22 Fla. L. Weekly Supp. 675a

Online Reference: FLWSUPP 2205INFIInsurance — Personal injury protection — Coverage — Medical expenses — Policy which provided that insurer would pay 80% of medical expenses and, on separate page, that it would pay 200% of Medicare Part B schedule was ambiguous and must be interpreted in favor of insured — Trial court properly entered final summary judgment in favor of provider, but it is unclear whether amount awarded was properly calculated — Remand for recalculation of damages reflecting endorsement provision providing greater coverage

INFINITY AUTOMOBILE INSURANCE COMPANY, Appellant-Defendant, v. SUNSHINE REHAB & MEDICAL, INC., a/a/o Osvaldo Borras, Appellee-Plaintiff. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 12-179 AP. L.T. Case No. 11-200 SP 21. January 5, 2015. On appeal from a final judgment rendered by the County Court for Miami-Dade County. Honorable Jacqueline Schwartz. Counsel: Suzanne Labrit, Shutts & Bowen, LLP, Tampa; Lewis F. Collins, Jr., Anthony J. Russo, and Ezequiel Lugo, Butler Pappas Weihmuller Katz Craig, LLP, Tampa, for Appellant-Defendant. Ryan Peterson and Richard Patino, Patino Law Firm, Hialeah, for Appellee-Plaintiff.

(Before KORVICK, JOSE RODRIGUEZ, and LOBREE, JJ.)

(PER CURIAM.) Infinity Automobile Insurance Company (“insurance company” or “insurer”) challenges a final summary judgment rendered in Sunshine Rehab Medical, Inc.’s (“provider”) favor. Section 26.012(1), Florida Statutes, authorizes us to review this appeal. We review a final summary judgment resolving a pure legal question de novo. Kingsway Amigo Ins. Co. v. Ocean Health Inc., 63 So. 3d 63, 66 (Fla. 4th DCA 2011) [36 Fla. L. Weekly D1062a].

According to the provider, the policy informs that the insurer will limit payment to the “schedule of maximum charges, rather than 80% of the schedule of maximum charges.” The provider advances that nothing in the policy permits the 20% reduction; thus, the insurer “must pay 100% of the schedule of maximum charges, rather than 80%.”

The statutory provision at issue states:

With respect to a determination of whether a charge for a particular service, treatment, or otherwise is reasonable, consideration may be given to . . . various federal and state medical fee schedules applicable to automobile and other insurance coverages . . . 2. The insurer may limit reimbursement to 80 percent of the following schedule of maximum charges: . . . f. For all other medical services, supplies, and care, 200 percent of the allowable amount under the participating physicians schedule of Medicare Part B.

§ 627.736(5)(a)2.f., Fla. Stat. (2010) (emphasis added).¹ We read section 627.736(5)(a)2.f. as authorizing an insurer to limit reimbursement to eighty percent (80%) of two-hundred (200%) percent of the amount allowed pursuant to the Medicare Part B schedule. Regarding incorporating subsection (5)(a)2.f. into the policy, the insurer must specifically elect the payment method in the policy. Geico Indem. Co. v. Virtual Imaging Servs., 79 So. 3d 55, 56 (Fla. 3d DCA 2011) [36 Fla. L. Weekly D2597a]; Kingsway, 63 So. 3d at 64.The Insurance Policy

This insurer amended its policy by replacing the personal injury protection provision with an endorsement (R. 321). An endorsement to a policy limits or amends the policy’s general provisions. 43 Am. Jur. 2d Insurance § 304. Florida courts apply an endorsement’s plain meaning. Harris v. Cotton States Mut. Ins. Co., 821 So. 2d 1211, 1213 (Fla. 1st DCA 2002) [27 Fla. L. Weekly D1681c]. We read each policy as a whole, endeavoring to give every provision its full meaning and operative effect. Riveroll v. Winterthur Intern. Ltd., 787 So. 2d 891, 892 (Fla. 3d DCA 2001) [26 Fla. L. Weekly D1067a]. However, where “a contract is susceptible to two different interpretations, each one of which is reasonably inferred from” the contract terms, “the agreement is ambiguous.” Commercial Capital Res., LLC v. Giovannetti, 955 So. 2d 1151, 1153 (Fla. 3d DCA 2007) [32 Fla. L. Weekly D814a] (emphasis added).

Here, the insurance company separated the terms “80% of medical expenses” and “200 percent” of the Medicare Part B schedule by a page in the endorsement. Because the insurer separated the 80% modifier from the 200% of Medicare Part B modifier on different pages, we reasonably infer that this insurer intends to cover (1) 80% of all medical expenses or (2) 200% of the Medicare Part B fee schedule (R. 324-325). We conclude that this policy constitutes an ambiguous contract. When language in an insurance policy is ambiguous, a court will resolve the ambiguity in the insured’s favor by adopting the reasonable interpretation that provides coverage as opposed to the interpretation limiting coverage. State Farm Mut. Auto. Ins. Co. v. Menendez, 70 So. 3d 566, 570 (Fla. 2011) [36 Fla. L. Weekly S469a]. See Am. Indep. Ins. Co. v. Gables Ins. Recovery, Inc., a/a/o Lima, 19 Fla. L. Weekly Supp. 14b (Fla. 11th Cir. Ct. Oct. 12, 2011). Because this endorsement discusses two (2) different payment methods, we rely upon Menendez as requiring this insurer to pay the higher coverage amount.

Here, the county court did not clarify whether the $1,321.07 constitutes payment pursuant to 80% of medical expenses or 80% of 200% of the Medicare Part B schedule (R. 387). Accordingly, we affirm the final summary judgment but remand for the trial court to amend the final summary judgment to include re-calculated damages reflecting the endorsement provision providing greater coverage. See Menendez, 70 So. 3d at 570; Lima, 19 Fla. L. Weekly Supp. 14b.

Our decision to render appellate judgment against the insurer satisfies section 627.428(1)’s criteria. Accordingly, we grant the provider’s motion for section 627.428(1) appellate attorney’s fees. AFFIRMED, REMANDED WITH DIRECTIONS, and ATTORNEY’S FEES GRANTED.

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¹The insurance declaration indicates coverage effective February 11, 2010 through August 11, 2010 (R. 321). We apply the version of section 627.736(5)(a)2.f. in effect on February 11, 2010, the policy’s effective date. United Auto. Ins. Co v. Tejada, 18 Fla. L. Weekly Supp. 353a (Fla. 11th Cir. Ct. Feb. 8, 2011).