20 Fla. L. Weekly Supp. 186a
Online Reference: FLWSUPP 2002COCHInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Fact that insurer is mandated by statute to reserve $5,000 for emergency medical service providers does not preclude insurer from applying claim filed by provider within that classification to deductible
EMERGENCY MEDICAL ASSOCIATES OF FLORIDA, LLC, as assignee of Recy Cochran, Plaintiff, vs. ALLSTATE INDEMNITY COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 2011-SC-2162. November 13, 2012. Jerri Collins, Judge. Counsel: Robert D. Bartels, Bradford Cederberg, P.A., Orlando, for Plaintiff. Anthony J. Parrino, Reynolds Parrino Spano, P.A., St. Petersburg, for Defendant.
REVERSED. FLWSUPP 2205COCH
ORDER GRANTING DEFENDANT’S MOTION FORFINAL SUMMARY JUDGMENT AND DENYINGPLAINTIFF’S MOTION FOR FINAL JUDGMENT
THIS MATTER having come before the Honorable Court OP Plaintiff’s and Defendant’s Competing Motion for Final Summary Judgment and this Honorable Court having heard arguments of counsel on the issue of whether providers of emergency services and care who submit their bill(s) in accordance with Florida Statutes 627.736(4)(c) are entitled to have their bills(s) paid regardless of the existence of a deductible, and the Court being otherwise fully advised in the premises, finds as follows:FINDINGS OF FACTS
1. The parties stipulated to the facts and the Court hereby adopts the facts.
2. On February 23, 2011, Recy Cochran was involved in a motor vehicle accident.
3. On February 23, 2011, Cochran was insured by Allstate Indemnity Company (Defendant).
4. The insurance policy provided Personal Injury Protection (PIP) coverage in the amount of $10,000 and the policy had a $500 deductible. There was no medical payments coverage on the policy.
5. As a result of the February 23, 2011 accident, Cochran sustained injuries and received medical treatment.
6. Defendant was notified of the accident on February 23, 2011.
7. On February 28, 2011, Defendant received a bill from Plaintiff, Emergency Medical Associates of Florida, LLC for treatment provided to Cochran. The total amount of the bill was $298. The entire bill was applied to the deductible.
8. On March 3, 2011, Defendant received a bill from St. Joseph’s Hospital for treatment provided to Cochran.
9. St. Joseph’s Hospital charged $871.02 for its services. On March 28, 2011, Defendant applied a portion of the hospital bill to the deductible and once the deductible was satisfied, Defendant paid the remaining balance of the hospital bill.
10. Plaintiff submitted its bill within thirty (30) days from the date Defendant received notice of the accident.
11. The treatment provided by Plaintiff was reasonable, related and medically necessary. The Plaintiff’s charge was reasonable.
12. Plaintiff provided emergency services and care as defined by Florida Statute 395.002(9).
13. On March 21, 2011, Defendant generated an Explanation of Medical Bill Payment advising that it would not pay the claim because the entire bill was applied to the deductible.
14. The Plaintiff moved for Final Summary Judgment asking the Court to rule as a matter of law that Florida Statute 627.736(4)(c) mandates PIP insurers to reserve $5,000 in benefits for payment to physicians, such as Plaintiff, who provide emergency services and care, and preclude Defendant from applying the bill to the deductible when the bill was received within thirty (30) days from the notice of the accident.
CONCLUSION OF LAW AND RULING
It is well settled that in attempting to discern legislative intent, courts first look to the actual language used in the statute. Saleeby v. Rock Elson Construction, Inc., 3, So.3rd 1078 (Fla.2009) [34 Fla. L Weekly S106a] Vreuls v. Progressive Employer Services, 881 So.2d 688 (Fla. 1st DCA 2004) [29 Fla. L. Weekly D1990b]. Plaintiff argues that because Fla. Stat. 627.736(4)(c) sets forth a $5,000 reserve for physicians and emergency service providers, the deductible cannot be applied to Plaintiff’s bill. The statute does not state that these types of charges cannot be subjected to the deductible requirement.
On January 1, 2008, the Legislature revived the PIP statute which created for the first time a mandatory set aside of $5,000 for, payment of bills submitted by a special class of providers. Florida Statutes 627.736(4)(c) states in relevant part:
Upon receiving notice of an accident that Is potentially covered by personal injury protection benefits, the insurer must reserve $5,000 of personal injury protection benefits for payment to physicians licensed under chapter 458 or chapter 459 or dentists licensed under chapter 466 who provide emergency services and care, as defined in s. 395.002(9), or who provide hospital inpatient care. The amount required to be held in reserve may be used only to pay claims from such physicians or dentists until 30 days after the date the insurer receives notice of the accident. After the 30 day period, any amount of the reserve for which the insurer has not received notice of a claim from a physician or dentist who provided emergency services and care or who provided hospital inpatient care may then be used by the insurer to pay other claims. The time periods specified in paragraph (b) for required payment of personal injury protection benefits shall be tolled for the period of time that an insurer is required by this paragraph to hold payment of a claim that is not from a physician or dentist who provided emergency services and care or who provided hospital inpatient care to the extent that the personal injury protection benefits not held in reserve are insufficient to pay the claim. This paragraph does not require an insurer to establish a claim reserve for insurance accounting purposes.
Section 627.739(2), of the Florida Statues, states that a deductible must be applied to 100 percent of the expenses and losses described in s.627.726 and further states that “after the deductible is met, each insured is eligible to receive up to $10,000 in total benefits as described in s.627.736(1).” The plain meaning of the statute requires the deductible to be satisfied before it triggers the total benefits.
There is no language in s.627.736(4)(c) that excludes this special class of providers from the deductible requirement. Plaintiff argues that because the statute creates a reserve that it also creates a prohibition to the application of a deductible.
But there is nothing in the statute to support this proposition. The legislature has previously enacted such prohibition in s.627.736(1)(c). The law prohibits the application of a deductible to death benefits. This “death benefit” prohibition sets a precedence for this type of restriction. Yet, the statute in question is silent as to emergency service providers giving credence that if the legislature intended to exclude this class of providers it would have clearly indicated in the plain language of the statute.
This Court reads s.627.736(4)(c) Florida Statutes in pari materia with s. 627.739(2), Florida Statutes. To read the law otherwise would completely ignore the plain meaning of established law and principles of contract law. The assignee and the defendant agreed to a deductible. The premiums would be lower in exchange for a deductible. If the Plaintiff’s argument were to be applied there would be instances where the bills would be paid without any deductible ever being met.
The Court believes that if the legislature enacts laws that mandates insurance companies to offer deductibles, as set forth in s.627.739(2), then it would specifically set forth in plain language exceptions to the application of said deductibles. Since there is not such wording in s. 627.736(4)(c), the defendant was correct in applying the Plaintiff’s bill toward the policy’s deductible.
Accordingly, the Court grants Defendant’s Motion for Final Summary Judgment and Denies Plaintiff’s Motion for Final Summary Judgment.
Based upon the parties’ stipulation, there are no remaining issues of fact in dispute and Defendant is entitled to Final Summary Judgment as a matter of law.
Final Judgment is hereby granted in favor of Defendant, All State Indemnity Company. The Defendant is entitled to reasonable attorney’s fees and costs. The Court reserves jurisdiction to determine the amount of Defendant’s attorney’s fees and costs pursuant to Florida Statute.
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