22 Fla. L. Weekly Supp. 152a
Online Reference: FLWSUPP 2201TMILInsurance — Personal injury protection — Coverage — Emergency medical condition — Amendments to PIP statute requiring 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 are harmonized to limit benefits to $2,500 unless provider has determined that claimant had emergency medical condition, not to require payment of up to $10,000 in benefits unless provider notified insurer that claimant had not suffered such condition
SOUTHSIDE CHIROPRACTIC CENTRE, INC. (TELLY MILLER), Plaintiff, v. USAA GENERAL INDEMNITY COMPANY, Defendant. County Court, 17th Judicial Circuit and for Broward County. Case No. COCE 13-020731. June 10, 2014. Honorable Linda R. Pratt, Judge.
ORDER GRANTING SUMMARY JUDGMENT ANDFINAL SUMMARY JUDGMENT FOR DEFENDANT
This matter came on to be heard on May 28, 2014 on the Defendant, USAA GENERAL INDEMNITY COMPANY’S, Motion for Summary Judgment. After hearing argument of counsel, the Court makes 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, SOUTHSIDE CHIROPRACTIC CENTRE, INC. (hereinafter “Plaintiff’) as assignee of TELLY MILLER (hereinafter “Claimant”) against the Defendant, USAA GENERAL INDEMNITY COMPANY (hereinafter “Defendant”), arising out of a motor-vehicle accident that occurred July 5, 2013. At the time of the 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, as amended in 2012, for the policy period beginning March 22, 2013 (hereinafter “the Policy”). Specifically, under the policy, the Defendant agreed to pay to or for the benefit of the “covered person” medical benefits in accordance with the statute. Both the policy and statute contained the following limitation on benefits:
3. Reimbursement for services and care provided in subparagraph 1. or subparagraph 2, 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 provided in subparagraph 1. or subparagraph 2. is limited to $2,500.00 if a provider listed in subparagraph 1. or subparagraph 2. determines that the injured person did not have an emergency medical condition.
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. See § 627.732(16), Fla. Stat. (2013).
Following the accident, the claimant sought treatment from various medical providers for injuries allegedly sustained as a result of the accident and the Defendant received bills for reimbursement. Among the charges received were bills from the Plaintiff for treatment rendered from July 5, 2013 to October 21, 2013. The Defendant reviewed and adjusted the bills received in accordance with the terms of the Policy and the applicable provisions of the Florida Motor Vehicle No-Fault Law. It limited the reimbursements to $2,500.00 because the medical records did not show that 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 (a “qualified provider”) had determined that the claimant had an emergency medical condition as statutorily required to authorize additional reimbursement. 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, subsequently filed a Memorandum of Law in Opposition to the Defendant’s Motion for Summary Judgment in which it argued that the language of the policy and the Florida Motor Vehicle No-Fault Law clearly and unambiguously 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 sections 627.736(1)(a)(3)-(4), Fla. Stat. . The Defendant’s argument is that the statute should be read as a whole to give effect to all of its parts. The Plaintiff, in turn, argues the Court should isolate 627.736(1)(a)(4), Fla. Stat. and require a determination by a treating physician before the $2500 reimbursement limitation on medical benefits would apply.
A review of this statutory language in light of the established tenets of statutory construction requires this Court to harmonize the various provisions of the statute. “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). Courts should “avoid readings that would render part of a statute meaningless.” Unruh v. State, 669 So.2d 242, 245 (Fla.1996) [21 Fla. L. Weekly S104a] (quoting Forsythe, 604 So.2d at 456). In reviewing those 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.
Here there is no genuine issue as to any material fact. No qualified provider had determined that the insured had an emergency medical condition. Therefore, in this case, the issue before this Court is one of law involving the legal application of a contract based upon the Florida Motor Vehicle No-Fault law, as amended. In considering the provisions of section 627.736(1), Fla. Stat. (2013), there is only one reasonable conclusion that gives harmony and meaning to all provisions. The available medical benefits are limited to $2,500.00, unless there is a determination by a qualified provider that the patient in fact had an emergency medical condition.
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’s Motion for Final Summary Judgment against the Plaintiff, SOUTHSIDE CHIROPRACTIC CENTRE, INC. as assignee of TELLY MILLER, is GRANTED as the pleadings, answers to interrogatories, affidavits, and other materials as would be admissible in evidence on file show that there is no genuine issue of material fact and that as a matter of law, the Defendant has no liability to the Plaintiff. SUMMARY JUDGMENT IS ENTERED IN FAVOR OF THE DEFENDANT AND IT SHALL GO HENCE WITHOUT DAY, and this court reserves jurisdiction to determine entitlement and amount of fees and costs to the Defendant as well as to any other relief as this Court deems just and proper, upon timely motion.
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