22 Fla. L. Weekly Supp. 719a
Online Reference: FLWSUPP 2206ADAMInsurance — 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 MEDICINE PROFESSIONALS, P.A., as assignee of Damari Adams, Plaintiff, v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. County Court, 7th Judicial Circuit in and for Volusia County. Case No. 2014 22686 CONS. January 14, 2015. Shirley A. Green, Judge. Counsel: Mark A. Cederberg and Rutledge Bradford, Bradford Cederberg P.A., Orlando, for Plaintiff. Neil Andrews, Orlando, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTIONFOR FINAL SUMMARY JUDGMENTAND DENYING DEFENDANT’S MOTIONFOR SUMMARY FINAL JUDGMENT
THIS MATTER came before this Honorable Court on January 5, 2015 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 stipulated to the facts relevant to this matter. See Notice of Filing Joint Stipulation of Facts bearing certificate of service date December 10, 2014. The Court incorporates the stipulated facts into this Order.
Damari Adams was involved in an automobile accident on April 7, 2014 at which time he was insured by the Defendant, Progressive Select Insurance Company, under a policy of insurance which included $10,000.00 in Personal Injury Protection benefits (PIP) with a $500.00 deductible.
The Plaintiff, Emergency Medicine Professionals, P.A., rendered emergency services and care, as defined in Florida Statute §395.002(9), to Damari Adams on April 7, 2014. Plaintiff’s bill for these services was received by Defendant on April 28, 2014 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 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 and the services at issue were related and necessary as a result of the insured’s motor vehicle collision on April 7, 2014.
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. The Plaintiffs are medical doctors who staff the emergency departments at local hospitals in Volusia county. They are “front-line” providers who do not have the luxury to pick and choose their patients and must treat all persons who present to the emergency room regardless of ability to pay, in accordance with both State and Federal EMTALA laws.
In 2008, the Florida Legislature re-enacted 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 PIP 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 in PIP benefits. The deductible is not even contemplated, nor should a deductible be contemplated, at the time the Defendant is required to reserve the PIP benefits for payment.
Clearly, the Legislature carved out a protected class of providers, pursuant to Fla. Stat. §627.736(4)(c) and set forth a specific time period to submit their bills in order to take advantage of the statutory protection. The intent of Fla. Stat. §627.736(4)(c) mandatory reserve was to give priority of PIP benefits to providers of emergency services and care. In reality, if the protected providers are timely submitting their bills, they are running a great risk of their bills being applied to the deductible. On the other hand, if they do not submit their bills within the 30-day time limit, they lose their protection under the statute. If the intent of the statutory section was to prioritize PIP benefits for payment to these providers, it makes no sense that by following the statute they run a greater risk of their bill not being paid. Their protection becomes a matter of luck and timing. This approach, and Defendant’s position in this matter, ignore the intent of Fla. Stat. §627.736(4)(c) and render it meaningless. After careful consideration and review of the Legislative amendments dating back to 2003, this Court finds that it is reasonable to believe that the Legislature intended for Plaintiff’s bill to be paid out of the (4)(c) reserve and that the non-protected providers’ bills be applied to the deductible.
ACCORDINGLY, it is ORDERED AND ADJUDGED that the Plaintiff’s Motion for Final Summary Judgment is GRANTED and the Defendant’s Motion for Summary Final Judgment is DENIED. In light of the Court’s ruling, Defendant’s Motion for Protective Order is rendered MOOT.
WHEREFORE, in granting Plaintiff’s Motion for Final Summary Judgment, the Court finds that Plaintiff is entitled to recover from Defendant $268.00 (80% of $335.00) plus accrued interest in the amount of $9.00 (4.75% from April 28, 2014) for a total of $277.00 for which let execution issue forthwith. Post judgment interest of 4.75% per annum shall be due on the judgment pursuant to Fla. Stat. §55.03. The Court also finds that Plaintiff is hereby entitled to reasonable attorneys’ fees and costs and reserves jurisdiction to determine the amount.
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