22 Fla. L. Weekly Supp. 446a
Online Reference: FLWSUPP 2204GODOInsurance — Personal injury protection — Coverage — Medical expenses — Emergency medical condition — Where qualified medical provider did not diagnose claimant with an emergency medical condition, the available benefits under policy and statute were properly limited to $2500
EDUARDO J. GARRIDO, D.C., P.A., a/a/o ALEJANDRO J. GODOY, Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 13-4491 CC 26 (03). January 8, 2015. Michaelle Gonzalez-Paulson, Judge.
ORDER GRANTING DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT AND DENYINGPLAINTIFF’S MOTION FOR SUMMARY JUDGMENTRE: EMERGENCY MEDICAL CONDITION
THIS CAUSE came to be heard by the Court on December 18, 2014 on the Defendant’s Motion for Summary Judgment and Plaintiff’s Cross-Motion for Summary Judgment regarding Emergency Medical Condition.UNDISPUTED FACTS
The evidence submitted revealed that Progressive American Insurance Company (“Progressive”) issued an insurance policy, which provided personal injury protection (“PIP”) benefits, to Alejandro Godoy. The policy elected the fee schedules set forth in F.S. 627.736(5)(a)(2).
Progressive made payment to Plaintiff (a chiropractor) in the amount of $2,500.00 as no emergency medical condition had been diagnosed pursuant to F.S. 627.736(1)(a). The instant lawsuit followed.
In support of Plaintiff’s Cross Motion for Summary Judgment, Plaintiff filed the affidavit of the treating chiropractor, Eduardo Garrido, D.C. Dr. Garrido stated in his affidavit that he had diagnosed Alejandro Godoy with an “emergency medical condition.” The medical records from Plaintiff do not make any mention of an “emergency medical condition.”
ANALYSIS
F.S. 627.736(1)(a)(4) states that “reimbursement for services and care provided in subparagraph 1. or subparagraph 2. is limited to $2,500 if any provider listed in subparagraph 1. or subparagraph 2. determines that the injured person did not have an emergency medical condition.”
An “emergency medical condition” can only be diagnosed by “a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced registered nurse practitioner licensed under chapter 464” pursuant to F.S. 627.736(1)(a)(3). Dr. Garrido, a chiropractor, is not a provider authorized to determine an “emergency medical condition” under the statute.
Both parties agreed the statute, as written, is clear and unambiguous. Therefore, it must be given its plain and obvious meaning.
Plaintiff argued that coverage for this claim must default to $10,000 under F.S. 627.736(1)(a)(4) because the record is silent as to whether the insured sustained or did not sustain an emergency medical condition. However, “the statute does not contain a default provision establishing the coverage limit when a qualified medical professional ‘makes no determination that the patient did not have an emergency medical condition.’ ” Robbins v. Garrison Property and Casualty Ins. Co., 2014 WL 6685500 (S.D.Fla.)
However, Plaintiff’s reading of the statute ignores the language in F.S. 627.736(1)(a)(3) and this court must construe the language of the statute within the context of the entire statutory scheme. Robbins citing Hill v. Winn-Dixie Stores, Inc. 699 F.Supp. 876, 877 (M.D. Fla. 2009). “A statute should be interpreted to give effect to every clause in it, and to accord meaning and harmony to all of its parts.” Jones v. ETC of New Orleans, Inc., 793 So. 2d 912 (Fla. 2001) [26 Fla. L. Weekly S549a].
A qualified medical provider did not diagnose Alejandro Godoy with an “emergency medical condition.” As no such diagnosis was made, the available benefits under Progressive’s policy of insurance and F.S. 627.736 were properly exhausted to the available limit of $2,500.00.CONCLUSION
The Court hereby grants Defendant’s Motion for Summary Judgment and denies Plaintiff’s Motion for Summary Judgment.
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