22 Fla. L. Weekly Supp. 609a
Online Reference: FLWSUPP 2205SUDDInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Because insurer is mandated by statute to reserve $5,000 for emergency service providers, insurer should not have applied claim by plaintiff provider within that classification to deductible
EMERGENCY MEDICAL ASSOCIATES OF FLORIDA, L.L.C., as assignee of Janith Suddath, Plaintiff, v. MERCURY INSURANCE COMPANY OF FLORIDA, Defendant. County Court, 7th Judicial Circuit in and for Volusia County. Case No. 2012 31231 COCI. August 6, 2013. Dawn P. Fields, Judge. Counsel: Steven Dell, Bradford Cederberg, P.A., Orlando, for Plaintiff. Aaron E. Leviten, Law Office of Gotschall and O’Hara, Maitland, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTIONFOR FINAL SUMMARY JUDGMENT
THIS MATTER came before this Honorable Court on May 9, 2013 after due notice to the parties, on Plaintiff’s and Defendant’s competing Motions for Final Summary Judgment on the interpretation of Florida Statutes §627.736(4)(c) and §627.739.
FINDINGS OF FACT
The parties have previously stipulated to the facts relevant to this matter. The Court incorporates the stipulated facts into this Order:
Janith Suddath, was involved in an automobile accident on October 27, 2011 at which time she was insured by the Defendant, Mercury Insurance Company of Florida, under a policy of insurance which included $10,000.00 Personal Injury Protection benefits (PIP) and contained a $1000.00 deductible.
The Plaintiff, Emergency Medical Associates of Florida, LLC, rendered emergency services and care as defined in Florida Statute §395.002(9), to Janith Suddath on October 27, 2011. Plaintiff’s bill for services was received by Defendant on November 14, 2011 within thirty (30) days of the date Defendant received notice of the accident potentially covered under PIP benefits. The Plaintiff’s bill for services met all the requirements necessary to qualify for the statutory reserve of $5,000 in PIP benefits set forth in Florida Statute §627.736(4)(c). Defendant received multiple bills from medical providers which did not meet the requirements under Florida Statute §627.736(4)(c) to qualify for the reserve. The Plaintiff’s charges were reasonable, related and necessary as a result of the insured’s motor vehicle collision on October 27, 2011.
CONCLUSION OF LAW AND RULING
The Court finds Plaintiff’s position is well-reasoned and supported based on the plain reading of the statute as applied to the facts at issue. In 2008, the Florida Legislature reenacted the PIP statute and established for the first time, a mandatory $5,000.00 reserve, for payment to certain providers, like Plaintiff, who provide emergency services and care. The plain language of 627.736(4)(c) clearly states that an insurer must reserve $5,000 in benefits for payment to physicians whose bills are received in accordance with the subsection. To suggest that “for payment” means that the bills may go unpaid by applying them to an insured’s elected deductible is not consistent with the plain language of the statute. The first required action by the Defendant, “upon receiving notice of an accident that is potentially covered by personal injury protection benefits” is reservation of the $5,000.00. The deductible is not even contemplated, nor should a deductible be contemplated, at the time the Defendant is required to reserve the benefits for payment.
Plaintiff’s bill should have been reserved for payment at the point in time when non-protected bills were received by the Defendant which exceeded the policy deductible. The bills received from these providers should have been applied to the deductible in the order of receipt in accordance with the English rule of priority, which Florida follows. Boulevard Nat. Bank of Miami v. Air Metal Industries, Inc., 174 So. 2d 559 (Fla. 3rd DCA 1965). Upon satisfaction of the deductible by non-reserve bills the Plaintiff’s claim should be taken from the reserve amount and paid in accordance with 627.736(4)(c).
The Court is not persuaded by the Defendant’s arguments that the Plaintiff’s bill can be applied to the deductible or that Florida Statute §627.739 and its application to the facts in this matter divest the Plaintiff of standing to file suit. Florida Statute §627.739(2) explains how a deductible shall be calculated. The calculations used by the Defendant, in the facts before this Court, were improper and not in compliance with the statute. The plain language of the statute requires the Defendant apply 100% of the expenses and losses to bills subjected to the deductible. Defendant improperly reduced the allowed amount to 75% of the charges submitted on Saint Joseph Hospital’s bill, the reduction was taken prior to application of the deductible in violation of the statute. This violation of the statute resulted in an underpayment of the Plaintiff’s bill. Thus, the Plaintiff has standing to pursue payment of its charges.
ACCORDINGLY, it is ORDERED AND ADJUDGED that the Plaintiff’s Motion for Final Summary Judgment is GRANTED and the Defendant’s Motion for Final Summary Judgment is DENIED on the basis of the plain wording of Fla. Statute 627.736(4)(c). In so ruling, the court has determined that the Plaintiff has met its burden of proof and is entitled to judgment as a matter of law. When a provider submits its bill for payment to a PIP carrier and satisfies each of the requirements set forth in 627.736(4)(c), it is entitled to be paid from the $5,000.00 reserve and its charges cannot be used to satisfy an elected deductible.
WHEREFORE, the Court grants Plaintiff’s Motion for Final Summary Judgment and orders that Plaintiff is entitled to payment of its $298.00 medical bill at 80% (i.e. $238.40) plus statutory interest at 4.75% per annum for which let execution issue forthwith. The Court finds the Plaintiff is hereby entitled to reasonable attorney fees and costs and reserves jurisdiction to determine the amount.
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