7 Fla. L. Weekly Supp. 591a
Insurance — Personal injury protection — Before insurer reduces medical charges and/or defends lawsuit for benefits, insurer must obtain report from physician stating that charges are excessive — Requirement that report be obtained applies to any nonpayment of medical benefit due to finding that services were not reasonable, related, or necessary, including a reduction of benefits based upon finding that medical charges were in excess of usual and customary rates
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant/Defendant, v. RICKY LOCKETT D.O., d/b/a WHOLISTIC REHAB ASSOCIATES, as assignee of Kenneth Mascarina, Appellee/Plaintiff. Circuit Court, 13th Judicial Circuit (Appellate) in and for Hillsborough County, Civil Division. Case No. 00-395, Division J. June 6, 2000. Edward H. Ward, Judge. Counsel: Robert H. Oxendine and Gerard P. Duignan, Oxendine & Oxendine, P.A., Tampa. Wendy Coxhead, Tampa.
OPINION AFFIRMING ORDER OF COUNTY COURT
THIS CAUSE is before the Court on Appellant, State Farm Automobile Insurance Company’s, Appeal from the county court’s Final Judgment and Certification in favor of Appellee, Ricky Lockett. The Court, having reviewed the briefs of both parties, considered the legal authority cited to the Court by the parties, and being otherwise fully advised in the premises, finds that the county court’s order is AFFIRMED.
This action arose from Appellant’s failure to obtain a physician’s report, as mandated by Section 627.736(7)(a), Florida Statutes, prior to reducing payment to Appellee, a medical provider of State Farm’s insured. In reliance on United Auto. Ins. Co. v. Viles, 726 So. 2d 320 (Fla. 3d DCA 1998) the lower court granted Appellee’s Motion for Summary Judgment and held that 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. Appellant failed to obtain such a report before reducing Appellee’s medical charges, claiming that they were in excess of the usual and customary rates.
Appellant contends that the Viles decision only applies to cases involving a withdrawal or denial of medical payments, not an insurer’s reduced payment of medical bills, as in the case here. On the other hand, Appellee argues that §627.736(7)(a) and Viles do apply to situations involving an insurers’ reduction of charges. Appellee points out that the certified question in Viles, which was answered affirmatively, specifically encompassed whether a physician’s report is required prior to reducing, withdrawing, or denying benefits.
After careful consideration of the Viles decision and other cases cited to the Court by Appellant, the Court cannot make a pragmatic distinction between reducing and withdrawing or denying benefits. It clearly appears to the Court that Viles and §627.736(7)(a) contemplate any nonpayment of medical payment due to a finding that the services were not reasonable, related, or necessary. It is therefore
ORDERED AND ADJUDGED that the decision of the county court is AFFIRMED. It is further ORDERED that Appellee’s Motion to Tax Attorney’s Fees and Costs is GRANTED, and this matter is remanded for an evidentiary hearing to determine costs and reasonable appellate attorney’s fees.
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