18 Fla. L. Weekly Supp. 1182b
Online Reference: FLWSUPP 1811BAYF
Insurance — Personal injury protection — Coverage — Policy issued during statutory gap period — Where PIP policy was executed during statutory gap period when there was no PIP statute, mandatory policy language requiring that medical expenses be paid at 80% of reasonable charges controls over permissive statutory language allowing for reduced reimbursement
BAYFRONT MEDICAL CENTER, INC., a Florida Corporation (assignee of Mossett, Anita), Plaintiff, vs. METROPOLITAN GENERAL INSURANCE COMPANY, Defendant. County Court, 6th Judicial Circuit in and for Pinellas County, Small Claims Division. Case No. 522010SC002033XXSCSC. Ref. No. 10002033SC 046. August 30, 2011. 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
THIS CAUSE having come before the Court on August 10, 2011, on the Plaintiff’s Motion for Partial Summary Judgment, and the Court having considered the motion, legal 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 2007 PIP statute expired October 1, 2007. The new PIP statute went into effect January 1, 2008. The effective date of the policy of insurance in this case was December 9, 2007 through June 9, 2008. Subsection 627.7407(2), Florida Statutes (2008), provides that “[a]ny 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.”
On April 7, 2008, the Defendant’s insured was involved in a motor vehicle accident and treated that same day in the Plaintiff’s 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 2008 Florida PIP statute. The Plaintiff contends, among other things, that the adjustment was not permitted under the insurance policy.
This Court agrees with the Plaintiff and finds that the Defendant was 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 services.
The reduced reimbursement rates set forth in Fla. Stat. § 627.736(5)(a)(2) are merely optional and the subject policy of insurance was never amended to state otherwise. As such, the mandatory policy language controls over the permissive statutory language. See State Farm Florida Ins. Co. v. Nichols, 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.
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.
