24 Fla. L. Weekly Supp. 100a

Online Reference: FLWSUPP 2402MORAInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that any amounts payable “shall be subject to any and all limitations” authorized by PIP statute including “all fee schedules” does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule — Mandate is withheld pending Florida Supreme Court’s decision resolving conflict in district court of appeal opinions

ALLSTATE INSURANCE COMPANY, Appellant-Defendant, v. GABLES INSURANCE RECOVERY, INC., a/a/o Luis Moran, Appellee-Plaintiff. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 13-305 AP. L.C. Case No. 12-6662 SP 25. May 18, 2016. On appeal from a final judgment rendered by the Miami-Dade County Court, Honorable Don S. Cohn, Judge. Counsel: Douglas G. Brehm and Suzanne Y. Labrit (on briefs), Shutts & Bowen LLP, and Peter J. Valeta (oral argument), Cozen O’Connor, for the Appellant-Defendant. G. Bart Billbrough, Billbrough & Marks, P.A., for the Appellee-Plaintiff.

(Before LEDERMAN, COHEN, & PRESCOTT, Circuit Judges.)

(PER CURIAM.) Gables Insurance Recovery, Inc. (“Claim-Collector” or “Plaintiff-Collector”) alleged that Allstate Insurance Company (“Insurer” or “Insurance Company”) breached an insurance contract by failing to timely pay No-Fault Benefits. The county court entered a Rule 7.135 summary disposition in the Plaintiff-Collector’s favor based upon a stipulated legal question involving the Insurer’s election to limit reimbursement pursuant to the Medicare Part B schedule, § 627.736(5)(a)2.f., Fla. Stat. (2010). The stipulated legal question decided by the county court focused upon an insurance policy provision:

Any amounts payable under this coverage shall be subject to any and all limitations authorized by section 627.736, or any other provisions of the Florida Motor Vehicle No-Fault law, as enacted, amended or otherwise continued in the law, including but not limited to, all fee schedules.

(R. at 56 & 72, ¶ 7). On appeal, the litigants focus upon whether this provision adequately notified the Claim-Collector that the Insurer would limit reimbursement pursuant to the Medicare Part B schedule. § 627.736(5)(a)2.f., Fla. Stat. (2010).¹ We have jurisdiction to review the summary disposition². § 26.012(1), Fla. Stat. (2016).

Interpreting Geico Gen. Ins. Co. v. Virtual Imaging Servs., Inc., 141 So. 3d 147 (Fla. 2013) [38 Fla. L. Weekly S517a], Florida’s appellate courts conflict as to whether the policy language at issue here sufficiently notifies policyholders and medical providers regarding the Insurer’s election to reimburse pursuant to the Medicare Part B schedule. See Allstate Fire & Cas. Ins. v. Stand-Up MRI of Tallahassee, P.A., 40 Fla. L. Weekly D693b *1 (Fla. 1st DCA Mar. 18, 2015) (holding that the “policy provided adequate notice of its election to use the Medicare fee schedules referenced in § 627.736(5)(a)2”), review pending, SC15-962; contra Orthopedic Specialists v. Allstate Ins. Co., 177 So. 3d 19, 25-26 (Fla. 4th DCA 2015) [40 Fla. L. Weekly D1918a] (considering the same policy language ambiguous and stating that a “policy is not sufficient unless it plainly and obviously limits reimbursement to the Medicare fee schedules exclusively”), review pending, SC15-2298. Recently, the second district certified conflict with Orthopedic Specialists and concluded that the same policy language provided “legally sufficient notice, as required by Virtual Imaging,” regarding the insurer’s “election to use the Medicare fee schedules.” Allstate Indem. Co. v. Markley Chiropractic & Acupuncture, LLC, 41 Fla. L. Weekly D793b (Fla. 2d DCA Mar. 30, 2016).

Analyzing the conflicting opinions issued by the first and fourth district courts as well as conflicting opinions from Florida’s Eleventh Judicial Circuit, a recent circuit panel concluded that a policy, identical to the policy at issue here, “insufficiently notified” the provider that the insurer “would reimburse based upon limitations authorized by section 627.736(5)(a)2.f., the Medicare Part B schedule.” Allstate Fire & Cas. Ins. Co. v. Hallandale Open MRI LLC, a/a/o Blake, 23 Fla. L. Weekly Supp. 683a (Fla. 11th Cir. Ct. Dec. 7, 2015), review pending, 3D16-38. Blake reasoned that the supreme court’s Virtual Imaging decision approved Geico Indem. Co. v. Virtual Imaging Servs., Inc. (“Virtual I”), 79 So. 3d 55 (Fla. 3d DCA 2011) [36 Fla. L. Weekly D2597a], “to the extent Virtual I remained consistent with the supreme court’s decision.” 23 Fla. L. Weekly Supp. 683a. Blake considered Virtual “more closely aligned with the reasoning in Orthopedic Specialists rather than Stand-Up MRI.” Id. We agree with Blake‘s reasoning that the third district’s Virtual I decision dictates that we follow Orthopedic Specialists.³ Therefore, we affirm the summary disposition based upon Orthopedic Specialists, Virtual I, and Blake.

The Florida Supreme Court is currently reviewing the conflicting opinions issued by the First and Fourth District Courts of Appeal. Allstate Ins. Co. v. Orthopedic Specialists, etc., Case No. SC15-2298; Stand-Up MRI of Tallahassee, P.A., etc. v. Allstate Fire & Cas. Ins. Co., Case No. SC15-962.⁴ By separate order issued to the Clerk’s Office, we withhold the mandate pending the supreme court’s decision resolving the conflict between the First, Second, and Fourth District Courts of Appeal. Fla. R. App. P. 9.340(a); Chandler v. State, 41 So. 3d 1107, 1110 (Fla. 3d DCA 2010) [35 Fla. L. Weekly D1889a].Claim-Collector’s Motion for Appellate Attorney’s Fees

The Claim-Collector requests appellate attorney’s fees pursuant to section 627.428, Florida Statutes (2010). Because we affirm the summary disposition, we grant the Claim-Collector’s motion for section 627.428(1) appellate attorney’s fees.

AFFIRMED; MANDATE WITHHELD; APPELLATE FEES GRANTED.

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¹On appeal, both litigants rely upon the 2008 statute. However, this appellate record includes the policy declaration, which indicates a policy period from January 15, 2010 through July 15, 2010 (R. at 22). See id. at 13, § I, ¶ 2 (the Plaintiff-Collector identifying the policy’s coverage “for the period from 1/15/2010 through 7/15/2010” as an undisputed material fact). We apply the statute in effect on the date that the “insurer and insured entered into” the policy as indicated by the declaration. United Auto. Ins. Co. v. Tejada, 18 Fla. L. Weekly Supp. 353a (Fla. 11th Cir. Ct. Feb. 8, 2011). Because the declaration demonstrates coverage beginning January 15, 2010 and the Claim-Collector did not dispute this coverage period, we apply the statute in effect on January 15, 2010.

²We treat a Rule 7.135 summary disposition as a summary judgment requiring de novo review on appeal. Morales v. Zhelyazkov, 20 Fla. L. Weekly Supp. 860a n.1 (Fla. 11th Cir. Ct. June 21, 2013).

³The third district considered policy language different from the policy provision analyzed by us and Orthopedic Specialists.

⁴On December 17, 2015, the supreme court stayed its proceedings in Case No. SC15-962 pending disposition in Orthopedic Specialists, Case No. SC15-2298.