ALLSTATE INDEMNITY COMPANY, APPELLANT,
v.
MAURICE DERIUS, APPELLEE
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Allstate sought to reduce medical bills under Florida's no-fault insurance statute without obtaining a physician's report as required by Section 627.736(7)(a). The court held that insurers need not obtain a written physician report as a condition precedent to contesting the reasonableness of medical bills, answering the certified question in the negative and reversing summary judgment for the insured.
No. An insurer is not required to obtain a written report from a like-licensed physician as a condition precedent to contesting or reducing payment of a medical bill on grounds of reasonableness, necessity, or relationship to the accident.
[1] An insurance company seeking to reduce medical treatment bills pursuant to Section 627.736(1)(a), Florida Statutes, is not required to first obtain a report from a physic…
[2] Failure to obtain proof that an insurer is not responsible for payment does not deprive the insurer of its right to contest payment.
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Join FLexlaw to unlock all legal intelligence“Must an insurance company, who seeks to reduce bills for medical treatment; pursuant to Section 627.736(l)(a), first obtain a report from a physician licensed under the same licensing chapter as the treating physician stating that the bills for treatment are not reasonable, pursuant to Section 627.736(7)(a), Florida Statutes?”
The certified question of great public importance presented to the appellate court
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Join FLexlaw to unlock all legal intelligenceMaurice Derius was injured in an automobile accident on August 10, 1994, and received medical treatment covered by an Allstate PIP policy. Allstate re…
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LENDERMAN, JOHN C., Associate Judge.
We have on appeal a final summary judgment entered for appellee and containing a certified question of great public importance. This court has jurisdiction pursuant to Florida Rules of Appellate Procedure 9.030(b)(4)(a) and 9.160. The Palm Beach County Court certified the following question of great public importance:
Must an insurance company, who seeks to reduce bills for medical treatment; pursuant to Section 627.736(l)(a), first obtain a report from a physician licensed under the same licensing chapter as the treating physician stating that the bills for treatment are not reasonable, pursuant to Section 627.736(7)(a), Florida Statutes?
We answer the certified question in the negative.
Material Facts
On August 10, 1994, Maurice Derius sustained injuries as a result of an automobile accident. Derius received treatment for injuries sustained during the accident and had a policy with Allstate providing for personal injury protection (PIP) and medical expense coverage. Allstate reduced the amount of some of the doctor bills submitted by Derius, prompting Derius to sue Allstate and alleged that on the basis that the PIP statute required a report from a physician before no-fault benefits could be denied, withheld, or reduced.
The trial court granted Derius summary judgment against Allstate because Allstate did not have a report to contest the reduction of one doctor’s bill. Thus, the issue on appeal is whether a PIP insurer must first obtain a report from a like-licensed physician in order to contest the reasonableness of a treating physician’s bill.
Analysis
A corollary issue was recently addressed by this court in AIU Ins. Co. v. Daidone, 760 So. 2d 1110 (Fla. 4th DCA 2000), where this court disagreed with Perez v. State Farm Fire & Cas. Co., 746 So. 2d 1123 (Fla. 3d DCA 1999), rev. granted, United Auto. Ins. Co. v. Rodriguez, 767 So. 2d 464 (Fla.2000). There, we held that the PIP statute did not require an insurer to obtain a written report as to the reasonableness of treatment within thirty days of notice of the bill in order to contest the payment. We noted that “[flailing to obtain proof that it is not responsible for payment, however, does not deprive the insurer of its right to contest payment.” Id. at 1113. In addition, we noted that this court previously held in Derius v. Allstate Indem. Co., 723 So. 2d 271, 272 (Fla. 4th DCA 1998), that “an insurer is not hable for any medical expense to the extent that it is not a reasonable charge for a particular service or if the service is not necessary.”
We do not interpret section 627.736(7)(a), Florida Statutes (1999), as requiring a written report as a condition precedent to reducing payment of a bill for treatment on the grounds of reasonableness, necessity or relationship. We distinguish this case from United Auto. Ins. Co. v. Viles, 726 So. 2d 320 (Fla. 3d DCA 1998), because in that case the insurer withdrew all payments for treatment as fraudulent and not related to the accident. In the instant case, we deal only with the reduction of a physician’s bill. We answer the certified question in the negative. We reverse the trial court’s entry of final summary judgment entered for Derius and direct that the trial court enter partial summary judgment on this issue in favor of Allstate.
WARNER, C.J., and TAYLOR, J., concur.
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State Farm Mut. Auto. Ins. Co. v. Rhodes & Anderson, D.C., P.A., 18 So. 3d 1059 (Fla. 2d DCA 2008)…ent of PIP benefits. In examining this relationship, we consider one case—United Automobile Insurance Co. v. Viles, 726 So. 2d 320 (Fla. 3d DCA 1999)—which applied section 627.736(7)(a), and another case—Allstate Indemnity Co. v. Derius (Derius II), 773 So. 2d 1190 (Fla. 4th DCA 2000)—which declined to apply it. Section 627.736(7)(a) provides: Whenever the mental or physical condition of an injured person covered by personal injury protection is material to any claim that has been or may be made for past or…
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Allstate Ins. Co. v. Ouida Schall, 778 So. 2d 317 (Fla. 4th DCA 2000)…at the bills for treatment are not reasonable, pursuant to section 627.736(7)(a), Florida Statutes? We agree with the trial court and note that this court has also recently answered this question in the negative. See Allstate Indent. Co. v. Derius, 773 So. 2d 1190 (Fla. 4th DCA 2000). We affirm the trial court’s denials of Schall’s motions for summary judgment and for directed verdict. [*320] Schall also argues m her cross appeal that the trial court erred at trial in allowing Allstate to present to the jury…1 / 2
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Derius v. Allstate Indem. Co., 837 So. 2d 406 (Fla. 2003)…SHAW, Senior Justice. We granted review in Allstate Indemnity Co. v. Derius, 773 So. 2d 1190 (Fla. 4th DCA 2000), based on conflict with Perez v. State Farm, Fire & Casualty Co., 746 So. 2d 1123 (Fla. 3rd DCA 1999), quashed sub nom. United Automobile Insurance Co. v. Rodriguez, 808 So. 2d 82 (Fla.2001). We have jurisdiction. See art. V, § 3…
Previewing 3 of 4 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- Derius v. Allstate Indem. Co., 723 So. 2d 271 (Fla. 4th DCA 1998)
- AIU Ins. Co. v. Daidone, 760 So. 2d 1110 (Fla. 4th DCA 2000)
- Perez v. State Farm Fire & Cas. Co., 746 So. 2d 1123 (Fla. 3d DCA 1999)
- United Auto. Ins. Co. v. Metelit Viles, 726 So. 2d 320 (Fla. 3d DCA 1998)