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Allstate Insurance v. Schall
Citations: 778 So. 2d 317; 2000 Fla. App. LEXIS 16619; 2000 WL 1854102Docket: No. 4D99-3908
Court: District Court of Appeal of Florida; December 19, 2000; Florida; State Appellate Court
Allstate Insurance Company appeals a partial summary judgment in favor of Ouida Schall regarding payment for a neurological test denied under her personal injury protection (PIP) insurance. Schall cross-appeals the denial of her motions for summary judgment and directed verdict, as well as a jury verdict against her. Following an automobile accident, Schall was treated by a licensed chiropractor, who conducted a nerve test on July 9, 1997. Allstate received the bill on August 5, 1997, but took 34 days to send it for review, ultimately denying payment based on a report stating the test was not medically necessary. Additionally, Allstate reduced payments for other related tests, asserting they exceeded reasonable charges. The trial court ruled in favor of Schall for the nerve test, citing Allstate's failure to pay or obtain reasonable proof of non-responsibility within 30 days, violating section 627.736(4)(b), Florida Statutes (1997). Allstate contests this ruling, referencing a precedent that allows insurers to contest payments without obtaining such proof within the specified timeframe. Consequently, the court found that Allstate should not be penalized for not securing proof in this case. The trial court also denied Schall's summary judgment on the range of motion test bills, determining Allstate was not obligated to obtain a report from a physician licensed under the same chapter as Schall's treating physician to justify its payment reduction. As a result, the appellate court reverses the summary judgment for Schall regarding the nerve test and remands for trial, while affirming the trial court's denial of Schall’s motions related to the range of motion test claims. The trial court posed a significant question regarding whether an insurance company must obtain a report from a physician licensed under the same chapter as the treating physician before contesting the reasonableness of medical bills as per section 627.736(1)(a) and section 627.736(7)(a) of Florida Statutes. The court concurred with the trial court's decision, aligning with its previous ruling in Allstate Indent. Co. v. Derius, which asserted that such a report is not required. The trial court's denials of Schall's motions for summary judgment and directed verdict were upheld. Schall's cross appeal, which argued that the trial court improperly allowed Allstate to present the issue of the necessity of range of motion tests without sufficient evidence, was also dismissed. The court emphasized that an insurer's failure to prove non-responsibility does not negate its right to contest payment. The jury's verdict favoring Allstate was affirmed, and the appeal was reversed while the cross appeal was affirmed. Additionally, the court noted a certified conflict with Perez v. State Farm Fire and Cas. Co. and referenced Daidone regarding the insurer's rights in payment disputes.