22 Fla. L. Weekly Supp. 948a
Online Reference: FLWSUPP 2208GONZInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — Where PIP policy clearly elects to pay pursuant to permissive statutory fee schedule, insurer properly applied fee schedule to bills before applying deductible
ROYAL CARE MEDICAL CENTER A/A/O SAMANTHA GONZALEZ, Plaintiff, v. ESURANCE PROPERTY & CASUALTY INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 13-1108 CC 24. January 21, 2015. Rodolfo A. Ruiz, Judge. Counsel: Ryan A. Peterson, The Patino Law Firm, Hialeah, for Plaintiff. Patrick F. Kissane, Law Offices of Norma Miranda Davies, Fort Lauderdale, for Defendant.
ORDER GRANTING DEFENDANT’S MOTION FOR FINALSUMMARY JUDGMENT AND DENYING PLAINTIFF’SMOTION FOR FINAL SUMMARY JUDGMENT
THIS CAUSE, having come before the Court on November 5, 2014, on Defendant’s Motion for Final Summary Judgment and Plaintiff’s Motion for Final Summary Judgment, and the Court having heard argument of counsel and being otherwise fully advised of the premises, it is hereby
ORDERED and ADJUDGED as follows:
1. Defendant properly applied its policy deductible to Plaintiff’s medical bills by first applying the Medicare Fee Schedule reductions as elected by the subject policy of insurance, and then applying the deductible.
2. The deductible only applies to losses covered under the policy of insurance, not simply the total bills submitted. See Gen. Star. Indem. Co. v. W. Fla. Village Inn, Inc., 874 So. 2d 26, 33-34 (Fla. 2d DCA 2004 [29 Fla. L. Weekly D348a].)
3. The insurer should first determine which bills are deemed reasonable, related and necessary under the policy of insurance, and then apply the deductible. If the insurer has properly elected to pay pursuant to the applicable fee schedules as described in section 627.736 of the Florida Statutes, the insurer may first apply the fee schedules to the submitted bills, and then apply the deductible. See New Medical Group, Inc. a/a/o Elisa Collazo v. United Auto. Ins. Co., Order Denying Plaintiff’s Motion for Summary Judgment Alleging Defendant Improperly Applied its Policy Deductible, Case. No. 11-01871 SP 26 (04) (Fla. 11th Cir., Miami-Dade Cty. Court, Mar. 15, 2013.)
4. On April 16, 2014, this Court held that Defendant’s policy of insurance at issue clearly elects to pay pursuant to the fee schedules set forth under section 627.736(5)(a)(2) of the Florida Statutes, thereby conforming with Geico Gen. Ins. Co. v. Virtual Imaging Servs. Inc., 141 So. 3d 147 (Fla. 2013) [38 Fla. L. Weekly S517a].
5. Moreover, sections 627.739 and 627.736 of the Florida Statutes must be read together, in pari materia. By applying the Medicare Fee Schedule limitations prior to the application of the policy deductible, Defendant has complied with section 627.739(2) and applied the deductible to 100% of the expenses and losses as described in section 627.736. See Goldcoast Physicians Center, Inc. v. Garrison Prop. & Cas. Ins. Co., 20 Fla. L. Weekly Supp. 711a (Fla. 17th Cir., Broward Cty. Court, Mar. 9, 2013); see also Gen. Star. Indem., 874 So. 2d at 34.
6. Ultimately, this Court adopts the rationale set forth in New Medical Group, Inc. a/a/o Elisa Collazo v. United Auto. Ins. Co., Order Denying Plaintiff’s Motion for Summary Judgment Alleging Defendant Improperly Applied its Policy Deductible, Case No. 11-01871 SP 26 (04) (Fla. 11th Cir., Miami Dade Cty. Court, Mar. 15, 2013), and Goldcoast Physicians Center, Inc. v. Garrison Prop. & Cas. Ins. Co., 20 Fla. L. Weekly Supp. 711a (Fla. 17th Cir., Broward Cty. Court, Mar. 9, 2013).
7. For the reasons set forth herein, Defendant’s Motion for Final Summary Judgment is GRANTED and Plaintiff’s Motion for Final Summary Judgment is DENIED.
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