7 Fla. L. Weekly Supp. 505b
Insurance — Personal injury protection — Denial of benefits based upon physician’s report that treatment was not reasonable, related, or necessary — Report need not be based upon actual physical examination of patient — Statute requires interest on late payments to accrue from date bill is received by insurer
County court order at 6 Fla. L. Weekly Supp. 721b
GOVERNMENT EMPLOYEES INSURANCE COMPANY, Defendant/Appellant, vs. MICHELLE FIGUEROA, Plaintiff/Appellee. Circuit Court, 13th Judicial Circuit (Appellate) in and for Hillsborough County, Civil Division. Case No. 99-4386, Division J. May 22, 2000. Edward H. Ward, Judge. Counsel: Vince Iacano, for Appellant. Timothy A. Patrick and Mark Tischhauser, for Appellee.
APPELLATE OPINION
THIS CAUSE came before the Court upon Government Employees Insurance Company’s (hereinafter GEICO) appeal of a final summary judgment entered by the county court in favor of Michelle Figueroa. For the reasons stated below, this Court reverses in part, affirms in part, and remands this case to the county court for proceedings consistent with this opinion.
The facts pertinent to this appeal are straightforward. Michelle Figueroa made claims for personal injury protection benefits under her policy of insurance with GEICO for a video-fluoroscopy and chiropractic treatment. The video-fluoroscopy was provided by Nu-Best Diagnostic Labs, Inc. and was interpreted by Dr. William E. Gatlin, M.D. Both Nu-Best and Dr. Gatlin submitted bills to GEICO for payment under Ms. Figueroa’s PIP policy. GEICO denied payment of Nu-Best and Dr. Gatlin’s bills pursuant to a peer-review report of John Kurpa, D.C. Chiropractor Kurpa’s report was based upon a review of the pertinent medical records but he did not perform an actual physical examination of Ms. Figueroa. He concluded that the video-fluoroscopy was “performed without medical necessity, reasonableness or relatedness to the collision.” In addition, Robert D. Densmore, D.C. submitted bills to GEICO for chiropractic treatment provided to Ms. Figueroa. GEICO paid two of these bills thirty-six (36) days after they were received and included interest for six (6) days.
Ms. Figueroa filed a motion for summary judgment arguing that Section 627.736(7), Florida Statutes, and the decision of United Automobile Insurance Co. v. Viles, 726 So.2d 320 (Fla. 3rd DCA 1999) required that the report in this case be based upon an actual physical examination of Ms. Figueroa. Because no physical examination occurred, Ms. Figueroa argued that GEICO should be precluded from defending the claim and that she was entitled to judgment as a matter of law. In addition, Ms. Figueroa argued that Section 627.736(4)(b) requires late payment of PIP benefits to include interest from the time the bill was received by the insurer. Ms. Figueroa argued that GEICO should have paid thirty-six (36) days of interest rather than the six (6) days worth paid by GEICO, and she argued that she was entitled to judgment as a matter of law.
The county court found that Section 627.736(7)(a) and the decision in Viles do require a report to be based upon an actual physical examination and entered judgment in favor of Ms. Figueroa requiring GEICO to pay the charges of Nu-Best and Dr. Gatlin. In addition, the county court found that Section 627.736(4)(b) does require interest to be paid from the day the bill was received by GEICO and entered judgment in favor of Ms. Figueroa requiring GEICO to pay thirty-six (36) days of interest. GEICO filed this timely appeal.
After considering the briefs, oral argument of the parties, and the points and authorities presented, this court holds that Section 627.736(7)(a), Florida Statutes, does not require a report to be based upon a physical examination of the patient. Nationwide Mutual Fire Insurance Co. v. Southeast Diagnostics, Inc., [25 Fla. L. Weekly D316] 2000 WL 121801 (Fla. 4th DCA 2000); United Automobile Insurance Co. v. Viles, 726 So.2d 320 (Fla. 3rd DCA 1999). To that extent, the summary judgment is reversed as to the bills of Nu-Best and Dr. Gatlin. However, this court holds that Section 627.736(4)(b) does require interest on late payments to accrue from the date the bill is received by the insurer. Thus, GEICO should have paid thirty-six (36) days of interest for the two bills paid late to Chiropractor Densmore instead of only six (6) days interest. To that extent, the summary judgment is affirmed.
This cause is reversed in part, affirmed in part, and is remanded to the trial court for proceedings consistent with this opinion.
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