17 Fla. L. Weekly Supp. 1145a
Online Reference: FLWSUPP 1711MURR
Insurance — Personal injury protection — Coverage — Medical expenses — Emergency services and care — Exhaustion of benefits — Hospital lien — PIP insurers are required to reserve no less than $5,000 of PIP benefits to compensate physicians and dentists licensed under specified chapters who provide emergency services — As of enactment of statute, this $5,000 reserve became an asset exempt from the Hospital Lien Law for 30 days after insurer receives notice of the accident, and exhaustion of benefits defense was not available to insurer, which exhausted benefits by paying entire benefit to hospital — Insurer’s motion for summary judgment denied
ORTHOPAEDIC CLINIC OF DAYTONA BEACH, P.A. as assignee for CHARLES MURRAY, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 7th Judicial Circuit in and for Volusia County. Case No. 2008 33989 COCI. July 15, 2010. Mary Jane Henderson, Judge. Counsel: Luis R. Gracia, Rue & Ziffra, P.A., Port Orange, for Plaintiff. James C. Rinaman, III, Rinaman and Associates, P.A., Jacksonville, for Defendant.
ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE came to be heard on the Motion for Summary Judgment served by Defendant State Farm Mutual Automobile Insurance Company on or about the 29th day of October, 2009. The Court, having heard the argument of counsel and having reviewed legal authorities, considered the pleadings, affidavits of record and being otherwise duly advised in the premises, hereby finds and holds as follows:
I. FINDINGS OF FACT
The Court adopts the following facts as it finds them to be undisputed:
1. Charles Murray was involved in a motor vehicle accident on May 10, 2008.
2. On the same date, and as a result of injuries he sustained in the accident, Mr. Murray was admitted at Halifax Medical Center and began receiving both emergency and inpatient care at the hospital.
3. Due to the nature and extent of Mr. Murray’s injuries, Dr. Malcolm Gottlich, M.D., and Dr. Todd A. McCall, M.D., both board certified orthopedic surgeons licensed under chapter 458 of the Florida Statutes, were called in to render emergency care and inpatient treatment to Mr. Murray. Dr. Gottlich and Dr. McCall are employed with Plaintiff, Orthopaedic Clinic of Daytona Beach, P.A., (Orthopaedic Clinic), and provided care to Mr. Murray on May 10, and on May 12 and 15, 2008, respectively.
4. At all times relevant to this matter Defendant State Farm Mutual Automobile Insurance Company (State Farm) insured Charles Murray under a policy of insurance that provided $10,000.00 in No-Fault/Personal Injury Protection (PIP) benefits.
5. On May 14, 2008, Halifax Medical Center recorded an original signed and notarized claim of lien dated May 12, 2008 for $61,514.20 in the record of Volusia County’s Clerk of Courts. Defendant was thereby purportedly placed on notice of the lien.
6. On May 30, 2008, the Defendant received a bill from Halifax Medical Center in the amount of $140,450.38 requesting payment of PIP benefits for hospital inpatient care rendered to Mr. Murray.
7. Also on May 30, 2008, State Farm received bills submitted by the Plaintiff, Orthopaedic Clinic, for medical services rendered by Dr. Gottlich and Dr. McCall.
8. State Farm chose to pay the entire $10,000.00 of PIP benefits to Halifax Medical Center, thereby exhausting its insured’s available benefits.
9. As State Farm denied payment of Plaintiff’s medical bills due to the fact that it had exhausted benefits by paying all of the policy’s available PIP funds to Halifax Medical Center, Plaintiff filed the present action. Specifically, Plaintiff alleges that section 627.736(4)(c) of the Florida Statutes mandates PIP insurance carriers to reserve $5,000.00 in benefits for payments to physicians such as doctors Gottlich and McCall and, therefore, it precluded State Farm from exhausting benefits on the hospital.
10. State Farm has moved for Summary Judgment alleging that, first, its payment and exhaustion of PIP benefits to Halifax Medical Center was done in good faith and in compliance with the hospital’s properly recorded lien, which State Farm claims has priority over the requirements of Florida’s PIP statute by virtue of Volusia County’s Hospital Lien law as well as cases interpreting hospital lien laws, and, second, that since benefits were exhausted prior to suit being filed there is nothing that the Plaintiff, as assignee of Mr. Murray, can pursue absent a showing of bad faith in the exhaustion of said benefits.
II. CONCLUSIONS OF LAW AND RULING
11. It is well settled that in attempting to discern legislative intent, courts first look to the actual language used in the statute. Daniels v. Florida Dept. of Health, 898 So.2d 61 (Fla. 2005). In addition, when the statute is clear and unambiguous, the plain and ordinary meaning must control, unless this leads to an unreasonable result or a result clearly contrary to legislative intent. Id.
