UNITED AUTO INSURANCE
v.
ABACO CHIROPRACTIC

15th Cir. Ct. App. Div. | 2009-10-05
1 FLCA 1324 Fifteenth Judicial Circuit Court, Appellate Division (2009)

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

United Auto Insurance appeals a summary judgment grant in favor of ABACOA Chiropractic for unpaid PIP benefits. The appellate court reverses, holding that a peer review report based on record review alone—without independent medical examination—can constitute a valid report under Florida's PIP statute, and remands for further analysis of the report's legal sufficiency.


Holding

A valid report under § 627.736(7)(a) may be prepared by a physician reviewing treatment records alone; independent personal examination of the insured is not required. The disjunctive statutory language permits reports prepared either by examining the injured person or by reviewing treatment records. Dr. Marfski's report qualified as potentially valid if it otherwise met the statutory requirements.


Headnotes

[1] A physician's peer review report is considered valid for the purpose of challenging the necessity of medical treatment under a PIP policy if it is prepared and signed by…

[2] A physician's peer review report does not require a personal examination of the injured person to be considered valid, provided the physician reviews the relevant treatme…

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Key Quotes

“A valid report is one that is prepared and signed by the physician examining the injured person or reviewing the treatment records of the injured person and is factually supported by the examination and treatment records if reviewed and that has not been modified by anyone other than the physician.”

The statutory definition of a valid report under § 627.736(7)(a), establishing that the disjunctive 'or' permits reports based on record review without personal examination.

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Facts & Procedural History

United Auto insured Yolanda Rivera under a PIP automobile insurance policy. Ms. Rivera was injured in an automobile accident and treated at ABACOA, as…

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Opinion of the Court

Paul Adams, Esq. and Robert Stein, Esq., 2300 Glades Rd., Suite #200 West, Boca Raton, FL 33431

REVERSED and REMANDED.

United Automobile Insurance Company ("United Auto") appeals the lower court's order granting summary judgment in favor of ABACOA Town Center Chiropractic, Inc., d/b/a ABACOA Physical Medicine, Inc., a/a/o Yolanda Rivera ("ABACOA").

We reverse the decision of the lower court. United Auto insured Yolanda Rivera under a PIP automobile insurance policy. She was involved in an automobile accident wherein Ms. Rivera was treated for her injuries at ABACOA, and she assigned to ABACOA her benefit rights under the policy. ABACOA filed a complaint against United Auto for breach of contract for failure to pay PIP benefits under the policy. Thereafter, ABACOA filed a motion for summary judgment, alleging that all treatment provided was reasonable, related and necessary to Ms. Rivera's recovery pursuant to § 627.736(7), Fla. Stat. (2005).

In support of its motion, ABACOA filed an affidavit of the treating physician. In opposition to ABACOA's motion for summary judgment, United Auto filed the affidavit and peer review report of Dr. Joseph Marfisi, who did not perform an examination of Ms. Rivera but reviewed the treating physician's notes in coming to the conclusion that some of the treatment provided by ABACOA was not reasonable, related or necessary. ABACOA argued that this affidavit and peer review report should not be considered because it was not a "valid report" under section 627.736(7)(a) as it was not based upon an independent medical examination of Ms. Rivera. After a hearing, the lower court agreed with ABACOA and did not consider Dr. Marfisi's report in determining whether an issue of material fact existed. The court then granted ABACOA's motion for summary judgment as well as its motion for attorney's fees.

We review the lower court's granting of summary judgment de novo.

The outcome of this case is controlled by the disjunctive language of the statute. Section 627.736(7)(a) provides:

A valid report is one that is prepared and signed by the physician examining the injured person or reviewing the treatment records of the injured person and is factually supported by the examination and treatment records if reviewed and that has not been modified by anyone other than the physician. (Emphasis added).

It is clear that the physician preparing the report does not have to personally examine the insured so long as the report is prepared by a physician who has reviewed the treatment records of the patient. See also United Automobile Insurance Co. v. Bermudez, 980 So. 2d 1213 (Fla. 3d DCA 2008).

Here, Dr. Marfisi did not himself examine Ms. Rivera. It is clear from the record, however, that Dr. Marfisi prepared his affidavit and report after reviewing the records of the treating physician.

Therefore, reference to Dr. Marfisi's affidavit and peer review was permissible in ruling upon ABACOA's motion for summary judgment so long as Dr. Marfisi's report met the remaining requirements of section 627.736(7)(a).

Based upon the foregoing, it is hereby ORDERED AND ADJUDGED that the order granting summary judgment in favor of ABACOA and the fee judgment are REVERSED. The case is REMANDED for further determination of whether the affidavit and peer review report were otherwise legally sufficient under section 627.736(a).

FRENCH, ROSENBERG and KELLEY, JJ., concur.


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