15 Fla. L. Weekly Supp. 249a
Insurance — Personal injury protection — Claims — Timeliness — Requirement that medical bills be submitted to insurer within 35 days of treatment applies to medical providers but not insureds — Insurer’s claim that amendatory endorsement of policy excluding coverage for medical expenses not payable under No-Fault Act bars insured’s recovery is not dispositive where endorsement includes exceptions to exclusion in which coverage may be provided even though medical expenses are not payable under Act
REVERSED. 35 Fla. L. Weekly D150b. (State Farm Mutual Auto. Ins. Co. v. Pressley, Fla. 1DCA, Jan. 12, 2010.)
MELINDA PRESSLEY, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. Circuit Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2007-CA-0003161, Division CV-C. January 2, 2008. L. Haldane Taylor, Judge. Counsel: Bruce A. Gartner, Bruce A. Gartner, P.A., Jacksonville, for Plaintiff. James C. Rinaman, III, James Rinaman, III & Associates, P.A., Jacksonville, for Defendant.
ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE came before the Court on Thursday, November 29, 2007, upon the Defendant’s Motion for Summary Judgment. The Court, having considered the Motion, argument, the record in this cause, and relevant authority, and being otherwise fully advised, finds and concludes as follows:
1. The Plaintiff was involved in a motor vehicle accident on May 6, 2004.
2. The Plaintiff filed her Complaint on May 18, 2007.
3. The Defendant filed its Motion for Summary Judgment on September 4, 2007.
4. The Defendant’s motion states two grounds for dismissing the Complaint. First, “[n]one of the medical bills claimed to be at issue and detailed in the Plaintiff’s demand letter, were submitted to Defendant in accordance with Florida Statute § 627.736(5)(c)(1) (2004).” (Mot. Summ. J. ¶ 6.) Second, the subject policy of insurance contains an exclusion for medical expenses that are not payable under no fault, and the “medical bills that are the subject of this suit are not payable under the No-Fault Act.” (Id. ¶ 15.)
5. The 6910 Amendment to the Policy states:
What Is Not Covered Under Coverage C
THERE IS NO COVERAGE UNDER MEDICAL PAYMENTS:
I. FOR ANY MEDICAL EXPENSES THAT ARE NOT PAYABLE UNDER NO-FAULT — COVERAGE P, except for:
a. the 20% of expenses we do not pay under no-fault — coverage P because of the 80% limitation;
b. expenses not paid because the medical expense benefits of all no-fault coverages that apply have been exhausted;
6. Section 627.736(5)(c)(1) Florida Statutes (2004) provides as follows:
With respect to any treatment or service . . . the statement of charges must be furnished to the insurer by the provider and may not include, and the insurer is not required to pay, charges for treatment or services rendered more than 35 days before the postmark date of the statement.
7. A summary judgment is appropriate “if the pleadings, depositions, answers to interrogatories, and admissions on file together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.” Fla. R. Civ. P. 1.510(c). “To establish entitlement to a summary judgment, the moving party must demonstrate conclusively that no genuine issue exists as to any material fact, even after all reasonable inferences are drawn in favor of the party opposing the summary judgment.” Johnson v. Circle K Corp., 734 So. 2d 536, 536-37 (Fla. 1st DCA 1999) (citing Moore v. Morris, 475 So. 2d 666 (Fla. 1985)).
8. The Court concludes the requirements of section 627.736(5)(c)(1) Florida Statutes (2004) apply to medical providers and not insureds. “[W]hen the language of the statute is clear and unambiguous and conveys a clear and definite meaning, there is no occasion for resorting to the rules of statutory interpretation and construction; the statute must be given its plain and obvious meaning.” GTC, Inc. v. Edgar, 967 So. 2d 781, 785 (Fla. 2007). The Defendant’s own motion states the language “is clear and unambiguous, and requires medical providers to submit its billing.” (Mot. Summ. J. ¶ 8.) Because Florida Statutes section 627.736(5)(c)(1) (2004) states in clear and unambiguous language that medical providers are required to submit bills to insurers within a specified time period, this Court cannot extend that requirement to include insureds where the legislature has not expressed any intention to do so.
9. The Court disagrees with the Defendant’s reliance on Coral Imaging Servs. v. GEICO Indem. Ins. Co., 955 So. 2d 11 (Fla. 3d DCA 2006). Defendant cites Coral Imaging Servs. for the proposition Defendant“is statutorily prohibited from paying the untimely and improperly billed charges at issue in this suit.” (Mot. Summ. J. ¶ 11.) The Third District Court of Appeal, interpreting Florida Statutes section 627.736, held “the intent of the statutory provision at issue was to impose statutory time limits on the submission of medical bills.” Coral Imaging Servs., 955 So. 2d at 16. However, the present case does not involve the submission of bills by a medical provider directly to insurance companies as was present in Coral Imaging Servs., but rather involves submission of a medical lien for reimbursement under PIP by the injured party. As such, Coral Imaging Servs. is distinguishable.
10. The Court also finds without merit the Defendant’ s claim that the subject insurance policy’s 6910 Amendatory Endorsement excludes coverage for expenses not payable under the No-Fault Act. The Defendant claims there is no coverage because the 6910 Amendment includes an exclusionary provision denying coverage “FOR ANY MEDICAL EXPENSES THAT ARE NOT PAYABLE UNDER NO FAULT.” (Mot. Summ. J. ¶ 14.) Under Florida law, “[t]he general rule is that terms of an exclusionary provision are to be narrowly construed in favor of coverage.” Croom’s Transp., Inc. v. Monticello Ins. Co., 692 So. 2d 255, 256 (Fla. 1st DCA 1997). Additionally, Florida law provides that “in construing insurance policies, courts should read each policy as a whole, endeavoring to give every provision its full meaning and operative effect.” Swire Pacific Holdings, Inc. v. Zurich Ins. Co., 845 So. 2d 161, 165 (Fla. 2003). Therefore, the exclusionary provision cannot be read out separate from the remainder of the 6910 Amendment. Given both the general rule of construction in regard to exclusionary provisions and the need to read the entire policy as a whole, the Court looks to the remainder of the 6910 Amendment to give the exclusion its full meaning. In doing so, this Court notes that immediately following the portion of the exclusion quoted by the Defendant are exceptions to that exclusion in which coverage may be provided even though the medical expenses are not payable under the No-Fault Act. Because of these exceptions, the Defendant’s claim that the “medical bills that are the subject of this suit are not payable under the No-Fault Act” is not dispositive of the issue of whether or not the Defendant is liable for coverage. (Mot. Summ. J. ¶ 15.) Thus, this Court concludes the Defendant’s claim that summary judgment should be granted because the 6910 Amendment precludes coverage is without merit.
In light of the above, it is
ORDERED AND ADJUDGED that the Defendant’s Motion for Summary Judgment is hereby DENIED.
