United Auto. Ins. Co. v. VilesUnited Auto. Ins. Co. v. Viles
Deutsch & Blumberg and James C. Blecke, Miami; Sirven & Adams and Tony Sirven, Hialeah, for appellee.
PER CURIAM.
Appellant, United Automobile Insurance Company (“United Auto“) appeals an ordеr directing a verdict in favor of appellee, Metelit Viles (“Viles“), in a breach of contract clаim for Personal Injury Protection (“PIP“) benefits. We affirm based upon our conclusion that
Vilеs filed suit seeking PIP benefits for injuries allegedly sustained by Viles in an October 1995 car accident. United Auto answered аnd affirmatively defended that the chiropractic bills were fraudulent and not reasonably related to the accident in question. United Auto paid $1,100 to Viles before denying payment on the outstanding bills.
At the end of the trial, Vilеs moved for directed verdict arguing that
Whenever the mental or physical condition of an injured persоn covered by personal injury protection is material to any claim that has been or may be madе for past or future personal injury protection insurance benefits, such person shall, upon the requеst of an insurer, submit to mental or physical examination by a physician or physicians.... An insurer may not withdraw paymеnt of a treating physician without the consent of the injured person covered by the personal injury prоtection, unless the insurer first obtains a report by a physician licensed under the same chapter as thе treating physician whose
treatment authorization is sought to be withdrawn, stating that treatment was not reasonаble, related, or necessary.
According to Viles, because United Auto failed to comply with this statutory rеquirement, it was required to pay the entire amount of his chiropractic bills. The court reserved ruling, and the сase was submitted to the jury.
The jury found that Viles had sustained reasonable and necessary medical bills of only $2,000. Since Viles had a $2,000 deductible and the verdict did not exceed that amount, United Auto argued that final judgment should be entered in its favor. However, despite these factual findings, the trial court granted Viles’ renewed motion for dirеcted verdict based upon
Final judgment was entered in favor of Viles in the amount of $3,632.00, the entire remaining sum owed to the doctor, and the triаl court certified the following question of great public importance to this Court:
In any claim for persоnal injury protection benefits in which the insurance carrier has withdrawn, reduced benefits or denied further benеfits, is it a condition precedent pursuant to Section 627.736(7)(a), Florida Statutes, that an insurer obtain a report by a physician licensed under the same chapter as the treating physician stating that the treatment wаs not reasonable, related or necessary in order for the insurance carrier to defend a suit fоr reduction, withdrawal or denial of further payments on the grounds of reasonableness, necessity or relаtionship?
We answer the certified question in the affirmative, and affirm the order below.
In construing statutory language, the words used in legislation must be given their ordinary and commonly accepted meaning. See Hancock Advertising, Inc. v. Dept. of Transportation, 549 So.2d 1086 (Fla. 3d DCA 1989), rev. denied, 558 So.2d 17 (Fla. 1990). Statutes will not be interpreted in a manner that leads to an unreasonable or ridiculous result or a result obviously not intended by the legislature. See Drury v. Harding, 461 So.2d 104 (Fla. 1984); Palm Springs General Hospital, Inc. of Hialeah v. State Farm Mut. Auto. Ins. Co., 218 So.2d 793 (Fla. 3d DCA 1969), affirmed, 232 So.2d 737 (Fla. 1970). Moreover, statutory provisions under Florida‘s no fault laws will be construed liberally in favor of the insured. See Farmer v. Protective Cas. Ins. Co., 530 So.2d 356 (Fla. 2d DCA 1988).
Applying these principles to the language at issue in
This language is part of the independent medical examination requirement of section 627.736(7) which is “intended to give insurers an opportunity to determine the legitimаcy of a claim so that an appropriate decision can be made as to whether benefits should be paid.” U.S. Security Ins. Co. v. Silva, 693 So.2d 593, 596 (Fla. 3d DCA 1997). The quoted language from section 627.736(7)(a) sets up a procedural requirement that an insurer cannot withdraw payment of a treating physician unless the decision is supported by an expert that thе treatment does not comply with the statutory criteria. If the insurer were to act without complying with such a рrocedural requirement, any termination of payment would be ineffective. In this procedural hurdle, we do not discern a legislative intent to alter the burden of proof in a lawsuit for PIP benefits.
We also agree with the trial court‘s determination that because United Auto failed to comply with the statutory condition precedent, its termination of PIP benefits was ineffective. Accordingly, the trial court properly precluded а reduction of the amount sought by Viles. For the reasons stated
Affirmed.