CENTRAL MAGNETIC IMAGING OPEN MRI OF PLANTATION, LTD., A/A/O EVELYN DESHOMMES, PETITIONER,
v.
STATE FARM FIRE AND CASUALTY INSURANCE COMPANY, RESPONDENT

Fla. 4th DCA | 2009-11-18
No. 4D09-1457
STEVENSON, GERBER and LEVINE, JJ., concur.
22 So. 3d 782 Florida District Court of Appeal, Fourth District (2009) Positive Treatment
Cited by 11 cases

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

Central Magnetic Imaging sought certiorari review of a circuit court decision that reversed summary judgment and held that an insurer need not obtain an independent medical examination (IME) before denying a personal injury protection (PIP) claim, as long as a valid peer review report is obtained. The Florida Fourth District Court of Appeal affirmed the circuit court, holding that section 627.736(7)(a) permits denial of PIP claims based on a physician's review of treatment records without requiring an IME.


Holding

The statute does not require an insurer to obtain an IME before denying a PIP claim. A valid report under section 627.736(7)(a) may be based on a physician's review of treatment records, which constitutes a valid peer review report, without requiring a physical examination of the injured person.


Headnotes

[1] A "valid report" under Florida Statute section 627.736(7)(a) does not require an insurer to obtain an independent medical examination (IME) before denying a claim for per…

[2] A valid report under Florida Statute section 627.736(7)(a) may be based on a physician's review of the claimant's treatment records.

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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 plain language of section 627.736(7)(a) explicitly permitting reports based on review of treatment records without requiring an IME.

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Facts & Procedural History

On March 5, 2005, Evelyn Deshommes was in an auto accident. Within 90 days, she received 47 chiropractic treatments at Advanced Chiropractic, often on…

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Opinion of the Court
PER CURIAM.

PER CURIAM.

Central Magnetic Imaging Open MRI of Plantation, Ltd. (Central Magnetic) petitions this court for second-tier certiorari review of an appellate decision of the circuit court. We deny the petition but write to address one of the issues raised.

On March 5, 2005, the insured, Evelyn Deshommes, was involved in an auto accident. In the ninety days that followed, she received forty-seven chiropractic treatments at Advanced Chiropractic and Medical Center (Advanced Chiropractic), many times on successive days and up to four days in a row. Then, just before treatment was terminated, Advanced Chiropractic ordered an MRI at Central Magnetic. Central Magnetic, as assignee of Deshommes’s personal injury protection (PIP) benefits, submitted a bill for the MRI.

*783Deshommes’s insurer, State Farm Fire and Casualty Insurance Company (State Farm), had a doctor review Deshommes’s treatment and billing records. Based on his review of the records, the doctor submitted a report opining that the MRI was unreasonable, unrelated to the accident at issue, and medically unnecessary. State Farm refused to pay Central Magnetic’s bill.

Central Magnetic filed suit in county court for breach of Deshommes’s insurance contract. State Farm argued that the MRI was not reasonable, related, or necessary to any injury arising from the accident. Central Magnetic moved for summary judgment arguing that State Farm could not contest the MRI bill because it had failed to comply with section 627.736(7)(a), which requires an insurer to obtain a report from a qualified physician before withdrawing payment of a treating physician without the injured person’s consent. Central Magnetic argued that the report obtained by State Farm was invalid because the report was based solely on review of treatment records and not based on an independent medical examination (IME) of the insured.

The county court granted summary judgment in Central Magnetic’s favor. On appeal, the circuit court reversed, concluding that the statute does not require an IME before payment can be denied and that State Farm had obtained a valid report before denying payment. Central Magnetic seeks second-tier certiorari review of this decision.

The circuit court applied the correct law and afforded procedural due process, so we deny the petition. See Allstate Ins. Co. v. Kaklamanos, 843 So.2d 885, 889 (Fla.2003) (explaining the standard of review in second-tier certiorari proceedings from appellate decisions of the circuit court).

The issue that warrants discussion in this case is whether section 627.736(7)(a), Florida Statutes, requires an insurer to obtain an IME before denying a PIP claim or whether a “valid report” under the statute may be based on an expert’s review of the claimant’s treatment records, a so-called “peer review report.” Circuit and county court judges have interpreted the “valid report” requirement of the PIP statute differently. We conclude, in line with the Third District Court of Appeal, that the “valid report” required by the statute does not require an insurer to order an IME before denying a claim for PIP benefits. See United Auto. Ins. Co. v. Metro Injury & Rehab Ctr., 16 So.3d 897 (Fla. 3d DCA 2009); United Auto. Ins. Co. v. Bermudez, 980 So.2d 1213 (Fla. 3d DCA 2008), receded from on other grounds by United Auto. Ins. Co. v. Santa Fe Med. Ctr., 21 So.3d 60 (Fla. 3d DCA 2009) (en banc).

