17 Fla. L. Weekly Supp. 33b
Online Reference: FLWSUPP 1701AMAD
Insurance — Personal injury protection — Coverage — Medical expenses — Because amendment to PIP statute giving insurer option to pay charges at 200% of applicable Medicare Part B or Workers’ Compensation fee schedules with effective date of January 1, 2008, does not affect insured’s substantive contract rights, amendment applies to policy that went into effect before January 1, 2008, where assignment of benefits and medical services occurred after January 1, 2008 — Question certified
AMERICAN MOBILE HEALTH SERVICES, (a/a/o Joaquin Amador), Plaintiff, v. U.S. SECURITY INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 08-7044 SP 26 04. August 26, 2009. Eugene J. Fierro, Judge. Counsel: Wajih Ali Shirazi, for Plaintiff. David B. Pakula and Alina Palacios-Hart, for Defendant.
FINAL SUMMARY JUDGMENT
This matter came before the court on August 19, 2009 on the defendant’s Motion for Final Summary Judgment and the plaintiff’s Motion for Summary Judgment. Appearing as counsel were David B. Pakula, Esq., and Alina Palacios-Hart, Esq. for the defendant, U.S. Security Insurance Company, and Wajih Ali Shirazi, Esq. for the plaintiff, American Mobile Health Services, a/a/o Joaquin Amador. The resolution of this matter boils down to one issue: whether § 627.726(5)(a)2-5, Fla. Stat., with an effective date of January 1, 2008, applies to the facts of this case in a manner permitted by the Florida Constitution. The statutory amendment allows an insurer to limit the amount of personal injury protection (PIP) benefits payable to a medical provider to 200% of amounts reimbursable under Medicare Part B or Workers’ Compensation fee schedules. The insurance policy went into effect on December 16, 2007. The accident, the assignment of benefits and the medical services occurred after January 1, 2008, during the policy period.
The court must decide if the amendment affects substantive rights under the insurance contract. The medical provider stands in the shoes of the insured by taking an assignment of benefits. Therefore, the rights at issue would be those of the insured.
The court finds that the statutory amendment does not affect the insured’s substantive contract rights. It does not increase the premium paid by the insured or the insured’s financial obligation for the services rendered, and it does not reduce the amount of PIP coverage or the amount of treatment received by the insured. The plaintiff’s counsel argues that, prospectively, medical providers might not provide services to an insured because of the limitations on payment. However, this court finds that whether as a result of the statutory amendment a provider might or might not render treatment, prospectively, is not germane to the issue before the court.
For the foregoing reasons, it is ordered and adjudged that the plaintiff’s Motion for Summary Judgment is denied, and the defendant’s Motion for Final Summary Judgment is granted. Final summary judgment is hereby entered in favor of U.S. Security Insurance Company. The plaintiff shall take nothing by this action, and the defendant shall go hence without day.
Pursuant to Fla. R. App. P. 9.160, the court certifies the following question to be one of great public importance:
DOES THE FEE SCHEDULE LIMITATION OF PAYMENT TO A MEDICAL PROVIDER SET FORTH IN § 627.726(5)(a)2-5, FLA. STAT., WITH AN EFFECTIVE DATE OF JANUARY 1, 2008, APPLY CONSTITUTIONALLY TO AN INSURANCE CONTRACT THAT WENT INTO EFFECT BEFORE JANUARY 1, 2008, WHERE THE ASSIGNMENT OF BENEFITS TO THE MEDICAL PROVIDER AND THE MEDICAL SERVICES OCCURRED AFTER JANUARY 1, 2008?
