21 Fla. L. Weekly Supp. 989a
Online Reference: FLWSUPP 2110POLIInsurance — Personal injury protection — Coverage — Medical expenses — Policy that provides that all payments shall be subject to limitations authorized by all fee schedules unambiguously elects to limit reimbursement to statutory fee schedules
ALLSTATE FIRE AND CASUALTY INS. CO. Appellants, vs. HALLANDALE OPEN MRI LLC a/a/o Elisson Politesse, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 13-186 AP. Consolidated with 13-198 AP; 13-199 AP. June 23, 2014. An appeal from the County Court for Miami-Dade County, Florida, Judge Don S. Cohn. Counsel: Douglas G. Brehm, Suzanne Youmans Labrit, Shutts & Bowen LLP Miami; and Peter J. Valeta, Meckler Bulger Tilson Marick & Pearson LLP, Chicago, IL, for Appellants. Mark J. Feldman, Mark J. Feldman, P.A., Miami; and Marlene S. Reiss, Marlene S. Reiss P.A., Miami, for Appellee.
(Before KORVICK, BLOOM, and WALSH, JJ.)
(KORVICK, Judge.) This appeal concerns a de novo application of the law to stipulated facts. The lower court ruled against Allstate, finding that its policy language was insufficient to put an insured on notice that it would apply the fee schedule reimbursement limitations authorized by Florida Statute section 627.736(5)(a)(2) in calculating the amount that it would pay to the Appellee as a reasonable expense for medical care.
The Allstate policy language at issue reads: “Any amounts payable under this coverage shall be subject to any and all limitations authorized by section 627.736, or any other provisions of the Florida Motor Vehicle No-Fault Law, as enacted, amended, or otherwise continued in the law, including but not limited to, all fee schedules.” The Florida Supreme Court has opined on the sufficiency of insurance policy language as it relates to an insurer’s ability to use the fee schedules authorized by section 627.736. In GEICO General Ins. Co. v. Virtual Imaging Services, Inc., 2013 WL 3332385 (Fla. 2013) [38 Fla. L. Weekly S517a], the Court held that in exercising the option to utilize section 627.736(5)(a)2 fee schedules, “the insurer must provide notice in the policy of its election to use the fee schedules.” Id. at *10. The notice must be clear and unambiguous. Id. at *9.
This Court finds that Allstate’s policy language provides the “clear and unambiguous” notice to insureds required by the Florida Supreme Court in Virtual Imaging. The policy references the Florida Motor Vehicle No Fault Law generally, and leaves no room for ambiguity in specifying that amounts payable under the policy “shall be subject to” limitations authorized by all fee schedules. Allstate’s policy language is similar to language approved of by the Supreme Court in dicta when it noted that during the pendency of the Virtual Imaging case, GEICO had amended its policy to read that GEICO would “pay in accordance with the Florida Motor Vehicle No Fault Law . . . and where applicable in accordance with all fee schedules contained in the Florida Motor Vehicle No Fault Law . . .” 2013 WL 3332385 at *1. If the amended GEICO policy language provided sufficient notice to insureds that GEICO elected to limit reimbursements under the fee schedules, then it follows that Allstate’s similar policy language likewise provides such notice. Thus, we hold that Allstate’s policy adequately notified the insured of Allstate’s intent to take advantage of the fee schedule reimbursement limitations authorized by 627.736(5)(a)(2)(f), and therefore, Allstate was legally allowed to employ those fee schedules in calculating the amount it would pay to the Appellee as a reasonable expense for medical care.
Accordingly, we REVERSE and REMAND, with instructions that the trial court enter an order consistent with this opinion. (BLOOM, and WALSH, JJ., concur.)
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