22 Fla. L. Weekly Supp. 727a
Online Reference: FLWSUPP 2206HOUSInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Providers of emergency services and care who submit their bills in accordance with section 627.736(4)(c) are entitled to have their bills paid regardless of the existence of a deductible
EMERGENCY PHYSICIANS OF CENTRAL FLORIDA, LLP, as assignee of Tina House, Plaintiff, v. MERCURY INSURANCE COMPANY OF FLORIDA, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2011 SC 8734. October 2, 2013. Adam McGinnis, Judge. Counsel: Dean A. Mitchell, for Plaintiff.
Circuit court opinion, which affirmed, was QUASHED on review by DCA: 40 Fla. L. Weekly D2364a (Mercury Ins. Co. of Florida v. Emergency Physicians of Central, etc., 5D15-1064, 10-16-2015]
REVISED ORDER ON PLAINTIFF’S MOTION FORSUMMARY JUDGMENT AND DEFENDANT’SMOTION FOR SUMMARY JUDGMENT
THIS MATTER having come before the Court on Plaintiffs and Defendant’s Motions for Summary Judgment and this Honorable Court having heard argument and reviewed the evidence and law provided on the issue of whether providers of emergency services and care who submit their bill(s) in accordance with Florida Statutes 627.736(4)(c) are entitled to have their bill(s) paid regardless of the existence of a deductible, and the Court being otherwise fully advised in the premises, finds as follows:FINDING OF FACTS
1. Tina House was involved in a motor vehicle accident on July 17, 2011.
2. Ms. House was insured by Mercury Insurance Company of Florida (Defendant.)
3. The insurance policy provided for PIP benefits and had a deductible.
4. Ms. House sustained injuries and was subsequently treated as a result of the July 17, 2011 accident.
5. Defendant was notified of the accident on July 17, 2011.
6. On August 5, 2011, Defendant received a bill from Plaintiff for treatment provided to Ms. House. Plaintiff submitted the bill within 30 days from the date Defendant received notice of the accident. Plaintiff provided emergency services and care as defined by Florida Statute 395.002(9). In fact it was the only bill submitted within 30 day time frame.
7. The Plaintiff moved for Final Summary Judgment asking the Court to rule as a matter of law that Florida Statute 627.736(4)(c) mandates PIP insurers to reserve $5,000.00 in benefits for payment to physicians, such as Plaintiff, who provide emergency services and care, and preclude Defendant from applying the bill to the deductible when the bill was received within thirty (30) days from the notice of the accident.
8. The Defendant moved for Final Summary Judgment asking the Court to rule as a matter of law that Florida Statute 627.736(4)(c) mandates PIP insurers to reserve $5,000.00 in benefits for payment to physicians, such as Plaintiff, who provide emergency services and care, and does not preclude Defendant from applying the bill to the deductible when the bill was received within thirty (30) days from the notice of the accident.
9. Both the Plaintiff and Defendant stipulate that the only bill submitted prior the thirty (30) day deadline was the $191.00 bill submitted by the Plaintiff in this case.
10. Both the Plaintiff and Defendant stipulate that the Plaintiff medical provider is a member of the protected class contemplated in Florida Statute 627.736(4)(c).
11. Both the Plaintiff and Defendant stipulate that the Plaintiff’s entire bill was applied to the deductible in accordance with the insurance contract.
CONCLUSION OF LAW
The Court’s decision hinges on the thirty (30) day period in which the providers must submit their bill or lose the status as a protected provider. The Legislature created a protected class of providers when they drafted Florida Statute 627.736(4)(c).
Additionally the Legislature placed limitations on which providers are protected and the action they must take to take advantage of the protections afforded in 627.736(4)(c). It is clearly the intent of the Legislature to provide a priority in payment and access to PIP funds for providers of emergency care and services.
It is the contention of the Defendant in this case that the protection does not alleviate or circumvent the deductible provided for in the insurance contract. In fact Florida Statute 627.736(4)(c) does not expressly state that the protected class is exempt from the contractual obligations provided for in the insurance contract. In fact, when an Assignment of Benefits is executed the Plaintiff steps into the shoes of the insured. The insurance contract in the instant case provides that the deductible be applied to the first five hundred dollars ($500.00) of bills received.
The Court has limited guidance in coming to a conclusion in the instant case. Both the Plaintiff and Defendant in this case were aware of four (4) trial court opinions in the 5th DCA. They were unaware of any appellate opinions on point in any Jurisdiction. Having reviewed the trial court opinions in Emergency Medical Associates of Florida, LLC, Assignee of Recy Cochran v. All State Indemnity Company, (Fla. 18th Judicial Circuit Seminole County Court case number 2011-SC-2162) [22 Fla. L. Weekly Supp. 535a]. Emergency Physican of Central Florida, LLP, Assignee of Adriel Rodriguez v. USAA General Indemnity Company, (Fla. 18th Judicial Circuit Seminole County Court case number 2012-SC-705) [20 Fla. L. Weekly Supp. 697a], Emergency Physicians of Central Florida, LLP, Assignee of Asmaa Karani v. Progressive American Insurance Company, (Fla. 9th Judicial Circuit Orange County Court case number 2011-SC-8737) [20 Fla. L. Weekly Supp. 689a], and Emergency Physicians of Central Florida, LLP, Assignee of Tina Watts v. Direct General Insurance Company, (Fla. 18th Judicial Circuit Seminole County Court case number 2011-SC-2288) [22 Fla. L. Weekly Supp. 209c], the Court is compelled to find Plaintiffs argument and case law to be persuasive.
The Court finds the relevant statutory provisions ambiguous and, therefore, reads Florida Statute 627.736(4)(c) and 627.739(2) in pari material. This court is of the impression that to read these two statutes independently of one another would clearly result in an outcome not contemplated by the Legislature. This Court believes that the Legislature’s intent was to provide an additional level of protection for emergency care providers, thus ensuring payment of their invoices and bills. The thirty (30) day provision in 627.736(4)(c) would actually work as a disadvantage for emergency care providers as it forces them to promptly bill the insurance provider. This intern would subject them to the effects of the deductible. It is illogical to believe the Legislature created a special class, with its own funding and priority over other providers only to punish the members of the special class for timely submitting their bills to insurance providers.
Therefore, this Court agrees with Plaintiff and grants Plaintiff’s Motion for Final Summary Judgment.
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