22 Fla. L. Weekly Supp. 1103a
Online Reference: FLWSUPP 2209YENGInsurance — Personal injury protection — Coverage — Emergency medical condition — Under amendments to PIP statute requiring PIP insurer to pay benefits up to $10,000 if qualified medical provider has determined that claimant had emergency medical condition and limiting reimbursement to $2,500 if qualified provider has determined that claimant did not have emergency medical condition, insurer properly limited benefits to $2,500 where qualified provider has not determined that insured suffered emergency medical condition — No merit to argument that insurer was required to pay benefits up to $10,000 unless there was determination of absence of emergency medical condition
PAN AM DIAGNOSTIC SERVICES, INC. dba WIDE OPEN MRI a/a/o Austin Yengst, Plaintiff, v. GARRISON PROPERTY AND CASUALTY INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. COCE-14-011740, Division 55. March 31, 2015. Final Judgment April 8, 2015. Daniel J. Kanner, Judge. Counsel: Amir Fleischer, Marks & Fleischer, Ft. Lauderdale, for Plaintiff. Scott W. Dutton, Dutton Law Group, P.A., Tampa, for Defendant.
AFFIRMED. 25 Fla. L. Weekly Supp. 14a (Pan Am Diagnostic Services, Inc. (a/a/o Yengst) v. Garrison Property & Cas. Ins. Co., 17th Jud. Cir., Case No. CACE-15–007350 AP)
ORDER GRANTING SUMMARY JUDGMENTAND FINAL JUDGMENT FOR DEFENDANT
This matter came on to be heard on February 18, 2015 on the Defendant, Garrison Property and Casualty Insurance Company’s Motion for Summary Judgment, and after reviewing the record and hearing argument of counsel, the Court grants the Defendant’s Motion for Summary Judgment based on the following findings of fact and conclusions of law.I. FINDINGS OF FACTS
1. Plaintiff filed the instant action for payment of PIP benefits based on an assignment from Austin Yengst, who was insured under a policy of insurance issued by Garrison for injuries caused by an automobile accident that occurred on January 21, 2014.
2. Defendant alleges that reimbursement was limited to $2500 under the policy unless a medical provider authorized in § 627.736(1)(a)(4) determined that the covered person had suffered an emergency medical condition. Plaintiff alleges that $10,000 in medical benefits was available unless an authorized person determined that there was no emergency medical condition. Nothing provided to Garrison at any time showed that any determination was made as to the existence or non-existence of an emergency medical condition.
3. Pursuant to the Explanation of Reimbursement for the date of service February 18, 2014, no payment was made because there was no determination of an emergency medical condition by a medical provider authorized in § 627.736(1)(a)(4) and the $2,500 had already been reimbursed for payment of medical expenses, exhausting benefits.
4. The Explanation of Reimbursement also requested information as to whether a determination of an emergency medical condition had been made as to the claimant.
5. No response to the request was received from any person authorized in § 627.736(1)(a) whether claimant/plaintiff had or did not have an emergency medical condition.
6. Plaintiff sent a pre-suit demand letter on May 21, 2014.
7. Garrison responded stating that the $2500 reimbursement limits had been reached and in order to make additional reimbursement decisions, documentation was needed regarding the determination of an emergency medical condition.
8. No response was provided to this request, and suit was filed.
9. Defendant asserts that no charges were due or overdue because the Plaintiff never responded to the request made pursuant to § 627.736(6)(b), Fla. Stat.
10. Defendant asserts that it limited the reimbursements to $2500 because the medical records did not show that an authorized person had determined that the claimant had an emergency medical condition.
II. CONCLUSIONS OF LAW
This Court has previously decided two cases involving virtually identical facts. Doc Tony Westside Chiropractic, LLC (Santiago) v. United Services Auto. Assoc., 22 Fla. L. Weekly Supp. 640a (Fla. Broward Cty. Ct. Dec. 1, 2014); Pembroke Pines MRI, Inc. (Weinkle) v. USAA Cas. Ins. Co., 22 Fla. L. Weekly Supp. 448a (Fla. Broward Cty. Ct. Oct. 17, 2014). In its decisions, this Court opined that § 627.736(1)(a)(3) and (4), Fla. Stat., had only one reasonable interpretation: that medical benefits were limited to $2500 unless an authorized medical provider determined that the claimant had an emergency medical condition. In both those cases, this Court held that the insurer had properly limited medical benefits to $2500. Both of those cases contain detailed analyses of the operation of the relevant provisions of the Florida No-Fault Law, and the Court adopts the opinions in those cases in this case on the issues previously addressed.
It is therefore,
ORDERED AND ADJUDGED that the Defendant Garrison Property and Casualty Insurance Company’s Motion for Final Summary Judgment against the Plaintiff, Pan Am Diagnostic Services, Inc. be and hereby is, hereby GRANTED.
__________________FINAL JUDGMENT
THIS CAUSE came on to be heard on February 18, 2015, on the Plaintiff’s Motion for Summary Judgment and Defendant’s Motion for Summary Judgment with Memorandum of Law Regarding Emergency Medical Condition, Failure to Respond to Request for Information, and Premature Demand Letter, and the Court having heard argument of counsel and being otherwise informed in this matter, and the Court having entered an Order on March 31, 2015 Granting Defendant GARRISON PROPERTY AND CASUALTY INSURANCE COMPANY’s Motion for Summary Judgment, it is ORDERED AND ADJUDGED:
1. That Final Judgment is hereby entered against Plaintiff, PAN AM DIAGNOSTIC SERVICES, INC. dba WIDE OPEN MRI a/a/o Austin Yengst.
2. That Plaintiff, PAN AM DIAGNOSTIC SERVICES, INC. dba WIDE OPEN MRI a/a/o Austin Yengst take nothing by this action.
3. That Defendant, GARRISON PROPERTY AND CASUALTY INSURANCE COMPANY, go hence without day.
4. That this Court retains jurisdiction of this matter to tax costs and attorney’s fees
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