12. Section 627.736 (4)(c) of the Florida Statutes, which was in full force and effect during all times material to this case, states in relevant part:
Upon receiving notice of an accident that is potentially covered by personal injury protection benefits, the insurer must reserve $5,000 of personal injury protection benefits for payment to physicians licensed under chapter 458 or chapter 459 or dentists licensed under chapter 466 who provide emergency services and care, as defined in s. 395.002(9), or who provide hospital inpatient care. The amount required to be held in reserve may be used only to pay claims from such physicians or dentists until 30 days after the date the insurer receives notice of the accident.
13. The Court agrees with the Plaintiff and finds that the language of the statute is clear and unambiguous. PIP insurers must reserve no less than $5,000 of PIP benefits to compensate physicians licensed under the stated chapters of section 627.736 (4)(c) and such amount may only be used to pay claims from such physicians until 30 days after the date the insurer receives notice of the accident.
14. As a result, the Court further holds that as of the enactment of section 627.736 (4)(c), the 55,000 that must be reserved to pay the indicated physicians became an asset exempt from the Hospital Lien Law for 30 days after the insurer receives notice of the accident.
15. The Court has carefully considered State Farm’s argument, and cases in support of such, that Volusia County’s hospital lien law has priority over the clear language of the PIP statute but finds said argument to be unavailing.
16. To be specific, Volusia County’s hospital lien law, which was enacted in 1953 through chapter 2959l of the laws of Florida, states in pertinent part as follows:
Be It Enacted by the Legislature of the State of Florida;
Section 1. Every individual, partnership, firm, association, corporation, institution or any governmental unit or combination or parts thereof maintaining and operating a hospital in Volusia County, Florida, which shall furnish hospital care, treatment and maintenance to any person injured by reason of an accident shall, if such injured person shall assert or maintain a claim against another for damages for such injuries, have a lien upon that part going or belonging to such person (emphasis added), of any recovery of sum had or collected or to be collected by such person or by the legal representatives of such person, whether by judgment or by settlement or compromise, to the amount of the reasonable and necessary charges of such hospital for such hospital care, treatment and maintenance of such person in such hospital, up to the date of payment of such, damage.
17. Thus, the plain language of the law, which allegedly allows Halifax to file its claim of lien against PIP benefits, permits the hospital to have a lien “upon that part going or belonging to [an injured] person, of any sum . . . to be collected by such person . . .” (Emphasis added).
18. The Court finds that when the Legislature amended the PIP statute to require that $5,000 be “reserved” by PIP insurers for 30 days after notice of the accident, those $5,000 could no longer be considered an asset that would “go to or belong to” the insured for that period of time. Instead, that money must (if claims are timely filed) go to, and accordingly belongs to, the providers of emergency services and care or hospital inpatient care as stated in the statute. The $5,000 or the unclaimed amount of it) only becomes available to the insured if no claims are made within the 30 days that use up the entire “reserve”.
19. State Farm relies on several cases which stand for the proposition that a properly perfected lien takes priority over all other personal injury protection benefits. See Fernandez v. South Carolina Insurance Company 408 So.2d 753 (Fla. 3d DCA 1982). State Farm’s reliance on that line of cases is misplaced. As indicated by the Plaintiff in its Response to Defendant’s Filing of Supplemental Authority, the cases cited by State Farm in support of its “hospital lien priority” argument were held prior to the enactment of section 627.736(4)(c).
20. Without having to determine whether the “special law” creating the hospital lien right is constitutional or not, (the Court is aware of the First District Court of Appeal ruling on Mercury Insurance Co. of Florida v. Shands Teaching Hospital and Clinics, Inc., 21 So.3d 38 (Fla. 1st DCA 2009)), it is clear that the statutory change contained in section 627.736(4)(c) allowed for only $5000 of the $10,000 available PIP benefits to be subject to the lien. After 30 days, the unclaimed portion then becomes subject to the lien in the same manner in which a recorded money judgment becomes a lien on real property that ceases to be the homestead of the judgment debtor. Prior to the amendment and enactment of section 627.736(4)(c) in January of 2008, the entire $10,000 benefit was conceivably an asset that could have been paid out to the insured for his or her lost wages or would “belong” to the insured for the payment of the insured’s medical bills.
21.The Court also rejects State Farm’s position regarding its exhaustion of benefits defense. The Court agrees with the Plaintiff that since State Farm must have reserved $5,000 for payment to physicians licensed under chapter 458, exhaustion of benefits is not a defense to Plaintiff’s cause of action. Whether the Defendant acted in good faith or not is not the issue. The issues boil down to whether the Plaintiff timely filed its claim; whether the claim was for services meeting the definition of “emergency services and care”; whether the need for those services was related to the accident; and whether the charges were reasonable. At this point, there appears to be a factual dispute regarding some or all of those questions precluding the entry of a summary judgment. See Holl v. Talcott, 191 So.2d 40 (Fla. 1966).
22. Accordingly, it is ORDERED and ADJUDGED that the Motion for Summary Judgment filed by Defendant State Farm Mutual Automobile Insurance Company is hereby DENIED. The Court reserves jurisdiction over the matter of attorneys’ fees and costs.
