18 Fla. L. Weekly Supp. 406a
Online Reference: FLWSUPP 1804BERM
Insurance — Personal injury protection — Coverage — Mandatory policy language providing that insurer will pay 80% of reasonable charges controls over permissive language of PIP statute that allows more limited reimbursement
ACK-TEN GROUP, LLC D/B/A SEACREST OPEN MRI, a Florida Corporation (assignee of Berman, Tara), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE CO., Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 50-2009-SC-011674XXXXSB. February 7, 2011. Reginald Corlew, Judge.
ORDER GRANTING PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGMENT
THIS CAUSE came before the Court for hearing on January 14, 2011 on Plaintiff’s Motion for Partial Summary Judgment and the Court, having reviewed the motion; entire Court file; and relevant legal authorities and heard argument of counsel finds as follows:
Background: This is a P.I.P. case. Tara Berman received MRI services from the Plaintiff on January 2, 2009 for injuries sustained in an automobile accident on December 16, 2008. The applicable policy was issued on July 17, 2008 and provides “We will pay in accordance with the No-Fault Act. . . medical expenses: 80% of the reasonable charges incurred for necessary medical . . . services.”
Defendant issued payment at less than 80% of the amount charged by the Plaintiff and maintains that this payment was properly made according to the reimbursement limitations set forth in F.S. s. 627.736 (“fee schedule”). The Plaintiff moves for partial summary judgment asserting that the Defendant’s payment pursuant to the fee schedule was improper and that the Defendant is bound by the plain language of its policy which provides broader coverage than the permissive fee schedule and requires payment to be made at 80% of the reasonable charges incurred.
Legal Conclusions: The Court finds that the mandatory terms of the Defendant’s policy (which states: “We will pay in accordance with the No-Fault Act. . . medical expenses: 80% of the reasonable charges incurred for necessary medical. . .services”) control over the permissive language of the P.I.P. statute (which states: “The insurer may limit reimbursement”) and that the Defendant is obligated to “80% of medical expenses” as required by the plain language of its policy regardless of the limitation permitted by the statute. See State Farm v. Nichols, 21 So.3d 904 (Fla. 5th DCA 2009) [34 Fla. L. Weekly D2275b].
Accordingly, it is hereby:
ORDERED AND ADJUDGED that the Plaintiff’s Motion for Partial Summary Judgment is GRANTED. The Defendant was not permitted to apply the permissive fee limitation set forth in the P.I.P. statute to the Plaintiff’s claim; rather, Defendant was required to issue payment at 80% of Plaintiff’s medical expenses because the applicable policy required payment to be made as such.
