23 Fla. L. Weekly Supp. 189b
Online Reference: FLWSUPP 2302SINGInsurance — Personal injury protection — Standing — Assignment — Document assigning benefits to hospital and any involved provider confers standing on physicians who rendered services to insured in hospital emergency room — Coverage — Emergency services — Deductible — Because insurer is mandated by statute to reserve $5,000 for emergency service providers, insurer should not have applied claim by plaintiff provider within that classification to deductible
EMERGENCY PHYSICIANS OF CENTRAL FLORIDA, LLP, as assignee of Halle Singleton, Plaintiff, v. GARRISON PROPERTY AND CASUALTY INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Brevard County. Case No. 05-2011-SC-056496-XXXX-XX. June 17, 2015. A.B. Majeed, Judge. Counsel: Robert D. Bartels, Bradford Cederberg P.A., Orlando, for Plaintiff. David R. Hwalek, for Defendant.
ORDER
THIS MATTER having come before this Honorable Court on November 17, 2014 on Plaintiffs’ Motion for Final Summary Judgment and this Honorable Court having heard arguments of counsel and being otherwise fully advised in the premises, it is hereby,
ORDERED AND ADJUDGED that:
1. This is a claim for PIP benefits arising out of a motor vehicle collision that occurred on or about July 30, 2011.
2. The Plaintiff in this matter is Emergency Physicians of Central Florida, LLP as assignee of Halle Singleton.
3. The Plaintiff rendered emergency services and care to the Defendant’s insured, Halle Singleton, in the Emergency Department of Dr. Phillips Hospital, Orlando Health, following that collision.
4. The Plaintiff billed the Defendant for its Emergency Department services and care in the amount of $446.
5. Defendant allowed the bill in full, applied $356 towards the deductible and paid the remainder of the bill in the amount of $90. Said amount represented $72 for PIP and $18 for medical payment coverage.
6. Plaintiff provided emergency services and care to Halle Singleton on July 30, 2011.
7. Plaintiff’s bill was received within thirty (30) days of Defendant receiving notice of the loss.
8. The Plaintiff provided a pre-suit notice of intent to initiate litigation as required by Florida Statutes. The Defendant responded to the pre-suit notice and stood by its decision to apply the Plaintiff’s bill toward the patient’s deductible.
9 A lawsuit was filed and the Defendant has asserted as affirmative defenses that the Plaintiff lacks standing to bring this claim and that Defendant properly applied Plaintiff’s bill to the deductible.
I. Standing
10. The Defendant contends that the document executed by the Defendant’s insured in the Emergency Department of Orlando Health is not an assignment in favor of Plaintiff thereby depriving the Plaintiff of standing to bring this claim. The Defendant contends that the document references only Orlando Health. The Plaintiff contends that the assignment of insurance benefits at issue clearly and unambiguously assigns the patients insurance benefits to Plaintiff, the emergency department physicians, thereby conveying standing to Plaintiff to bring the present action.
11. The assignment of benefits at issue is entitled “Conditions for Treatment, Part B. FINANCIAL RESPONSIBILITY, ASSIGNMENT OF BENEFITS, RELEASE OF INFORMATION, AND PATIENT/GUARANTOR AGREEMENT” and in pertinent part reads:
1. ASSIGNMENT OF INSURANCE BENEFITS.
A. In the event I am entitled to benefits or other recovery of any type whatsoever arising out of any policy of insurance insuring the patient or any other party liable to the patient (including but not limited to private and group health and hospitalization benefits, automobile liability, general liability, personal injury protection, medical payments and uninsured or underinsured motor vehicle benefits) such benefits or recovery are hereby assigned directly to Orlando Health, Inc. for application to the patient’s bill and I authorize direct payment to Orlando Health, Inc. of such benefits or recovery. It is agreed that Orlando Health, Inc. may receipt (sp) for any such payment. I am responsible for charges not covered by this assignment.
B. I hereby assign the insurance benefits otherwise payable to the undersigned and/or patient to any involved provider(s), including but not limited to radiologists, cardiologists, pathologists, anesthesiologists, emergency department physicians, and Omnilight Helicopters, Inc., and I authorize direct payment to said providers of such benefits. I am responsible for charges not covered by this assignment. (emphasis added).
12. Other courts have determined that this document was a valid assignment of benefits thereby providing Plaintiff with standing. See e.g. Emergency Physicians of Central Florida, LLP as assignee of Rebecca Ferry v. USAA Casualty Insurance Company, CASE NO.: 2009-SC-567 (Orange County, County Ct., Judge Blechman)(Order Denying Defendant’s Motion for Final Summary Judgment on Standing, executed December 15, 2009) and in Emergency Physicians of Central Florida, LLP as assignee of Maria Humfleet v. USAA Casualty Insurance Company, CASE NO.: 2008-SC-3145 (Seminole County, County Ct., Judge Marblestone)(Order Denying Defendant’s Motion for Final Summary Judgment on Standing, executed December 10, 2009).
13. Most recently, Judge Collins determined that this document was a valid assignment of benefits thereby providing Plaintiff with standing. See Emergency Physicians of Central Florida, LLP a/a/o Adriel Rodriguez v. USAA General Indemnity Company, 20 Fla. L. Weekly Supp. 449b (Fla. 18th Jud. Cir. Seminole Co. 2012) affirmed by USAA General Indemnity Company v. Emergency Physicians of Central Florida, LLP a/a/o Adriel Rodriguez, case number 13-17-AP (Fla. 18th Jud. Cir. App. Seminole Co. October 16, 2014) [22 Fla. L. Weekly Supp. 341a].
