stating that the charge is excessive?
BIOCHEMICAL TRAUMA ASSOCIATION, INC. as assignee of Videa Belcon, Plaintiff, vs. PROGRESSIVE SPECIALTY INSURANCE COMPANY, Defendant. County Court of the 13th Judicial Circuit in and for Hillsborough County. Case No. 95-12089-SC, Division H. June 7, 1999. James M. Barton, II, Judge. Counsel: Wendy Coxhead, for Plaintiff. David A. Fifner, for Defendant.
FINAL JUDGMENT AND CERTIFICATION
THIS CAUSE having come before the Court on March 12, 1999 on Plaintiff’s Motion for Summary Judgment, the Court makes the following:
FINDINGS OF FACT
1. Plaintiff, assignee of personal injury protection (PIP) insurance benefits, filed this action for past due bills for medical services.
2. Plaintiff treated the insured for injuries she suffered during an accident, providing neurological treatment.
3. Defendant reduced the amount of the Plaintiff’s medical charges alleging that the charges were in excess of the usual and customary rates.
4. Defendant did not obtain a medical report from another physician prior to the reduction of these charges.
CONCLUSIONS OF LAW
1. Plaintiff’s Motion for Summary Judgment is GRANTED. This court finds that pursuant to United Automobile v. Viles, 726 So. 2d 320 (Fla. 3d DCA 1999), and according to F.S. 627.736(7)(a), an insurer must first, as a condition precedent to reducing medical charges, and/or defending a lawsuit for benefits, obtain a report from a physician with the same level of licensure as the treating physician stating that the charges are excessive.
2. Plaintiff, BIOCHEMICAL TRAUMA ASSOCIATION,(as assignee of Videa Belcon) shall recover from the Defendant, PROGRESSIVE SPECIALTY INSURANCE COMPANY stipulated damages in the amount of $131.09. This court reserves ruling on fees and costs.
CERTIFICATION OF QUESTION OF GREAT PUBLIC IMPORTANCE
This Court certifies the following question as one of great public importance pursuant to Florida Rules of Appellate Procedure 9.030(b)(4)(A), for direct review by the Second District Court of Appeal:
In a claim for personal injury protection benefits disputing the amount charged by the treating physician, is it a condition precedent, pursuant to F.S. 627.732(7)(a), that the insurer first obtain a report from a physician licensed under the same chapter as the treating physician, stating that the charge is excessive?
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