STATE FARM MUTUAL

v.

FLORIDA WELLNESS & REHAB CENTER OF FIU KENDALL

Appellant State Farm Mutual Automobile Insurance Company (“Appellant”) appeals from a Final Judgment dated February 22, 2017. Appellant contends the lower court erred in finding Appellee Florida Wellness and Rehabilitation Center of FIU/Kendall, LLC (“Appellee”) had proven its charges for chiropractic treatments were reasonable as a matter of law and in entering summary judgment in Appellee’s favor on that issue. This Court agrees with Appellant. The Final Judgment is hereby REVERSED and this matter is REMANDED to the County Court for further proceedings consistent with this opinion.

“Our standard of review of an order granting summary judgment is de novo.” White v. Ferco Motors Corp., 260 So. 3d 388, 390 (Fla. 3d DCA 2018). “We review the record to determine whether there are genuine issues of material fact that preclude summary judgment.” Id. In this case, Appellant raises three principal arguments on appeal. Specifically, Appellant contends the lower court’s Final Judgment should be reversed because (1) “reasonableness” is always a question of fact for a jury; (2) Appellee’s evidence was insufficient to satisfy its burden on summary judgment; and, (3) Appellant submitted evidence that demonstrated the existence of a genuine issue of material fact.

First, this Court rejects Appellant’s invitation to broadly hold that there is no case, and there are no circumstances, which would permit a court to determine that [*3] “reasonableness” had been established as a matter of law. It is sufficient for our purposes that, in this case, Appellant demonstrated the existence of a genuine issue of material fact.

Second, this Court rejects Appellant’s contention that Appellee failed to meet its initial prima facie burden. The Florida legislature has unambiguously provided that one can look to, among other things, evidence of the provider’s usual and customary charges and payments accepted by the provider involved in the dispute. See Fla. Stat. § 627.736(5)(a)1. (2010). Specifically, the statute provides, Any physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by personal injury protection insurance may charge the insurer and injured party only a reasonable amount pursuant to this section for the services and supplies rendered….In no event, however, may such a charge be in excess of the amount the person or institution customarily chargers for like services or supplies. With respect to a determination of whether a charge for a particular service, treatment, or otherwise is reasonable, consideration may be given to evidence of usual and customary charges and payments accepted by the provider involved in the dispute, and reimbursement levels in the community and various federal and state medical fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service, treatment or supply.

Id.

In this case, Appellee contends the mere submission of its bill is prima facie evidence of the reasonableness of the amount charged in said bill. This Court need [*4] not reach the issue of whether the presentation of Appellee’s bill, standing alone, is sufficient to meet Appellee’s prima facie burden. In this case, Appellee presented its bill and the affidavit of a Mr. Franz Schiebel. Appellee contends that, with Mr. Schiebel’s affidavit and the presentation of its bill, it has satisfied its initial, prima facie burden. This Court agrees. Mr. Schiebel attests to being Appellee’s records custodian. (R. at 82). Mr. Schiebel also attests to having personally “reviewed hundreds of medical files for billing records or patients, including the amounts billed for various CPT codes and the amounts reimbursed for various CPT codes” and determined that the charges in this case “did not exceed the amount the institution customarily charged for the same treatments, services, and supplies.” (R.82). Finally, Mr. Schiebel attests to having arrived at Appellee’s usual and customary charge after, among other things, conducting an “informal and random survey of other similar treatment facilities in the community to assess their prices and what is reimbursed to them.” (R. at 83).

Mr. Schiebel does not need to be an expert to testify on matters over which he has personal knowledge. See generally § 90.701 Fla. Stat. (2020); see also e.g. L.L. v. State, 189 So. 3d 252, 257 (Fla. 3d DCA 2016) (noting a distinction between testimony that requires “specialized knowledge” and testimony derived from “personal knowledge”). In this case, Mr. Schiebel’s affidavit provides a basis for [*5] how he obtained knowledge of Appellee’s usual and customary charges and reimbursements. The Florida Legislature has identified this sort of information as relevant to a determination of the reasonableness of a particular charge. See Fla. Stat. § 627.736(5)(a) (2010) (“With respect to a determination of whether a charge…is reasonable, consideration may be given to evidence of usual and customary charges and payments accepted by the provider involved in the dispute….”). It would appear the information provided by Mr. Schiebel, if left unrebutted, would be sufficient to establish that the charges at issue in this case were reasonable, thus allowing Appellee to meet its initial, prima facie burden on summary judgment. See Bryan A. Garner, Black’s Law Dictionary (10th ed. 2014) (defining “prima facie” as “sufficient to establish a fact or raise a presumption unless disproved or rebutted; based on what seems to be true on first examination, even though it may later be proved to be untrue.”). This Court, therefore, agrees with the lower court that Appellee met its initial burden.

Finally, Appellant contends it was able to demonstrate the existence of a genuine issue of material fact—namely, a dispute concerning the reasonableness of the charge(s). This Court agrees with Appellant. Much like Appellee produced an affidavit attesting to its usual and customary charges and reimbursements, Appellant produced affidavits attesting to alleged reimbursement amounts in South Florida and [*6] various fee schedules. See Affidavit of Mr. Michael W. Mathesie, D.C. at (R. 185- 202); see also Affidavit of Nicole Bonaparte, CPC, CPC-I at (R. 245-53). The Florida Legislature has identified the sort of information reviewed by Mr. Mathesie and Ms. Bonaparte as relevant to a determination of the reasonableness of a particular charge. See Fla. Stat. § 627.736(5)(a) (2010) (“consideration may be given to…reimbursement levels in the community and various federal and state medical fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement….”). Having reviewed said information, Mr. Mathesie and Ms. Bonaparte concluded Appellee’s charges are not reasonable. It would appear, therefore, that there is a genuine dispute concerning the reasonableness of Appellee’s charges. This genuine dispute precludes summary judgment.

Accordingly, the Final Judgment dated February 22, 2017 is REVERSED. This case is hereby REMANDED for further proceedings consistent with this Opinion. Appellee’s Motion for Appellate Attorney’s Fees is DENIED. Appellant’s Motion for Appellate Attorney’s Fees is GRANTED, so long as Appellant prevails on remand.

WALSH AND TRAWICK, JJ. CONCUR