17 Fla. L. Weekly Supp. 1228a
Online Reference: FLWSUPP 1712COMP
Insurance — Personal injury protection — Coverage — Medical expenses — Policy language requiring that insurer pay claim at 80% of reasonable expenses for medically necessary care controls over permissive language of PIP statute allowing reduced reimbursement rates
BAYFRONT MEDICAL CENTER, INC., a Florida Corporation (assignee of Compas, Fabiana), Plaintiff, vs. ESURANCE INSURANCE COMPANY, Defendant. County Court, 6th Judicial Circuit in and for Pinellas County, Small Claims Division. Case No. UCN 522009SC003762XXSCSC. Ref. No. 09003762SC SPC. August 4, 2010. Edwin B. Jagger, Judge. Counsel: Russel M. Lazega, Law Office of Russel Lazega, P.A., North Miami, for Plaintiff. Anthony J. Parrino, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGMENT AND DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come before the Court on April 14, 2010, on the Parties’ competing Motions for Summary Judgment, and the Court having considered the motions, memoranda, and argument presented by counsel, and being otherwise duly advised in the premises, rules as follows:
This case involves the Florida Motor Vehicle No-Fault (PIP) Law. The newly revived and amended PIP statute went into effect January 1, 2008. The subject policy of insurance was issued on February 19, 2008.
On March 4, 2008, the Defendant’s insured was involved in a motor vehicle accident and treated that same day in the Plaintiffs emergency room. The Defendant subsequently received a bill from the Plaintiff for those services. At issue here is the manner in which payment of the Plaintiff’s bill should be calculated. The Defendant applied a certain percentage reduction to the bill pursuant to the Florida PIP statute. The Plaintiff contends that the adjustment was not authorized under the insurance policy.
This Court agrees with the Plaintiff and finds that the reimbursement limitations set forth in the PIP statute, specifically Fla. Stat. § 627.736(5)(a)(2), are not applicable to the Plaintiffs claim. The Defendant was instead required to pay the Plaintiff’s claim at 80% according to the terms of the insurance policy. While the statute provides that the insurer “may limit reimbursement” to the schedule set forth in Fla. Stat. § 627.736(5)(a)(2), the plain language of the insurance policy provides that the Defendant “will pay. . . 80% of reasonable expenses for medically necessary” care.
The reduced reimbursement rates set forth in Fla. Stat. § 627.736(5)(a)(2) are merely optional and were not referenced in the policy of insurance or otherwise incorporated therein. As such, the mandatory policy language, which provides for broader coverage than the statute, controls over the permissive statutory language. See State Farm Florida Ins. Co. v. Boyd Nichols and Linda Nichols, et al., 21 So.3d 904 (Fla. 5th DCA 2009) [34 Fla. L. Weekly D2275b] (holding that mandatory language of insurance policy controls over permissive statutory language; and, as such, the policy language is not in conflict with the statute and is binding on the parties to the insurance contract).
Accordingly, it is hereby ORDERED AND ADJUDGED that the Plaintiff’s Motion for Partial Summary Judgment is GRANTED and the Defendant’s Motion for Summary Judgment is DENIED.
Given this ruling, the Court finds it unnecessary to address the issue concerning application of the deductible.
The Court will retain jurisdiction of this matter to enter such further orders and/or judgments that are proper and consistent with this ruling. The Court will further reserve jurisdiction on the issue of attorney’s fees and costs.
