18 Fla. L. Weekly Supp. 405b
Online Reference: FLWSUPP 1804JONE
Insurance — Personal injury protection — Coverage — Insurer is entitled to limit reimbursement to 200% of Medicare fee schedule as allowed by 2008 PIP statute where policy states that insurer will pay in accordance with No-Fault Statute — Further, terms of 2008 PIP statute are incorporated into every PIP policy pursuant to section 627.7407 — Application of statutory fee schedules does not impair, but enhances, contractual rights of insured by allowing insured to have more available benefits for treatment before exhaustion of policy limits
PALM BEACH REGIONAL MRI, INC., a/a/o Sylvia Jones, Plaintiff, v. METROPOLITAN CASUALTY INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 502008CC017195XXXXMB. County Divison: RF. February 11, 2011. Debra Moses Stephens, Judge.
ORDER GRANTING RECONSIDERATION AND VACATING AND RE-ENTERING ORDER ON SUMMARY JUDGMENT
THIS CAUSE having come on to be heard before the Court on Defendant Metropolitan Casualty Insurance Company’s (“Metropolitan”), Motion for Reconsideration and/or Rehearing on the Order Granting the Plaintiff’s Motion for Final Summary Judgment and Denying Defendant’s Motion for Final Summary Judgment and Entering Final Judgment in Favor of the Plaintiff signed by the Court on September 15, 2010 and filed on the Court’s docket on September 16, 2010, and the court having reviewed the Defendant’s Motion for Reconsideration and/or Rehearing; reviewed the parties Cross Motions for Summary Judgment with Memoranda of Law; reviewed the entire court file; reviewed the relevant legal authorities; heard argument of counsel on the cross motion for summary judgment on August 24, 2010 and on January 11, 2011, and being otherwise fully advised on the premises, the Court finds as follows:
The Order granting Plaintiff’s Motion for Final Summary Judgment and denying Defendant’s motion for Final Summary Judgment and entering final judgment in favor of the Plaintiff dated September 15, 2010 is hereby vacated; and this Court hereby grants the Defendant’s Motion for Final Summary Judgment and hereby enters Final Judgment in favor of the Defendant, Metropolitan.
Metropolitan issued an automobile insurance policy to Sylvia Jones in November of 2007. There is no dispute that Metropolitan originally issued an automobile insurance policy to Sylvia Jones in November of 2007, without PIP coverage and that PIP was endorsed onto the policy as of January 1, 2008.
On January 17, 2008, Plaintiff, PALM BEACH REGIONAL MRI, INC., provided a cervical MRI to Sylvia Jones for injuries related to her January 7, 2008, motor vehicle accident. Pursuant to an assignment of benefits, Plaintiff billed Metropolitan $1,400.00 for the MRI provided to its insured, Sylvia Jones. In response, Defendant Metropolitan allowed and paid the plaintiff $881.22 for the MRI performed by the plaintiff on Metropolitan’s insured. Metropolitan determined the amount allowed by applying the Medicare Fee Schedule reimbursement option found in Florida Statute §627.736(5)(a)(2)(f) and (3) (2008).
Plaintiff filed an action for declaratory relief, upon which its Motion for Summary Judgment was based, which alleges that Metropolitan’s contract does not allow for Metropolitan to limit payments made to medical providers for services rendered to its PIP insured, to the amount allowed by the applicable fee schedule.
The plaintiff acknowledges that Metropolitan’s policy states that, “Metropolitan will pay, in accordance with the Florida Motor Vehicle Law, to or for the benefit of the injured person, 80% of medical expenses………” However, the plaintiff argues that Metropolitan cannot limit payments made to the amount allowed by the applicable fee schedule set forth in Florida Statute 627.736(5)(a)(2)(f) and (3) unless the insurance contract expressly states that Metropolitan may do so.
The Defendant filed a motion for final summary judgment seeking the court’s determination as to whether Metropolitan is entitled to limit its payment for services rendered to its insured as a result of any automobile accident to the amount allowed by Medicare Part B, with the applicable limitations, in this case the OPPS cap, for the time period and location where the services were performed. The Defendant contends that Florida Statute 627.736(5)(a)(2)(f) and (3)(2008) allows insurers the option to limit its reimbursement for medical services to the applicable fee schedules, with the appropriate limitations. Specifically, the defendant contends that Metropolitan is entitled to limit the payment for the MRI performed on Sylvia Jones, to 200% of the amount allowed by Medicare Part B, with the OPPS cap applied. For the reasons set forth herein, as well as those reasons expressed in Defendant’s Final Motion for Summary Judgment, this Court agrees with the Defendant.
This Court finds that the plain and unambiguous language of Metropolitan’s policy that states that “Metropolitan will pay, in accordance with the Florida Motor Vehicle Law, to or for the benefit of the injured person, 80% of medical expenses……..” is sufficient to allow Metropolitan to pay claims in accordance with the Florida No-Fault Statute.
Further, pursuant to Florida Statute 627.7407, the terms of the 2008 No-Fault Statute are incorporated into every insurance policy that is in force and effect as of January 1, 2008. This Court finds that 627.736(2008)(5)(a)(2)(f) and (3), as incorporated into Metropolitan’s policy, states that an insurer may limit reimbursement to 80 percent of the amount allowed by the various fee schedules set forth in Florida Statute 627.736(2008).
This Court also finds that the language of Florida Statute 627.736(5)(a)(2)(f) and (3) (2008) is clear and unambiguous. Florida Statute 627.736(5)(a)(2)(f) and (3) (2008) states that an insurer may limit payment for services rendered to an insured as a result of an automobile accident to 80 percent of 200 percent of the amount allowed by Medicare Part B for the services performed, or if not payable by Medicare, to 100 percent of the Florida Worker’s Compensation Fee Schedule, with the applicable payment limitations applied.
The Florida Legislature’s use of the word “may” as used in the Florida PIP Statute, means that something is permissive, not prohibited. Nationwide v. Jewell, 862 So.2d 79 (Fla. 2nd DCA 2003.) [28 Fla. L. Weekly D2605a] There is nothing uncertain or ambiguous about the word “may.” Id. Therefore, absent some clear warrant for doing so in the statutory context, such provision should not be read to impose an implied prohibition. Id. Any such prohibitive reading of the provision can only be based on an unwarranted assumption concerning legislative intent — assumptions that are detached from, and unsupported by the words actually employed in the statute. Fortune Insurance Company v. Everglades Diagnostic, Inc., 721 So.2d 384, 385 (Fla. 4th DCA 1998) [23 Fla. L. Weekly D2495a].
While courts are required to interpret statutes in their entirety, they are not free to add provisions to parts of a statute under the guise of such reading. Holly v. Auld, 450 So.2d 217, 219 (Fla. 1984). This Court is without power to construe an unambiguous statute in a way which would extend, modify or limit its express terms or its reasonable and obvious implications. Id. To do so, would be an abrogation of legislative power. Pub. Health Trust v. Lopez, 531 So.2d 946, 949 (Fla. 1988).
It is the Court’s obligations to enforce the clear and unambiguous terms of both Metropolitan’s policy and the Florida No-Fault Statute, as written, and to give each policy and statutory provision its intended meaning and effect.
This Court also finds that while it may be in the best interest of the medical provider to obtain the greatest amount of payment for services rendered, this is contrary to the best interest of the assignor insured. Payment at the new statutory rate benefits the insured because it allows the insured to have more available benefits for treatment prior to the exhaustion of benefits. Therefore, applying the applicable fee schedules to the medical claims in this case does not impair, and instead enhances, the contractual rights of the insured.
