7 Fla. L. Weekly Supp. 324b
Insurance — Personal injury protection — PIP insurer refusing to pay insured’s medical bills on ground that medical treatment was not related, reasonable, or necessary must obtain reasonable proof that it is not responsible within thirty days of receiving written notice of the fact of a covered loss and the amount of the loss — Issue of reasonableness of insured’s medical bills should not have been presented to jury where insurer obtained report that bills were not reasonable or necessary more than thirty days after bills were submitted to insured’s adjuster
LORNA BENT, Appellant, v. ALLSTATE INSURANCE COMPANY, Appellee. Circuit Court, 15th Judicial Circuit (Appellate) in and for Palm Beach County. Case No. AP 98-4955 AY. Opinion filed February 25, 2000. Appeal from Nancy Perez, J., County Court in and for Palm Beach County. Counsel: Allen R. Seaman, Lake Worth. Steven W. Kuveikis, Boca Raton. Richard A. Sherman, Ft. Lauderdale.
(PER CURIAM.) The issue in this case is how long does an insurer have to verify medical PIP claims after receipt of the bills, pursuant to Florida Statute 627.736. Under Fla. Stat. § 627.736 the only defense an insurer has in not paying the insured’s medical bills is that the medical treatment was not related, not reasonable and/or not necessary. The insurer must obtain a report through an independent medical examination, by a doctor licensed under the same chapter as the treating physician, stating one of the above reasons that payment should be discontinued. This is required under Fla. Stat. § 627.736(7) to constitute “reasonable proof” and must be obtained within 30 days of receiving written notice of the fact of a covered loss and of the amount of the same before an insurance company can defend on the basis that the medical bills are not reasonable, related and/or necessary. Id.
Lorna Bent submitted bills for diagnostic tests to Allstate’s adjuster on March 3, 1995. On May 18, 1995, Allstate obtained a report that the bills were not reasonable or necessary and denied the claim. Lorna Bent brought suit against Allstate.
Judge Perez initially ruled in favor of Bent on a motion for partial summary judgment. She subsequently reversed the order and allowed the case to go to the jury. A verdict was entered, finding the bills not to be reasonable or necessary. This issue should not have been presented to the jury.
In Perez v. State Farm Fire and Cas. Co., and United Auto. Ins. Co. v. Rodriguez, 23 Fla. L. Weekly D2355 (Fla. 3d DCA October 13, 1999) it was held that the PIP statute requires the insurer to obtain reasonable proof within thirty days that it is not responsible for the payment. If the insurer fails in this regard, it must immediately pay the claim and interest. See also Amador v. United Auto. Ins. Co., 24 Fla. L. Weekly D2437 (Fla. 3d DCA October 27, 1999); Fortune Ins. Co. v. Pacheco, 695 So.2d 394 (Fla. 3d DCA 1997); Martinez v. Fortune Ins. Co., 684 So.2d 201 (Fla. 4th DCA 1996); United Auto. Ins. Co. v. Viles, 726 So. 2d 320 (Fla. 3d DCA 1998). This Court further remands this case to the trial court for a determination of attorneys fees and costs and prejudgment interest.
REVERSED/REMANDED. (CARLISLE, RAPP AND FINE, JJ., concur.)
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