State Farm Mutual Automobile Insurance Co. v. Rhodes & Anderson, D.C., P.A.

18 So. 3d 1059, 2008 Fla. App. LEXIS 4342, 2008 WL 786856
CourtDistrict Court of Appeal of Florida
DecidedMarch 26, 2008
Docket2D07-3109
StatusPublished
Cited by11 cases

This text of 18 So. 3d 1059 (State Farm Mutual Automobile Insurance Co. v. Rhodes & Anderson, D.C., P.A.) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Farm Mutual Automobile Insurance Co. v. Rhodes & Anderson, D.C., P.A., 18 So. 3d 1059, 2008 Fla. App. LEXIS 4342, 2008 WL 786856 (Fla. Ct. App. 2008).

Opinion

CANADY, Judge.

State Farm Mutual Automobile Insurance Company seeks certiorari review of the circuit court’s decision affirming final summary judgments entered in county court personal injury protection (PIP) actions in favor of the respondent, which is a provider of chiropractic care. For the reasons expressed below, we grant the petition and quash the circuit court’s order.

*1061 I. Background

In three separate county court cases, the respondent filed actions against State Farm for PIP benefits. In each of the cases, the respondent had provided treatment to State Farm’s insureds for injuries sustained in automobile accidents. The respondent submitted charges to State Farm for certain diagnostic tests, and State Farm denied payment for the tests on the basis that the tests were not reasonable or medically necessary. State Farm’s denials of payment were based on reviews of the insureds’ records by licensed chiropractors.

The respondent filed motions for summary judgment in each of the cases, arguing that State Farm was precluded from defending against the respondent’s claims for PIP benefits because State Farm denied payment for diagnostic tests before obtaining a valid report under section 627.736(7)(a), Florida Statutes (2003), which requires a valid report based on a physical examination conducted by a similarly licensed physician before payment can be withdrawn. Concluding that the denials of payment in these three cases constitute withdrawals of payment as contemplated by section 627.736(7), the county court entered summary judgment against State Farm.

State Farm appealed the orders of summary judgment to the circuit court, and the cases were consolidated on appeal. State Farm argued in the circuit court — as it had in the county court — that the denials of payment in the instant cases did not constitute withdrawals of payment under section 627.736(7). State Farm asserted that the denial of payment for a particular bill or service is governed by section 627.736(4)(b), which does not require a physical examination before payment is denied. The circuit court agreed with the county court that section 62?.736(7)(a) applies and that State Farm did not obtain valid reports before withdrawing payment to the provider.

In its petition for writ of certiorari, State Farm argues that the circuit court’s opinion finds no support in section 627.736(7)(a). It claims that State Farm never withdrew payment to the provider or contested the authorization to continue treatment of the insureds and that, therefore, section 627.736(7)(a) was not implicated.

II. Analysis

A. Standard for Second-Tier Certiorari Review

Second-tier certiorari review “is limited to those instances where the lower court did not afford procedural due process or departed from the essential requirements of law,” and it “should not be used to grant a second appeal.” Allstate Ins. Co. v. Kaklamanos, 843 So.2d 885, 889 (Fla.2003).

[ T]he departure from the essential requirements of the law necessary for the issuance of a writ of certiorari is something more than a simple legal error. A district court should exercise its discretion to grant certiorari review only when there has been a violation of a clearly established principle of law resulting in a miscarriage of justice.

Id. “ ‘[Ajpplied the correct law’ is synonymous with ‘observing the essential requirements of law.’ ” Haines City Cmty. Dev. v. Heggs, 658 So.2d 523, 530 (Fla.1995). “[I]n addition to case law dealing with the same issue of law, an interpretation or application of a statute, a procedural rule, or a constitutional provision may be the basis for granting certiorari review.” Kaklamanos, 843 So.2d at 890.

Second-tier certiorari relief has been afforded because a miscarriage of justice has resulted when a “circuit court’s [appellate] *1062 decision establishes a rule of general application” for future cases in county court, “thus exacerbating the effect of the [circuit court’s] legal error.” Progressive Express Ins. Co. v. McGrath Cmty. Chiropractic, 913 So.2d 1281, 1287 (Fla. 2d DCA 2005); see also Gould v. State, 974 So.2d 441 (Fla. 2d DCA 2007); State Farm Fla. Ins. Co. v. Lorenzo, 969 So.2d 393, 398 (Fla. 5th DCA 2007).

B. The Appropriateness of State Farm’s Denials of Payment

To determine whether State Farm is entitled to relief, we begin by examining the relationship between section 627.736(7)(a)’s specific restriction on “withdrawing] payment of a treating physician” and section 627.736(4)(b)’s general provisions regarding payment 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 future personal injury protection insurance benefits, such person shall, upon the request of an insurer, submit to mental or physical examination by a physician or physicians.... 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.

(Emphasis added.) The issue in this case is whether this provision applies when the insurer seeks to deny a single payment for treatment.

In Viles, 726 So.2d at 320, the insured sought PIP benefits for injuries sustained in an accident, but the insurer defended on the ground that the chiropractic bills were fraudulent and not reasonably related to the accident. The insurer had paid a portion of the bills but denied payment on outstanding bills. The insured sought a directed verdict on the basis that the insurer must obtain a valid report under section 627.736(7)(a) before withdrawing payment. The county court granted the directed verdict in favor of the insured because the insurer “failed to obtain a physician[’]s report prior to denying payment.” Id. at 321. The county court certified the following question of great public importance:

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Bluebook (online)
18 So. 3d 1059, 2008 Fla. App. LEXIS 4342, 2008 WL 786856, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-mutual-automobile-insurance-co-v-rhodes-anderson-dc-pa-fladistctapp-2008.