8 Fla. L. Weekly Supp. 398a
Insurance — Personal injury protection — Summary judgment motion based on medical provider’s lack of standing to bring action for PIP benefits granted where insured executed document purporting to be assignment of benefits to medical provider and on same date executed another document stating that his benefits were not being assigned to medical provider — Legal effect of two documents was that documents canceled each other out making both a nullity — Insurer not entitled to summary judgment on ground that charges for performing an MRI were not medically necessary as matter of law and therefore no benefits are payable where affidavit of treating doctor stating that, based upon his care and treatment of insured, MRI was reasonable and necessary created genuine issues of material fact as to necessity of MRI
FLORIDA MRI, INC. (Rene Belidor), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 99-21108 COCE 53. February 27, 2001. William W. Herring, Judge. Counsel: Amir Fleischer, for Plaintiff. Steven R. Woods, Dickstein, Reynolds & Woods, Ft. Lauderdale, for Defendant.
ORDER ON MOTION FOR SUMMARY JUDGMENT
THIS CAUSE came before the Court on August 25, 2000, on the Motion for Summary Judgment filed by defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, and the Court having heard argument of counsel and being otherwise fully advised in the premises, finds as follows:
1. This is an action for PIP benefits brought by a medical provider. The Defendant-Insurer has filed a Motion for Summary Judgment asserting two grounds.
2. In the first ground, Defendant asserts that the Plaintiff-Provider lacked standing to bring the suit.
3. Plaintiff alleges that it has standing by virtue of an assignment attached to its Complaint, which is signed by the insured.
4. Defendant alleges in its First Affirmative Defense that:
“Plaintiff does not have standing to pursue this claim. Although the insured executed a document purporting to be an assignment of benefits in favor of the Plaintiff, on the same date the insured also executed a document stating that his benefits were not being assigned to the Plaintiff. As a result, the Plaintiff has no standing.”
5. The Deposition of the insured was taken on May 15, 2000. The transcript of said deposition has been filed with the Court. The insured testified that he signed exhibits “3” and “4” to his deposition. These documents reflect that they were signed on October 13, 1999. Exhibit “3” to the insured’s deposition is a copy of the assignment of benefits executed by the insured. This is the document that the Plaintiff attached to its Complaint as a basis for asserting standing. Exhibit “4” to the insured’s deposition, which he executed on the same day as the assignment, states in pertinent part, “THIS IS NOT AN ASSIGNMENT OF BENEFITS. I have not made you the owner of any benefits due me and hereby retain all my entitlement thereto, subject to the power conferred on you as set forth above.”
6. It is undisputed that the insured executed exhibits “3” and “4” to his deposition. These documents are inconsistent. Although the insured executed a document purporting to be an assignment of benefits, he also executed at the same time a document stating that
he had not assigned benefits to the Plaintiff.
7. The second basis for Summary Judgment asserted by Defendant is that, as a matter of law, the charges in question were not medically necessary and therefore no benefits are payable. Specifically, the Defendant asserts that Plaintiff seeks to recover charges for performing an MRI and that based upon the deposition testimony of the insured, the MRI was not medically necessary as a matter of law.
8. The insured testified that he received a letter from State Farm attached to his deposition as exhibit “1”. This letter was a request that the insured attend an independent medical examination. The insured testified that he took the letter from State Farm to his treating physician, Dr. Green. The insured further testified that Dr. Green told him to have an MRI because of the letter. He also testified that the reason he got the MRI is because he received the letter. He further testified that Dr. Green did not give him any other reason for having the MRI other than the letter sent by State Farm.
9. Defendant points out that the letter, which the insured testified caused him to have the MRI, was simply a request that the insured attend an Independent Medical Examination and that he bring any MRI films with him. Defendant argues that as a matter of law this letter cannot establish a medically necessary basis for obtaining an MRI. However, Plaintiff served an affidavit from the treating doctor setting forth that, based upon his care and treatment of the insured, he determined that an MRI was needed and that in his professional opinion an MRI was reasonable and necessary. Based upon the affidavit of the treating doctor the Court finds there is a genuine issue of material fact as to the necessity of the MRI.
Based upon the foregoing findings, it is hereby,
ORDERED AND ADJUDGED that:
1. The Defendant’s Motion for Summary Judgment is granted as to the first basis asserted. The two documents executed by the insured on the same date are inconsistent. Based upon this Court’s prior ruling in OGD Diagnostic Rehabilitation Services, Inc. v. Allstate Insurance Company, 6 Florida Law Weekly Supp. 725, the legal effect of a healthcare provider having an insured sign one document that says it is not an assignment of benefits, and simultaneously having the insured sign another document that says it is an assignment, is that the documents cancel each other out making both a nullity. Accordingly, the Plaintiff lacked standing. The date of the two documents is significant to the Court because they were executed prior to the Florida Supreme Court’s decision in Delta Casualty Company v. Pinnacle Medical, 753 So. 2d 55 (2/3/00). The healthcare provider was playing it both ways so that they could produce either form depending upon how the Florida Supreme Court decided Delta Casualty. A ruling to the contrary would create an untold potential for abuse.
2. The Motion for Summary Judgment is denied as to the second basis asserted. The affidavit of the treating doctor creates an genuine issue of material fact giving all benefit of the doubt to the non-moving party.
__________________
FINAL SUMMARY JUDGMENT IN FAVOR OF DEFENDANT
THIS CAUSE came before the Court on August 25, 2000, on the Motion for Summary Judgment filed by defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY. The Court having heard argument of counsel and being otherwise fully advised in the premises, and having set forth its findings of fact and conclusions of law in the Order on Defendant’s Motion for Summary Judgment also entered on this date, the Court hereby enters Summary Judgment in favor of Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY and against Plaintiff, FLORIDA MRI, INC. Defendant shall go hence without day. The Court retains jurisdiction to award taxable costs and reasonable attorney’s fees if Defendant is so entitled.
* * *
