UNITED AUTOMOBILE INSURANCE COMPANY
v.
PROGRESSIVE HEALTH SERVICES, A/A/O JEAN DEVAUGHN
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United Automobile Insurance Company appeals a summary judgment awarding Progressive Health Services $671.24 for allegedly reasonable PIP charges. The trial court rejected the insurer's affidavit evidence challenging the reasonableness of the medical provider's charges as speculative and conclusory. The appellate court reversed, finding the affidavit sufficient to create a genuine issue of material fact regarding the reasonableness of Progressive Health's charges under Florida's PIP statute.
The court reversed the summary judgment, holding that the adjuster's affidavit was neither speculative nor conclusory and was sufficient to create a genuine issue of material fact regarding whether Progressive Health's charges were reasonable.
[1] An affidavit by an insurance adjustor that describes the adjustor's training and experience and provides data supporting a reasonableness challenge to medical provider ch…
Previewing 1 of 1 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“a medical provider '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.'”
Florida Statutes section 627.736(5)(a)1. describing the statutory requirement that medical providers charge only reasonable amounts for PIP-covered services.
Jean DeVaughn was injured in a 2010 automobile accident and received treatment from Progressive Health Services. Progressive Health, as the assignee o…
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Opinion filed August 4, 2021. Not final until disposition of timely filed motion for rehearing.
________________ No. 3D21-109 Lower Tribunal Nos. 12-665SP & 20-88AP ________________
United Automobile Insurance Company,
Appellant,
vs.
Progressive Health Services, a/a/o Jean Devaughn, Appellee. An Appeal from the County Court for Miami-Dade County, Lawrence D. King, Judge. Michael J. Neimand, for appellant. A Able Advocates – Stuart L. Koenigsberg, P.A., and Stuart L. Koenigsberg, for appellee. Before EMAS, LOGUE and SCALES, JJ. SCALES, J.
United Automobile Insurance Company (“United Automobile”) appeals a summary judgment and subsequent entry of final judgment in favor of Progressive Health Services (“Progressive Health”). We reverse.
Progressive Health is the assignee of PIP benefits of United Automobile’s insured, Jean DeVaughn. After DeVaughn received treatment from Progressive Health for an injury suffered in a 2010 automobile accident, Progressive Health billed United Automobile and received payment that Progressive Health considered insufficient. On January 30, 2012, Progressive Health filed a breach of contract lawsuit against United Automobile. Among its defenses, United Automobile raised the unreasonableness of Progressive Health’s charges pursuant to section 627.736(5) of the Florida Statutes.1 On June 13, 2019, Progressive Health filed a motion for summary judgment on the issue of the reasonableness of its charges, accompanied by a supporting affidavit of its owner, Dr. Jason Levine. United Automobile filed an opposing summary judgment affidavit of its adjustor, Marcia Lay. In 1 This statute provides that a medical provider “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. . . .” § 627.736(5)(a)1., Fla. Stat. (2010).
her affidavit, Lay provided a description of her training and experience, along with the data she used in evaluating Progressive Health’s charges.
The trial court agreed with Progressive Health that its charges were reasonable and granted summary judgment on December 9, 2019. In its order, the trial court found that Lay’s affidavit “is insufficient as a matter of law as it solely presents conclusions of law without supporting facts, and said opinion is therefore speculative.” On March 10, 2020, the trial court entered final judgment, awarding Progressive Health the sum of $671.24.
Upon our de novo2 review of the record, we conclude that Lay’s affidavit is neither speculative nor conclusory, and it is sufficient to create a genuine issue of material fact. See United Auto. Ins. Co. v. Progressive Rehabilitation and Orthopedic Servs., LLC, No. 3D21-108 (Fla. 3d DCA July 21, 2021); United Auto. Ins. Co. v. Cent. Therapy, Inc., No. 3D21-58 (Fla. 3d DCA July 28, 2021).
Reversed.
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