18 Fla. L. Weekly Supp. 92a
Online Reference: FLWSUPP 1801NAVA
Insurance — Personal injury protection — Coverage — Policy issued during statutory gap period — Where reenacted PIP statute provided that reenacted law was effective January 1, 2008, and expressly provided that any PIP policy in effect on or after that date would be deemed to incorporate provisions of reenacted law, insurer was entitled to pay claim for treatment provided after January 1, 2008, in accordance with fee schedule provided in reenacted statute notwithstanding fact that policy was purchased or renewed during statutory gap period created by sunsetting of PIP statute
OASIS DIAGNOSTIC CENTER, INC., a/a/o Maritza Navarro, Plaintiff, v. PROPERTY & CASUALTY INSURANCE COMPANY OF HARTFORD, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 08 06792 SP 26. September 8, 2010. Honorable Patricia Marino Pedraza, Judge. Counsel: Tahya Fuenmayor. Scott W. Dutton, Dutton Law Group, PA, Tampa.
FINAL SUMMARY JUDGMENT
THIS MATTER came on to be heard on July 13, 2010 on the Defendant’s Motion for Summary Judgment. After having reviewed the Defendant’s motion, reviewed the affidavits and exhibits in support of defendant’s motion, and hearing the argument from counsel for Property & Casualty Insurance Company of Hartford and Oasis Diagnostic Center, Inc., it is ORDERED AND ADJUDGED that the Defendant’s Motion for Summary Judgment is hereby GRANTED.
This is an action filed by Plaintiff, Oasis Diagnostic Center, Inc. (hereinafter “Oasis”) for personal injury protection benefits arising out of a motor vehicle accident that occurred on February 2, 2008. As a result of the accident Oasis’s assignor, Maritza Navarro, was injured such that she required treatment or care with the Plaintiff on February 12, 2008, such is the date of service in dispute in this litigation. The Defendant, Property & Casualty Insurance Company of Hartford (hereinafter “the Hartford”), insured Navarro at the time of the subject accident under an insurance policy written on October 18, 2007 with a policy term ending in calendar year 2008.
The Florida legislature repealed Florida’s “old” Motor Vehicle No-Fault Law §§627.730-627.7405, effective October 1, 2007. Ch. 2003-411, §19, Laws of Fla. However, on October 11, 2007 the legislature “revived and reenacted” the “new” No-Fault Law. Ch. 2007-324, §§9-19, Laws of Fla. The “new” No-Fault Law was revived and reenacted, effective January 1, 2008, and all policies in effect on January 1, 2008 were “deemed to incorporate the provisions of the Florida Motor Vehicle No-Fault Law, as revived and amended by this act.” Ch. 2007-324, §21(2), Laws of Fla.
Here, the Hartford’s insurance policy is clear in that under Part II — Personal Injury Protection — Coverage P, the Hartford policy states, “We will pay in accordance with the Florida Motor Vehicle No-Fault Law, personal injury protection benefits to or for an insured who sustains bodily injury.” Florida law provides that where a contract of insurance is entered into on a matter surrounded by statutory limitations and requirements, the parties are presumed to have entered into such agreement with reference to the statute, and the statutory provisions become a part of the contract. Grant v. State Farm and Casualty Company, 638 So. 2d 936, 938 (Fla. 1994) (quoting Standard Marine Insurance Co. v. Allyn, 333 So. 2d 497 (Fla. 1st DCA 1976)).
In re-enacting the PIP statute, the legislature amended subparagraph (5) relating to “Charges for Treatment to Injured Persons” and added a new section. The new section provides in pertinent part (the new section is italicized):
627.736(5) Charges for treatment of injured persons. —
(a) 1. Any physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by personal injury protection insurance may charge the insurer and injured party only a reasonable amount pursuant to this section for the services and supplies rendered, and the insurer providing such coverage may pay for such charges directly to such person or institution lawfully rendering such treatment, if the insured receiving such treatment or his or her guardian has countersigned the properly completed invoice, bill, or claim form approved by the office upon which such charges are to be paid for as having actually been rendered, to the best knowledge of the insured or his or her guardian. In no event, however, may such a charge be in excess of the amount the person or institution customarily charges for like services or supplies. With respect to a determination of whether a charge for a particular service, treatment, or otherwise is reasonable, consideration may be given to evidence of usual and customary charges and payments accepted by the provider involved in the dispute, and reimbursement levels in the community and various federal and state medical fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service, treatment, or supply.
2.The insurer may limit reimbursement to 80 percent of the following schedule of maximum charges:
f. For all other medical services, supplies, and care, 200 percent of the applicable Medicare Part B fee schedule.
3. For purposes of subparagraph 2., the applicable fee schedule or payment limitation under Medicare is the fee schedule or payment limitation in effect at the time the services, supplies, or care was rendered and for the area in which such services were rendered, except that it may not be less than the allowable amount under the participating physicians schedule of Medicare Part B for 2007 for medical services, supplies, and care subject to Medicare Part B.
Since the dates of service at issue in this matter took place after the inception of the “new” No-Fault Law, the Hartford paid according to the Medicare Part B Participating Physicians Fee Schedule. It is undisputed that all bills were paid at 80% of the allowed amount pursuant of Florida Statute and the Medicare Fee Schedule as outlined by Florida Statute 627.736.
Oasis disputes that the insurer is entitled to limit reimbursement of the charges in accordance with the Medicare Fee Schedule on the grounds that the subject policy was purchased or renewed in 2007. Oasis relies on a line of cases that hold the law in effect at the time the insurance contract was executed governs any issues arising under that contract.
The court finds that the key issue in this matter is the timing of the insurance policy. The policy was in effect and the contract was entered into on about October 18th of 2007. At that time, The PIP Statute had sunset, but the Governor signed into new law the 2008 revised amended statue on or about October 11th of 2007. The court finds that the insured in this case was presumed to know the law that was signed by the Governor on October 11, 2009.
Florida Statute 627.7407 specifically states that, “. . .subject to the requirements of 627.730 to 627.7405, the Florida Motor Vehicle No-Fault Law, as revised and amended by this act, must maintain security for personal injury protection; any policy in effect on or after January 1, 2008 shall be deemed to incorporate the provision of the Florida Motor Vehicle No-Fault Act; that if the policyholder already has injury protection coverage, that coverage will be amended, effective January 1, 2008, to incorporate legally required changes without any additional premium, and that the policyholder is not required to take any further action.”
The court finds as a matter of law that the Defendant was entitled to apply the provisions of the 2008 version of Florida Statutes section 627.736(5)(a)(2)(f), to the medical bills at issue, and thus payment of said bills at 80% of 200% of the applicable amounts established by Medicare Fee Schedule was proper.
WHEREFORE IT IS ORDERED AND ADJUDGED that the fee schedule established by the 2008 No-Fault Law, as amended, should apply to all treatment rendered after January 1, 2008, the effective date of the statute. The Court finds the legislature clearly expressed its intent that the fee schedules in the “new” statute be applied to all no fault claims after January 1, 2008. The treatment in issue in this case occurred after January 1, 2008 and thus the fee schedules will be applied to the treatment at issue,
IT IS FURTHER ORDERED AND ADJUDGED that no further payments are due and owing from the Defendant insurer, the Hartford, and as such, Hartford is entitled to Final Summary Judgment. WHEREFORE Final Summary Judgment is hereby entered in favor of the Defendant, the Hartford, and it shall go hence without day. Oasis shall take nothing from this action. The court reserves jurisdiction to determine the amount of taxable attorney’s fees and costs to award the Defendant.
