United Automobile Insurance Company v. Progressive Rehabilitation and Orthopedic Services, LLC, a/a/o Yasel Alonso
In a PIP suit over the reasonableness of medical charges, the county court granted summary judgment for the provider after finding the insurer's adjuster affidavit purely speculative. The Third DCA reversed, holding the adjuster's affidavit rested on a discernible, factually based chain of reasoning a her experience, education, review of the claims file and charges, fee schedules, and the statutory factors in section 627.736(5)(a) a and thus created a genuine issue of material fact. The court also clarified that the Daubert standard codified in section 90.702 does not categorically bar experience-based expert opinion.
Key facts
- United Automobile Insurance Company sought to challenge the reasonableness of medical charges billed by Progressive Rehabilitation and Orthopedic Services, LLC in a personal injury protection (PIP) insurance dispute involving patient Yasel Alonso.
- The county court granted summary judgment in favor of the medical provider, finding that the insurer's adjuster affidavit was purely speculative and lacked evidentiary support.
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Why it matters
The opinion is useful ammunition for insurers (and any party) defending the sufficiency of a claims-adjuster or experience-based expert affidavit against a 'purely speculative' attack, and it gives a workable… — full analysis with a trial
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