22 Fla. L. Weekly Supp. 378b
Online Reference: FLWSUPP 2203EXANInsurance — Personal injury protection — Deductible — PIP insurer properly reduced medical bills by applying Medicare fee schedule before applying deductible
BETTER CHIROPRACTIC AND REHAB CENTER LLC a/a/o SHELDA EXANTUS, Plaintiff, vs. GEICO INDEMNITY COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, General Jurisdiction Division. Case No. 13-2015-SP-24. September 24, 2014. Rodolfo Ruiz, Judge. Counsel: Charles Hubley, The Patino Law Firm, Hialeah, for Plaintiff. Kevin P. Sincerbox, GEICO Staff Counsel, Law Office of Haydee De La Rosa-Tolgyesi, Miami, for Defendant.
AMENDED ORDER DENYING PLAINTIFF’SMOTION FOR SUMMARY JUDGMENT THATDEFENDANT IMPROPERLY APPLIED THE DEDUCTIBLE
THIS CAUSE, having come before the Court on September 2, 2014, on Plaintiff’s Motion for Summary Judgment that the Defendant Improperly Applied its Policy Deductible, and the Court having heard argument of counsel and being otherwise advised of the premises, it is hereby ORDERED and ADJUDGED as follows:
1. Defendant properly applied its policy deductible to Plaintiff’s medical bills by first applying the Medicare Fee Schedule reductions as elected by the subject policy of insurance, and then applying the deductible.
2. The deductible only applies to losses covered under the policy of insurance, not simply the total bills submitted. See Gen. Star. Indem. Co. v. W. Fla. Village Inn, Inc., 874 So. 2d 26, 33-34 (Fla. 2d DCA 2004) [29 Fla. L. Weekly D348a].
3. The insurer should first determine which bills are deemed reasonable, related, and necessary under the policy of insurance, and then apply the deductible. If the insurer has properly elected to pay pursuant to the applicable fee schedules as described in section 627.736 of the Florida Statutes, the insurer may first apply the fee schedules to the submitted bills, and then apply the deductible. See New Medical Group, Inc. a/a/o Elisa Collazo v. United Auto Ins. Co., Order Denying Plaintiff’s Motion for Summary Judgment Alleging Defendant Improperly Applied its Policy Deductible, Case No: 11-01871 SP 26 (04) (Fla. 11th Cir., Miami-Dade County Court, March 15, 2013).
4. Here, GEICO’s policy of insurance clearly elects to pay pursuant to the fee schedules as described in section 627.736(5)(a)(2) of the Florida Statutes. Geico Gen. Ins. Co. v. Virtual Imaging Servs., Inc., No. SC12-905, 2013 WL 3332385, at *1 (Fla. Jul. 3, 2013) [38 Fla. L. Weekly S517a].
5. Moreover, sections 627.739 and 627.736 of the Florida Statutes must be read together, in pari materia. By applying the Medicare Fee Schedule limitations prior to the application of the policy deductible, Defendant has complied with section 627.739(2) and applied the deductible to 100% of the expenses and loses as described in section 627.736. See Goldcoast Physicians Center, Inc. v. Garrison Prop. & Cas. Ins. Co., 20 Fla. L. Weekly Supp. 711(a) (Fla. 17th Cir., Broward County Court, March 9, 2013); see also Gen. Star. Indem., 874 So. 2d at 34.
6. Ultimately, this Court adopts the rationale set forth in New Medical Group, Inc. a/a/o Elisa Collazo v. United Auto Ins. Co., Order Denying Plaintiff’s Motion for Summary Judgment Alleging Defendant Improperly Applied its Policy Deductible, Case No: 11-01871 SP 26 (04) (Fla. 11th Cir., Miami-Dade County Court, March 15, 2013) and Goldcoast Physicians Center, Inc. v. Garrison Prop. & Cas. Ins. Co., 20 Fla. L. Weekly Supp. 711(a) (Fla. 17th Cir., Broward County Court, March, 9, 2013).
7. For the reasons set forth herein, Plaintiff’s Motion for Summary Judgment that the Defendant Improperly Applied its Policy Deductible is hereby DENIED.
* * *
