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Ortega v. United Automobile Insurance Co.3/26/2003
Petitioner Pedro Ortega filed a Petition for Writ of Certiorari, seeking to quash an opinion of the Appellate Division of the Circuit Court which affirmed a directed verdict of the County Court entered in favor of Respondent United Automobile Insurance Company (United Auto). We grant the Petition, quash the opinion of the Appellate Division of the Circuit Court, and remand for further proceedings consistent with this Opinion.
Ortega suffered injuries in a May 1999 automobile accident and sought personal injury protection (PIP) benefits from United Auto. In August 1999, United Auto suspended benefits based on the opinion of its IME physician. Ortega subsequently filed an action in the County Court. At trial and on appeal, United Auto contended that, by virtue of Section 627.736(5)(d), Florida Statutes (Supp. 1998), Ortega was required to prove, as part of his prima facie case, that his medical providers were licensed to perform the services that they rendered. Ortega contended that the issue of licensure of his providers would be more appropriately raised as an affirmative defense by United Auto. The trial court agreed with United Auto and directed a verdict in favor of United Auto because Ortega failed to introduce any evidence that his medical providers possessed the valid licenses required to perform their services. On appeal to the Appellate Division of the Circuit Court, the court affirmed the order entered by the County Court. This Petition follows.
The proper inquiry under certiorari review is whether the Circuit Court afforded procedural due process and whether it observed the essential requirements of the law. See Ivey v. Allstate Ins. Co., 774 So. 2d 679, 682 (Fla. 2000) (citing Haines City Community Development v. Heggs, 658 So. 2d 523, 525 (Fla. 1995)). Certiorari jurisdiction is to be sparingly invoked in a situation where the District Court of Appeal is asked to review a decision of the Circuit Court sitting in its appellate capacity. See State v. Miketa, 824 So. 2d 970, 973 (Fla. 3d DCA 2002) (citing Ivey, 774 So. 2d at 682-83). As stated in Ivey, the precedent cases "suggest that the district court should examine the seriousness of the error and use its discretion to correct an error `only when there has been a violation of clearly established principle of law resulting in a miscarriage of justice.'" Ivey, 774 So. 2d at 682 (quoting Stilson v. Allstate Ins. Co., 692 So. 2d 979, 982-83 (Fla. 2d DCA 1997)).
In the instant case, Ortega contends that the Circuit Court departed from the essential requirements of the law when (1) it determined that Section 627.736(5)(d), Florida Statutes (Supp. 1998), required an additional statement of medical providers' licensure in addition to the other items required to provide notice to the insurer; and (2) based on the foregoing determination, concluded that Ortega was required to prove, as part of his prima facie case, that his medical providers were licensed to perform the services that they rendered. We agree with Ortega. Section 627.736(5)(d) , Florida Statutes (Supp. 1998), provides as follows:
All statements and bills for medical services rendered by any physician, hospital, clinic, or other person or institution shall be submitted to the insurer on a Health Care Finance Administration 1500 form, UB 92 forms, or any other standard form approved by the department for purposes of this paragraph. All billings for such services shall, to the extent applicable, follow the Physicians' Current Procedural Terminology (CPT) in the year in which services are rendered. No statement of medical services may include charges for medical services of a person or entity that performed such services without possessing the valid
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