18 Fla. L. Weekly Supp. 620c
Online Reference: FLWSUPP 1807RIGD
Insurance — Personal injury protection — Deductible — Proper formula for payment of PIP claim requires that deductible be subtracted from total billing amount before statutory reductions are applied
FLAGLER HOSPITAL, INC., (as assignee of Jody C. Rigdon), Plaintiff, vs. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. County Court, 7th Judicial Circuit in and for St. Johns County. Case No. SP10-2034, Division 66. April 14, 2011. Charles J. Tinlin, Judge.
ORDER GRANTING PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGMENT
This matter came before the Court for hearing on April 7, 2011, upon Plaintiff’s Motion for Partial Summary Judgment. The issue raised by the Plaintiff is how the insured’s $1,000.00 deductible amount should be applied to the charges billed by the Plaintiff for medical services it rendered to the Defendant’s insured pursuant to his PIP (Personal Injury Protection) benefits under sections 627.736 and 627.739 Florida Statutes.
The Defendant’s insured, Jody C. Rigdon, was injured as a result of a motor vehicle accident and was treated for his injuries by the Plaintiff on November 19, 2008. At the time he had PIP insurance with the Defendant with a $1,000.00 deductible amount and had assigned his benefits to the Plaintiff for billing. The total amount billed for the medical services was $4,584.10 which was sent to the Defendant for payment of which the Defendant paid $1,950.47. The Plaintiff alleges that the amount owed pursuant to its billing is $2,150.46. The controversy between the parties is whether the $1,000.00 deductible should be applied and subtracted from the total billing before the formula for payment pursuant to subsection 627.736(5)(a)2.b is applied or after the percentage reductions are applied.
The Court has earlier ruled on this matter in another of the Plaintiff’s cases, Flagler Hospital, Inc. v. Peak Property & Casualty Insurance Corporation, (Fla. St. Johns Co. Ct., SP-10-l878, April 2011). There the Court found that the proper formulation for the subtraction of the deductible is to subtract it from the total billing amount before the reductions pursuant to section 627.736 are applied. The Court based its opinion on the language in section 627.739(2) which states in pertinent part: The deductible amount must be applied to 100 percent of the expenses and loses described in s. 627.736 (emphasis added). The Court also relied on the Senate Staff Analysis for these statutory sections as well as an example for formulation cited in West’s Florida Practice Series, 7 Fla. Prac, Motor Vehicle No-Fault Law (PIP) sec 2:2(2010-2011 Ed.) where subsection (c) states in pertinent part:
. . . for policies written on or after October 1, 2003, the computations would be as follows:
Total Bill = $10,000.00 – $1,000.00 (maximum of PIP Deductible) = $9.000.00 x 80% = $7200.00 payable from PIP.
Therefore, the Court finds that the proper formula for payment based on the billing amount in the instant case would be as follows:
Total Bill = $4,584.10 – $1,000.00 deductible = $3,584.10 x 75% = $2.688/07 x 80 % = $2,150.46.
In its finding the Court is only ruling on the issue of the proper formula to be applied to the total amount billed pursuant to sections 627.736 and 627.739 F.S. and is not making a finding about the reasonableness of the amount billed or what is due and owing as those issues have not been raised in the Plaintiff’s motion for partial summary judgment.
WHEREFORE, it is hereby
ORDERED AND ADJUDGED that the Plaintiff’s Motion for Partial Summary Judgment is GRANTED as to the issue of the application of the insured’s deductible pursuant to section 627.739 (2) Florida Statutes.
