19 Fla. L. Weekly Supp. 1005b
Online Reference: FLWSUPP 1912PACHInsurance — Coverage — Deductible — Error to enter summary judgment in favor of insurer claiming that medical provider’s bill fell within deductible where there is disputed issue of material fact as to whether two bills received by insurer prior to provider’s bill were compensable and, therefore, should have been applied to deductible
RIVERO DIAGNOSTIC CENTER, a/a/o YOLANDA PACHO, Appellant, vs. MERCURY INS. CO. OF FLORIDA, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 09-388 AP. L.C. Case No. 08-7352 SP 25. September 12, 2012. An appeal from the County Court for Miami-Dade County, before Judge Lawrence D. King. Counsel: Marlene S. Reiss, for Appellant. Damaris E. Reynolds, for Respondent.
(Before FERNANDEZ and COLODNY, JJ.)
(COLODNY, Judge.) The Appellant, Rivero Diagnostic Center (Rivero), appeals the county court’s entry of summary judgment in favor of Mercury Insurance Company of Florida (Mercury). Mercury argues that Rivero’s bill fell within the applicable deductible, so that Mercury owed Rivero no money. However, there is a genuine issue of material fact as to whether two bills received by Mercury from another medical provider, prior to the receipt of Rivero’s bill, were compensable. If the other bills were compensable, then the deductible should have been applied to them and Rivero’s bill should have been paid. See Progressive Express Ins. Co. v. South Florida Institute of Medicine, Inc, 14 Fla. L. Weekly Supp. 520a (Fla. 11th Cir. April 11, 2007) (looking at the validity of the reason behind a reduction of benefits in determining whether policy limits have been exhausted). Because there is an unresolved genuine issue of material fact, summary judgment should not have been granted. As such, the county court’s entry of summary judgment in favor of Mercury is REVERSED. (FERNANDEZ, JJ. concur.)
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