14. This Court is in agreement with those rulings and is bound by the Rodriguez appellate decision. Thus the document relied upon by Plaintiff is a valid assignment of benefits and Plaintiff has standing. Therefore, Plaintiff’s Motion for Summary Judgment as to standing is granted.
II. Application of the Plaintiff’s bill to the deductible
15. The undisputed facts established that Plaintiff provided emergency services and care, the Plaintiff was one of the established providers protected by the mandatory reserve requirements contained within Florida Statute § 627.736(4)(c), that Plaintiff’s bill was received within thirty (30) days of the accident, that Defendant allowed the bill in full, applied a portion to the deductible and paid the remainder of the bill.
16. On January 1, 2008, the Legislature revived the PIP statute which created for the first time a mandatory set aside of $5,000 for payment of bills submitted by a special class of providers. Florida Statute § 627.736(4)(c) states in relevant part:
Upon receiving notice of an accident that is potentially covered by personal injury protection benefits, the insurer must reserve $5,000 of personal injury protection benefits for payment to physicians licensed under chapter 458 or chapter 459 or dentists licensed under chapter 466 who provide emergency services and care, as defined in s. 395.002(9), or who provide hospital inpatient care. The amount required to be held in reserve may be used only to pay claims from such physicians or dentists until 30 days after the date the insurer receives notice of the accident. After the 30-day period, any amount of the reserve for which the insurer has not received notice_of a claim from a physician or dentist who provided emergency services and care or who provided hospital inpatient care may then be used_by the insurer to pay other claims. The time periods specified in paragraph (b) for required payment of personal injury protection benefits shall be tolled for the period of time that an insurer is required by this paragraph to hold payment of a claim that is not from a physician or dentist who provided emergency services and care or who provided hospital inpatient care to the extent that the personal injury protection benefits not held in reserve are insufficient to pay the claim. This paragraph does not require an insurer to establish a claim reserve for insurance accounting purposes.
17. The Court agrees with Plaintiff and finds that the language of Florida Statute § 627.736(4)(c) is clear and unambiguous. PIP insurers must reserve $5,000 of PIP benefits for payment to physicians licensed under the stated chapters of Florida Statute § 627.736 (4)(c) and the $5,000 may only be used to pay claims for such physicians until 30 days after the date the insurer receives notice of an accident.
18. The Legislature did not address the deductible and/or the application of a deductible to the selected group of emergency medical providers in Florida Statute § 627.736(4)(c).
19. Based on the plain language of the statute, Plaintiff satisfied all of the requirements set forth in Florida Statute § 627.736(4)(c) and therefore Defendant was obligated to reserve benefits for payment to Plaintiff and should not have applied the bill to the deductible.
20. Therefore the Plaintiff’s bill should have been paid from the mandated $5,000 reserve.
21. This Court adopts and incorporates the rulings of Judges Marbelstone and Collins as well as the appellate decisions affirming their orders and incorporates the rationale and reasoning as if fully set forth herein. See Emergency Physicians of Central Florida, LLP a/a/o Oriol Saintilma v. Direct General Insurance Company, 19 Fla. L. Weekly Supp. 948a (Fla. 18th Jud. Cir., Seminole County, July 16, 2002) affirmed Direct General Insurance Company v. Emergency Physicians of Central Florida, LLP a/a/o Oriol Saintilma, 22 Fla. L. Weekly Supp. 209b (Fla. 18th Jud. Cir. App., Seminole County, August 29, 2014); see Emergency Physicians of Central Florida, LLP a/a/o Tina Watts v. Direct General Insurance Company, 19 Fla. L. Weekly Supp. 947a (Fla. 18th Jud. Cir., Seminole County, July 16, 2002) affirmed Direct General Insurance Company v. Emergency Physicians of Central Florida, LLP a/a/o Tina Watts, 22 Fla. L. Weekly Supp. 209c (Fla. 18th Jud. Cir. App., Seminole County, August 29, 2014), see Emergency Physicians of Central Florida, LLP a/a/o Adriel Rodriguez v. USAA General Indemnity Company, 20 Fla. L. Weekly Supp. 697a (Fla. 18th Jud. Cir., Seminole County, February 27, 2013) affirmed USAA General Indemnity Company v. Emergency Physicians of Central Florida, LLP a/a/o Adriel Rodriguez, 22 Fla. L. Weekly Supp. 341a (Fla. 18th Jud. Cir. App., Seminole County, October 16, 2014).
22. Accordingly, the Court grants Plaintiff’s Motion for Summary Judgment as to the deductible finding that Plaintiff’s bill should not have been applied to the deductible.
23. Finally, there are no other remaining issues of fact in dispute and Plaintiff is entitled to Final Summary Judgment as a matter of law.
24. Final Judgment is hereby granted in favor of Plaintiff, Emergency Physicians of Central Florida, LLP a/a/o Halle Singleton, wherein Plaintiff shall recover from Defendant, Garrison Property and Casualty Insurance Company, the sum of $356 plus 6% interest in the amount of $73.79 for a total sum of $429.79 for which sum let execution. Post judgment interest of 4.75% per annum shall be due on this judgment pursuant to Fla. Stat. § 55.03.
23. The Court finds that Plaintiff is entitled to reasonable attorney’s fees and costs. The Court reserves jurisdiction to determine the amount of Plaintiff’s attorney’s fees and costs pursuant to Fla. Stat. §§ 627.736, 627.428 and 57.041.
