23 Fla. L. Weekly Supp. 775a
Online Reference: FLWSUPP 2307PADRInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare fee schedule — Insurer waived argument that policy language has been approved by Office of Insurance Regulation, and thus complies with 2012 amendment to PIP statute, where argument was not preserved in joint pretrial stipulation
QUANTUM IMAGING HOLDINGS, LLC A/A/O Jose Padron, Plaintiff, v. ALLSTATE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. COCE 13-12364 53. November 13, 2015. Honorable Robert W. Lee, Judge. Counsel: Emilio R. Stillo, for Plaintiff. Gladys Perez, for Defendant.
FINAL JUDGMENT IN FAVOR OF THE PLAINTIFF
THIS CAUSE having come to be heard before the Court on non-jury trial on September 30, 2015 and the Court finds as follows:
This case involves competing interpretations of a PIP insurance policy. The Plaintiff’s interpretation would result in the Defendant (hereinafter referred to as “Allstate”) having to pay more on the individual medical bills submitted, and of course Allstate’s would result in a finding that the lesser amount it paid complied with the policy.
On May 26, 2015, the parties filed their Joint Pretrial Stipulation. The parties have stipulated that the amount in controversy is $ 1,044.83. The parties have also stipulated that the sole legal issue to be resolved for purposes of entry of a Final Judgment is whether Allstate’s policy permits it to limit reimbursement of the bills for the dates of service at issue pursuant to the schedule of maximum charges described in Florida Statute Section 726.736(5)(a)(1)(a-f). Further, the parties have stipulated that the Court’s decision would be case dispositive.
The policy language before the Court is addressed by the controlling decision of the appellate court in Orthopedic Specialists v. Allstate Insurance Company, 40 Fla. L. Weekly D1918a (Fla. 4th DCA Aug 19, 2015), which held that the referenced language did not clearly and unambiguously elect the Medicare fee schedules.
During trial, for the first time in this case Allstate attempted to raise an additional argument that their policy of insurance had been approved by the Office of Insurance Regulation and thus complied with the 2012 Legislative amendment to Florida Statute § 627.736(5)(a)(5).
This issue was not preserved in the Joint Pretrial Stipulation. The Court did not permit introduction of any exhibits which were not listed on the pretrial stipulation. Further, no witnesses were present which would have allowed the Defendant to place the unlisted exhibits into evidence.
The Court makes no ruling as the sufficiency of the language in the approval as it corresponds to the 2012 statute as the Court finds Allstate has waived this argument by not preserving it in the Joint Pretrial Stipulation.
Accordingly, the Court will enter Final Judgment in favor of the Plaintiff.
ORDERED AND ADJUDGED that the Plaintiff, QUANTUM IMAGING HOLDINGS, LLC A/A/O Jose padron recover from the Defendant ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY the sum of $ 1,044.83 , together with prejudgment interest in the amount of $ 141.05, for a total amount of $ 1,185.88 for all of which sums let execution issue.
The Plaintiff is entitled to recover the costs of this action and reasonable attorney’s fees under 627.428, Florida Statutes. This Court retains jurisdiction to determine the amounts of costs and attorney’s fees due Plaintiff.
