22 Fla. L. Weekly Supp. 389c
Online Reference: FLWSUPP 2203ALLEInsurance — 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
PRECISION DIAGNOSTIC, INC., d/b/a PRECISION MRI, assignee of ALLEN, JESSICA, Plaintiff, v. UNITED SERVICES AUTOMOBILE ASSOCIATION, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. CONO 14-001263 (72). August 14, 2014. Jill K. Levy, Judge. Counsel: Abraham Ovadia, Florida PIP Law Firm, P.A., Boca Raton, for Plaintiff. Scott W. Dutton, Dutton Law Group, P.A., Tampa, for Defendant.
ORDER GRANTING SUMMARY JUDGMENT ANDFINAL JUDGMENT FOR DEFENDANT
This matter came on to be heard on July 14, 2014 on the Defendant, UNITED SERVICES AUTOMOBILE ASSOCIATION’S Motion for Summary Judgment, and after hearing argument of counsel, the Court grants the motion based on the following findings of fact and conclusions of law.FACTS
This action involves a claim for personal injury protection medical benefits filed by the Plaintiff, PRECISION DIAGNOSTIC, INC., d/b/a PRECISION MRI, assignee of ALLEN, JESSICA, (hereinafter “Claimant”) against the Defendant, UNITED SERVICES AUTOMOBILE ASSOCIATION (hereinafter “Defendant”), arising out of a motor-vehicle accident. The Claimant was insured under a contract of insurance issued by the Defendant that provided PIP benefits in accordance with the Florida Motor Vehicle No-Fault Law.
Following the accident, the Claimant sought treatment from various medical providers for injuries sustained as a result of the accident and the Defendant received bills for reimbursement. Among the charges received were bills from the Plaintiff. The Defendant reviewed and adjusted the bills and limited reimbursement to $2,500.00 because the medical records did not show that a statutory “qualified provider” had determined that the Claimant had an emergency medical condition. That fact is not disputed.
CONCLUSIONS OF LAW
Plaintiff filed a suit contesting the Defendant’s adjustment of the claim. The Defendant filed a Motion for Summary Judgment and supporting Memorandum of Law regarding the determination of an emergency medical condition and its impact on a claim for benefits. In its Motion and Memorandum of Law the Defendant argued that the language of the policy and the Florida Vehicle No-Fault Law limits reimbursement of medical benefits to the claimant up to $2,500.00, unless a “qualified provider” determines that the claimant had an “emergency medical condition.” The Plaintiff, on the other hand, argued that the language of the policy and the Florida Motor Vehicle No-Fault Law requires an insurer to issue benefits to a claimant up to $10,000.00, unless a treating provider determines that the claimant did not have an emergency medical condition.
At the heart of the parties’ dispute is the interpretation of § 627.736(1)(a)(3)-(4), Fla. Stat. The statute, revised by the 2012 amendments to the Florida Motor Vehicle No-Fault Law, provides:
(1) Required benefits. — An insurance policy complying with the security requirements of s. 627.733 must provide personal injury protection to the named insured . . . to a limit of $10,000 in medical and disability benefits . . . resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle as follows:
(a) Medical benefits. — Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services[.] The medical benefits provide reimbursement only for:
. . .
3. Reimbursement for services and care provided . . . up to $10,000 if a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced registered nurse practitioner licensed under chapter 464 has determined that the injured person had an emergency medical condition.
4. Reimbursement for services and care . . . is limited to $2,500 if a provider listed in subparagraph 1. or subparagraph 2. determines that the injured person did not have an emergency medical condition.
§ 627.736, Fla. Stat. (emphasis added).
An “emergency medical condition” is defined as “a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in . . . (a) serious jeopardy to patient health, (b) serious impairment to bodily functions, [or] (c) serious dysfunction of any bodily organ or part. § 627.732(16), Fla. Stat. (2013).
“A basic tenet of statutory interpretation is that a ‘statute should be interpreted to give effect to every clause in it, and to accord meaning and harmony to all of its parts.’ ” Jones v. ETS of New Orleans, Inc., 793 So. 2d 912, 914-15 (Fla. 2001) [26 Fla. L. Weekly S549a] (quoting Acosta v. Richter, 671 So. 2d 149, 153-54 (Fla. 1996)[21 Fla. L. Weekly S29a]). A related principle is that when a court interprets a statute, it “must give full effect to all statutory provisions.” Forsythe v. Longboat Key Beach Erosion Control Dist., 604 So. 2d 452, 455 (Fla. 1992).
In reviewing the statute’s provisions, only one reasonable and harmonious interpretation of the statute is possible: the statute is intended to limit medical benefits to $2,500.00, unless a qualified provider has determined that the claimant had an emergency medical condition.
Moreover, even if the statute were ambiguous, this Court is obligated to give effect to the legislative intent. The House of Representatives Final Bill Analysis states:
Medical benefits of up to $10,000 are available for emergency medical conditions diagnosed by specified providers; medical benefits of up to $2,500 are available for non-emergency conditions.
House of Representatives Final Bill Analysis, HB 119, 5/7/2012, at 9.
In order to make this statutory intent workable, the statute must be interpreted to require the provider to provide the insurer with a determination that an emergency medical condition actually exists before the insurer may be liable for payment of medical benefits in excess of $2,500.00. To do otherwise would be to defeat the statutory intent to limit PIP payments, and would in effect continue to make $10,000.00 in benefits available on any claim, unless a treating provider notified the insurer that the claimant had NOT suffered an emergency medical condition. In practice, this would seldom, if ever, take place, and would defeat the purpose of the 2012 amendments recently enacted.
It is therefore
ORDERED AND ADJUDGED that the Defendant UNITED SERVICES AUTOMOBILE ASSOCIATION’S Motion for Final Summary Judgment against the Plaintiff, PRECISION DIAGNOSTIC, INC., d/b/a PRECISION MRI, assignee of ALLEN, JESSICA, be and hereby is, GRANTED. It is further
ORDERED AND ADJUDGED that the Plaintiff, PRECISION DIAGNOSTIC, INC., d/b/a PRECISION MRI, assignee of ALLEN, JESSICA take nothing by this action and that Defendant UNITED SERVICES AUTOMOBILE ASSOCIATION shall go hence without day. The Court reserves jurisdiction to determine the entitlement to and the amount of attorney’s fees and costs.
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