7 Fla. L. Weekly Supp. 289a
Insurance — Personal injury Protection — Interest — Insured not entitled to interest on payments for chiropractic services rendered after insurer discontinued chiropractic benefits, because insurer obtained timely report from appropriate physician before terminating chiropractic benefits, and therefore had reasonable proof it was not responsible for payment — Because insurer had reasonable proof as required by statute, no payments were overdue and insured could not be entitled to interest on overdue payments pursuant to no-fault statute — Even if case continued to trial and plaintiff proved services rendered by treating chiropractor were necessary, insurer still would have complied with requirements of no-fault statute before terminating chiropractic benefits — No-fault statute only provides for interest if insurer fails to comply with statute by having reasonable proof that it is not responsible for payment within 30 days of being furnished with notice of loss and amount of loss
Reversed at 10 Fla. L. Weekly Supp. 789b
CARLYNE SANDERS, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 99-4616 COCE 56. January 13, 2000. Linda R. Pratt, Judge. Counsel: Chris Boyar, Singer, Farbman & Associates, P.A., for Plaintiff. Steven R. Woods, Dickstein, Reynolds & Woods, for Defendant.
FINAL SUMMARY JUDGMENT IN FAVOR OF DEFENDANT
THIS CAUSE came before the Court on Defendant’s Motion for Summary Judgment, and the Court having reviewed argument of counsel and being otherwise fully advised in the premises, hereby finds as follows:
1) This is a suit filed by Plaintiff alleging that Defendant wrongfully failed to pay covered losses pursuant to the PIP benefits coverage provided in the policy of insurance issued by Defendant to the Plaintiff. Specifically, the Plaintiff alleges that Defendant failed to pay bills for services rendered by a chiropractor in the amount of $2,169.00.
2) Pursuant to a proper request by Defendant, Plaintiff attended a medical examination with a chiropractor. Defendant received a timely report from the chiropractor in which he opined that future chiropractic care was not reasonable or necessary as related to the subject accident.
3) Plaintiff was informed in a letter dated September 3, 1998. that based on the examiner’s findings and opinions, Defendant would no longer give consideration to chiropractic care effective September 9, 1998. Defendant received the postal service return receipt reflecting that Plaintiff received the letter on September 5, 1998. A copy of the letter was sent to the plaintiff’s treating chiropractor.
4) Pursuant to the plaintiff’s PIP and Med pay coverage, Defendant paid 100% of all of the bills submitted by the Plaintiff’s treating chiropractor for all services up to and including September 9, 1998. Defendant declined to pay bills for chiropractic care for services rendered subsequent to September 9, 1 998. The only bills at issue in the suit are those of the plaintiff’s treating chiropractor for services rendered after the discontinuation of chiropractic benefits.
5) At the time suit was filed, plaintiff’s benefits were not exhausted.
6) Subsequent to filing suit, Plaintiff made claim on Defendant, either directly or by virtue of assignment of benefits, for payment of additional medical expenses other than those of the chiropractor, which are in issue in the suit. Defendant did not contest the necessity of the additional medical expenses submitted after the filing of the lawsuit. Defendant paid the additional expenses to the extent of the remaining benefits. Plaintiff’s benefits were exhausted after suit was filed.
7) Defendant filed a Motion for Summary Judgment alleging that the Plaintiff had received the full benefit of her bargain, the suit was moot and the plaintiff could gain nothing further by the continuation of the suit.
8) Plaintiff asserts that although benefits were indeed exhausted, she could nevertheless go to trial and prove the necessity of the denied chiropractic services, and therefore be entitled to interest pursuant to F.S. sec. 627.736(4). Plaintiff further contends that if she obtained a judgment for interest, she would also be entitled to attorney’s fees under F.S. sec. 624.428.
9) Defendant argues that Plaintiff cannot be entitled to statutory interest because it obtained a timely report from an appropriate physician pursuant to F.S. Sec. 627.736(7) and therefore had “reasonable proof” it was not responsible for payment. Defendant argues that because it had “reasonable proof” as required by the Statute, the bills were not “overdue” and therefore the plaintiff could not be entitled to interest.
It is therefore
ORDERED AND ADJUDGED that Defendant’s Motion for Summary Judgment is hereby GRANTED.
F.S. sec. 627.736(7)(a) provides that before an insurer may withdraw payment of a treating physician without the consent of the insured, it must first obtain a report by a physician licensed under the same chapter as the treating physician whose treatment is sought to be withdrawn, stating that treatment was not reasonable, related or necessary. F S. sec. 627.736(4)(b) provides that any payment shall not be deemed overdue when the insurer has reasonable proof to establish that it is not responsible for payment. The no-fault statute only provides for interest on “overdue” payments. F.S. sec. 627.736(4)(c).
In this case the insurer complied with F.S. 627.736(7) by obtaining a timely report from an appropriate physician before terminating chiropractic benefits. This constituted “reasonable proof” it was not responsible for payment pursuant to F.S. sec. 627.736(4)(b). Therefore no payments are “overdue” and plaintiff cannot be entitled to statutory interest. Even if the case continued to trial and the plaintiff proved the services rendered by the treating chiropractor were necessary, the Defendant still would have complied with the requirements of the no-fault statute before terminating chiropractic benefits. The no-fault statute only provides for interest if the insurer fails to comply with the statute by having reasonable proof that it is not responsible for payment within thirty (30) days of being furnished with the notice of loss and the amount of same.
Accordingly, Summary Judgment is hereby entered in favor of Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY and against Plaintiff, CARLYNE SANDERS and Defendant shall go hence without day. The Court retains jurisdiction to award taxable costs.
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