 |
 |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|
|
|
|
State Farm Mutual Automobile Co. v. Renfroe10/31/2005
. Insertion of the word "medically" before "necessary" did not change the fact that the benefits provided were medical benefits or that the medical procedure, treatment or service must have been necessary. The amendment only clarified that not all medical procedures, treatment, or services were covered under the PIP provisions of the policy.
Before the Legislature defined "medically necessary" in section 5 of the act, the fact finder was left with great discretion to determine if a claimed expense was medically necessary. See Derius v. Allstate Indem. Co., 723 So. 2d 271 (Fla. 4th DCA 1998). Obviously, different fact finders could make different determinations as to what medical procedures, treatment or services were "medically necessary" based on similar facts. The courts have recognized that, if the Legislature chose to do so, they had the prerogative of defining the procedures, treatment or services that would qualify as "medically necessary," thus eliminating the potential for inconsistent results. See State Farm Mutual Auto. Ins. Co. v. Sestile, 821 So. 2d 1244, 1246 (Fla. 2nd DCA 2002) (citing Derius, 723 So. 2d at 274).
In passing section 627.732(2), Florida Statutes, section 5 of the act, the Legislature chose to exercise its prerogative. Under the statute, "medically necessary" is now defined as:
a medical service or supply that a prudent physician would provide for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptom in a manner that is:
(a) In accordance with generally accepted standards of medical practice;
(b) Clinically appropriate in terms of type, frequency, extent, site and duration; and
(c) Not primarily for the convenience of the patient, physician, or other health care provider.
ยง 627.732(2), Fla. Stat. (2001). Since the effective date of the definition was June 19, 2001, and the accident triggering the treatment at issue occurred in September of 2001, the "medically necessary" definition set forth in section 627.732(2), Florida Statutes, applied.
Conclusion
In refusing to apply the definition of medically necessary, the circuit court departed from the essential requirements of law. We GRANT the petition for writ of certiorari, QUASH the circuit court's order, and REMAND for proceedings consistent with this opinion.
WOLF and THOMAS, JJ., CONCUR.
Page 1 2 Florida Personal Injury Attorneys
Personal Injury Lawyers
|
| |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|