The disagreement among the lower courts arises from the 2001 amendment to section 627.736(7)(a). See Ch. 2001-271, § 6, Laws of Fla. This amendment added the following underlined language to this subsection:

An insurer may not withdraw payment of a treating physician without the consent of the injured person covered by the personal injury protection, unless the insurer first obtains a valid report by a Florida physician licensed under the same chapter as the treating physician whose treatment authorization is sought to be withdrawn, stating that treatment was not reasonable, related, or necessary. 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.

*784§ 627.736(7)(a), Fla. Stat. (2008) (emphasis added). The plain language of the statute permits a report to be based on review of treatment records. “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 ....” § 627.736(7)(a), Fla. Stat. (2008) (emphasis added).

Our case law before the 2001 amendment clearly permitted “peer review reports” and squarely held that an insurer was not required to obtain an IME before denying a PIP claim. Nationwide Mut. Fire Ins. Co. v. Se. Diagnostics, Inc., 766 So.2d 229 (Fla. 4th DCA 2000) (holding that a report under section 627.736(7)(a) can be based on review of medical records and need not be based on a physical examination). This court explained:

We can find no language in the [statute] that requires the medical report to be based upon a physical examination of the insured. Without express language from the legislature, there is no reason to conclude that a physical examination is required. We can envision many instances in which a competent physician upon reviewing medical records could conclude without the benefit of a physical examination that a treatment or test was not “reasonable, related, or necessary.” If we follow Southeast’s reasoning to its logical conclusion, every time a treating physician to whom a PIP carrier has paid benefits either conducted a diagnostic test or referred an insured for diagnostic testing, no matter how unconventional or medically unsound, a physical examination would be required before the payment could be refused.

Id. at 230-31 (emphasis added). We adhere to this sound reasoning and do not believe that the 2001 amendment requires otherwise.

The circuit court applied the correct law when it held that an IME is not required before a PIP claim may be denied.1 None of the other arguments raised in the petition merit any relief or discussion.

The petition for writ of certiorari is denied.

STEVENSON, GERBER and LEVINE, JJ., concur.


Cases With Similar Vibessemantic neighbors from the corpus


Citator

Cited By

  • MRI Assocs. OF Am. v. State Farm Fire & Cas. Co., 61 So. 3d 462 (Fla. 4th DCA 2011)
    …e appellate panel of the circuit court reversed and remanded to the county court for the entry of a judgment in favor of State Farm. First, the court applied Central Magnetic Imaging Open MRI of Plantation, Ltd. v. State Farm Fire and Cas. Ins. Co., 22 So. 3d 782 (Fla. 4th DCA 2009), to hold that the expert’s report could have been a proper basis for State Farm’s denial of the bill. Second, the court relied on Fountain Imaging of West Palm Beach, LLC v. Progressive Express Ins. Co., 14 Fla. L. Weekly Supp. 6…
  • United Auto. Ins. Co. v. Hollywood Injury Rehab Ctr., 27 So. 3d 743 (Fla. 4th DCA 2010)
    …. See Haines City Cmty. Dev. v. Heggs, 658 So. 2d 523, 530 (Fla.1995). We find a departure based on the law as explained by this court in the recent decision of Cent. Magnetic Imaging Open MRI of Plantation, Ltd. v. State Farm Fire & Cas. Ins. Co., 22 So. 3d 782 (Fla. 4th DCA 2009). As this court noted, a “valid report” as anticipated by section 627.736(7)(a), Florida Statutes, does not require an insurer to order an IME before denying a claim for PIP benefits. In Cent. Magnetic Imaging, we noted that our c…
  • United Auto. Ins. Co. v. Peter F. Merkle, M.D., P.A., 32 So. 3d 159 (Fla. 4th DCA 2010)
    …he circuit court did not provide leave for United to amend the affidavit. United then filed this petition for certiorari from that decision. In the interim, we decided Central Magnetic Imaging Open MRI of Plantation v. State Farm Fire and Casualty, 22 So. 3d 782 (Fla. 4th DCA 2009). In Central Magnetic, we concluded that an IME is not required for a peer review report. This is consistent with a recent decision by the Third District in United Automobile Insurance Co. v. Metro Injury & Rehab Center, 16 So. 3d…

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