6 Fla. L. Weekly Supp. 648a
Insurance — Personal injury protection — Insurer challenging reasonableness of medical provider’s charges for treatment/testing performed on named insured in action by medical provider as assignee of insured — Florida Statutes, section 627.736, does not require a report from a medical expert when insurer pays only that portion of charge which is reasonable — Matter is properly in binding arbitration — Fact that insurer does not have report from medical expert in case where only issue is whether charges of medical provider are reasonable does not render claim non-arbitrable — Motion to amend complaint denied
SENSORY NEURODIAGNOSTICS (as Assignee of Tessie E. Stepp), Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, an insurance company authorized to do business in FL, Defendant. Cty Court of the 13th Judicial Circuit in and for Hillsborough Cty, Civil Division. Case No. 97-15890-SC, Division “I”. May 25, 1999. Charlotte W. Anderson, Judge. Counsel: Wendy Coxhead, for Plaintiff. Karen A. Barnett, for Defendant.
ORDER ON PLAINTIFF’S MOTION TO AMEND
THIS CAUSE, having come on to be heard on May 11, 1999, on Plaintiff’s Motion to Amend Complaint, the Court having heard argument of counsel, reviewed the file, reviewed the Memoranda of Law and cases, and being otherwise fully advised in the premises, it is hereby ordered and adjudged as follows:
FINDINGS OF FACT
1. In this case, the insurer has challenged the reasonableness of the charges for treatment/testing performed by the plaintiff on the named insured, Tessie Stepp.
2. There has been no attempt to withdraw treatment or deny payment of medical bills incurred by the insured.
3. The insurer paid a portion of the charge submitted by the plaintiff, which they contend is the reasonable charge.
4. The insurer did not obtain a report from a medical expert in this case.
5. The plaintiff has stated that it has an assignment of benefits from the insured and is otherwise subject to the binding arbitration provisions of Florida Statute, §627.736(5).
6. The parties voluntarily submitted to binding arbitration in this matter in October 1997.
CONCLUSIONS OF LAW
1. Florida Statutes, §627.736 requires that all charges submitted to an insurer be reasonable. The Statute further states that the insurer may not withdraw treatment without a report from a medical expert stating that the treatment is not reasonable, necessary or related.
2. The statute does not require a report from a medical expert when the insurer pays only that portion of a charge which is reasonable.
3. United Auto. Ins. Co. v. Viles, 24 Fla. Law Weekly D14 (Fla. 3rd DCA, December 17, 1998) does not require a report from a medical expert where the only issue in the case is whether the charges of the medical provider are reasonable.
4. This matter is properly in binding arbitration.
5. Whether the plaintiff’s charges in this case were reasonable is a question of fact to be decided by the arbitrators.
6. The fact that the insurer does not have a report from a medical expert in this case where the only issue is the reasonableness of the charges does not render the claim non-arbitrable.
WHEREFORE, the Plaintiff’s Motion to Amend the Complaint is Denied.
1. The parties are referred back to binding arbitration for the conclusion of this matter.
2. The Court declines to rule on any question of attorney’s fees and costs until after a determination has been made by the arbitrators.
3. The Court reserves jurisdiction to determine entitlement to fees and the amount thereof following the arbitration of this cause.
* * *
