16 Fla. L. Weekly Supp. 668a
Online Reference: FLWSUPP 167BROW3
Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary services — Statutory amendment reviving previously repealed No-Fault Law does not apply to insurance policy periods that expired before January 1, 2008 — Where accident occurred during policy period that expired before January 1, 2008, insured is entitled to 80% of charges for reasonable, related and necessary services despite fact that treatment at issue was provided after January 1
CIEARA BROWN, an insured individual, by and through her assignee, BIGLEY & ASSOCIATES, P.A., d/b/a PREMIER ORTHOPEDICS OF ORLANDO, Plaintiff, v. MGA INSURANCE COMPANY, INC., Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 08-SC-8731. May 8, 2009. John E. Jordan, Judge. Counsel: David S. Dougherty, The Coury Law Firm, P.A., Lake Mary. Hanton Walters.
ORDER GRANTING PLAINTIFF’S MOTION FOR FINAL SUMMARY JUDGMENT AND DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE, having come before the Court and the Court having reviewed the Plaintiff’s Motion for Final Summary Judgment and Defendant’s Motion for Summary Judgment and being otherwise fully advised in the premises:
1. The parties stipulate that, for purposes of these competing summary judgment motions, only an issue of law is presented, namely, whether the 2007 or the 2008 version of Florida Statute §627.736 (commonly referred to as the Florida Motor Vehicle No-Fault law) applies to this action.
2. This case arises out of a contract for personal injury protection (PIP) insurance, which was in effect from February 15, 2007 to August 15, 2007.
3. The subject accident occurred during this policy period on May 7, 2007.
4. At the time of the accident, the relevant portion of the 2007 PIP statute provided that an insurer shall provide medical benefits consisting of:
“. . .Eighty percent of all reasonable expenses for medically necessary medical, surgical, x-ray, dental and rehabilitative services. . . .” See Fla. Stat. §627.736(1)(a) (2007)
5. The 2008 version of the statute, which took effect on January 1, 2008, amended section 627.736 to add the following provision.
“The insurer may limit reimbursement to 80 percent of the following schedule of maximum charges. . .” See Fla. Stat. 627.736(5)(a)(2) (2008) (This new provision incorporates the Medicare Part B Fee Schedule as the schedule.)
6. The treatment at issue is the initial examination which occurred on February 29, 2008, and the re-examination which occurred on March 12, 2008.
7. Defendant received bills for these examinations in the amount of $500.00 and $250.00 on March 24, 2008 and March 26, 2008, respectively.
8. Defendant subsequently paid $240.08 and $102.43, which would comply with the 2008 Medicare Part B Participating Physicians Fee Schedule; however it does not represent 80% of the charge for medically necessary services reasonably related to the accident.
9. Plaintiff is seeking the remaining balance from its charges in the amount of $159.92 and 97.57, respectively, for a sum total of $257.49 in PIP benefits.
10. In the absence of any ambiguity, the plain meaning of the statute prevails.
11. Florida Statute §627.7407(2) states: “Any personal injury protection policy in effect on or after January 1, 2008, shall be deemed to incorporate the provisions of the Florida Motor Vehicle No-Fault Law, as revived and amended by this act.” Since the policy period at issue expired on August 15, 2007, it is clear that it was not in effect on January 1, 2008. The 2008 amendment reviving the previously repealed Florida Motor Vehicle No-Fault Law does not apply to insurance policy periods that expired before January 1, 2008.
Therefore, it is hereby ORDERED AND ADJUDGED as follows:
12. Based upon the pleadings, interrogatory answers, admissions, depositions, joint stipulations and affidavits on file, if any, there is no genuine issue as to any material fact and the Plaintiff is entitled to summary judgment in its favor and against the Defendant as a matter of law.
13. Defendant’s Motion for Summary Judgment is DENIED.
14. Plaintiff’s Motion for Final Summary Judgment is GRANTED.
