22 Fla. L. Weekly Supp. 535a
Online Reference: FLWSUPP 2205COCHInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Because insurer is mandated by statute to reserve $5,000 for emergency service providers, trial court erred in finding that insurer was correct in applying emergency service provider’s claim to deductible
EMERGENCY MEDICAL ASSOCIATES OF FLORIDA, LLC as Assignee of RECY COCHRAN, Appellant, vs. ALLSTATE INDEMNITY COMPANY, Appellee. Circuit Court, 18th Judicial Circuit (Appellate) in and for Seminole County. Case No. 13-04-AP. L.T. Case No. 2011-SC-2162. Amended Decision filed December 29, 2014. Appeal from the County Court for Seminole County. Honorable Jerri L. Collins, County Court Judge. Counsel: Robert D. Bartels, Kevin B. Weiss, and Dean A. Mitchell, for Appellant. Anthony Parrino and Peter J. Valeta, for Appellee.
(RUDISILL, M.) The Court issues the following amended opinion, noting that the original opinion is modified only in regards to party names, with no substantive changes.
The Appellant seeks review of the trial court’s entry of summary judgment in favor of the Appellee. This case addresses the interplay and interpretation of Fla. Stat. §627.736(4)(c), providing for a prioritization of certain PIP benefits, and Fla. Stat. §627.739(2), addressing the application of a deductible in PIP cases. The trial court found that the deductible was properly applied to benefits paid to a priority provider, whose claim was first in time, when both priority and non-priority providers sought payment of PIP benefits. For the reasons stated below, the trial court’s interpretation of the statute was erroneous, and summary judgment in favor of the Appellee is reversed.
In this case, the policyholder was involved in an accident. The Appellee first received a bill from the Appellant for $298 and later received a bill from another medical services provider in the amount of $871.02. Since the policyholder’s insurance policy included a $500 deductible, the Appellee first applied the deductible to the Appellant’s bill, meaning that the Appellant was not reimbursed from the policy at all, and the remaining $202 of the deductible was applied to reduce the other service provider’s reimbursement. While acknowledging that 627.736 did not contain any language specifically allowing the application of a deductible to claims filed thereunder, the trial court found that 627.736 and 627.739 must be read in pare materia, and that if the legislature mandates insurers to offer deductibles, then it would have set forth exceptions to the application of those deductibles. Further, the court found no such exceptions within either section,1 and that Appellee was correct in applying Appellant’s claim to the policy’s deductible. Therefore, summary judgment was granted in favor of the Appellee and the Appellant’s competing motion for summary judgment was denied. Appellant moved for rehearing, which was denied without further comment, and subsequently filed this appeal.
This issue was resolved in Direct General Insurance Co. v. Emergency Physicians of Central Florida, LLC a/a/o Oriol Saintilma, Case No. 12-51-AP (Fla. 18th Judicial Circ., App. Div., August 29, 2014) [22 Fla. L. Weekly Supp. 209b] (affirming the decision of the trial court based on the reasoning in in Emergency Physicians of Central Florida, LLC v. USAA General Indemnity Co., 20 Fla. L. Weekly Supp. 697a (Fla. Seminole Cty. Ct. Feb. 27, 2013)). Under that decision, this Court held that allowing an insurer to apply a deductible against priority provider claims would contravene the legislative intent of protecting emergency service providers through the statutory scheme of section 627.736(4)(c). Id. See also Direct General Insurance Co. v. Emergency Physicians of Central Florida, LLC a/a/o Tina Watts, Case No. 12-52-AP (Fla. 18th Judicial Circ., App. Div., August 29, 2014) [22 Fla. L. Weekly Supp. 209c] (same); and USAA General Indemnity Co. v. Emergency Physicians of Central Florida, LLP a/a/o Adriel Rodriguez, Case No. 13-17-AP (Fla. 18th Judicial Circ., App. Div., October 16, 2014) [22 Fla. L. Weekly Supp. 341a].
As such, the summary judgment for Appellee is reversed. The award of attorney’s fees to Appellee is similarly reversed.
REVERSED and REMANDED.
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1The court and both parties recognize that there is a “Death Benefits” exception for deductibles, but no other exception that is applicable in this situation.
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