22 Fla. L. Weekly Supp. 274a
Online Reference: FLWSUPP 2202ROUSInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that subjects payments to any and all limitations authorized by PIP statute, including all fee schedules, clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule
GABLES INSURANCE RECOVERY, INC., a/a/o Rafael Rousseaux, Plaintiff, vs. ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 2013-16566-SP-25 (04). June 16, 2014. Honorable Charles K. Johnson, Judge. Counsel: Monica Lorie Holden, Monica Lorie Holden, P.A., Coral Gables, for Plaintiff. Douglas G. Brehm, Shutts & Bowen, LLP, Miami, for Defendant.
ORDER GRANTING ALLSTATE’S MOTIONFOR SUMMARY JUDGMENT AND DENYINGPLAINTIFF’S MOTION FOR SUMMARY JUDGMENT
This matter came before the Court upon the above parties’ Cross Motion for Summary Judgment. The Court, having heard argument of the Parties on June 16, 2014, and being otherwise duly advised in the matter, GRANTS Allstate’s Motion for Summary Judgment and DENIES Plaintiff’s Motion for Partial Summary Judgment in the above case.
1. Plaintiff’s Complaint challenges Allstate’s ability to limit reimbursements for medical services covered under the Personal Injury Protection (“PIP”) portion of Allstate’s policy of automobile insurance. Allstate contends that its policy specifically and expressly notifies its policyholder (as well as any assignee providers) that Allstate has elected to apply the fee schedule limitations to PIP reimbursements that are authorized under the No-Fault Statute.
2. The instant case involves no disputed facts. The facts of this case are set forth more fully in the Joint Stipulation of Fact that was filed in this case and may be summarized as follows: Allstate’s insured, Rafael Rousseaux was involved in an automobile accident and sustained injuries that were covered under Allstate’s policy and the corresponding provisions of Fla. Stat. 627.736 (2008). Pursuant to a valid assignment of benefits, Plaintiff, GABLES INSURANCE RECOVERY, INC. provided medical services to Rafael Rousseaux. The parties agree that these medical services were reasonable, related and necessary and otherwise covered under Allstate’s policy. Allstate reimbursed all invoices received from Plaintiff relating to this claim pursuant to the Medicare Part B Participating Physicians Fee Schedule.
3. The relevant portion of Allstate’s policy provides:
In accordance with the Florida Motor Vehicle No-Fault Law, Allstate will pay to or on behalf of the injured person the following benefits. . .
1. Medical Expenses.
Eighty Percent of reasonable expenses for medically necessary medical, surgical, X-ray, dental and rehabilitative services. . .
. . . .
Any amounts payable under this coverage shall be subject to any and all limitations authorized by Fla. Stat. § 627.736, or any other provisions of the Florida Motor Vehicle No-Fault Law, as enacted, amended or otherwise continued in the law including, but not limited to, all fee schedules.
4. For the reasons set forth in the appellate opinion in Allstate Property and Casualty Ins. Co. and Allstate Fire and Casualty Ins. Co. v. Royal Diagnostic Center Inc., Case No.: 13-073 AP, in the Circuit Court of The Eleventh Judicial Circuit in and for Miami-Dade County, Florida (April 3, 2014, Judges Rodney Smith, Fleur J. Lobree, and Maria Verde, JJ. Smith, J.) [21 Fla. L. Weekly Supp. 627a], this Court finds that Allstate’s policy language complies with the requirements established by the Florida Supreme Court and constitutes an enforceable election to apply the reimbursement limitations permitted under Fla. Stat. 627.736(5)(a)(2). The Court rejects Plaintiff’s contention that Allstate’s policy language is unclear and/or ambiguous.
Accordingly, Allstate’s Motion for Summary Judgment in this case is GRANTED, and Plaintiff’s Motion for Summary Judgment in this case is DENIED. Final Judgment is entered in favor of Allstate in this case. Plaintiff shall take nothing by this action, and Defendant shall go hence without day.
