24 Fla. L. Weekly Supp. 512a
Online Reference: FLWSUPP 2407MRIInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that adopts hybrid method of calculating reimbursement that includes elements of both Medicare fee schedule and reasonable amount method does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Plaintiff/Counter-Defendant, vs.MRI ASSOCIATES OF TAMPA, INC., d.b.a. PARK PLACE MRI, as assignee, and individually, Defendant/Counter-Plaintiff. Circuit Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 14-CA-008634, Division D. September 6, 2016. Claudia Isom, Judge. Counsel: Richard A. Gilbert, David M. Caldevilla, de la Parte & Gilbert, P.A., Tampa; Stuart C. Markman, Kristin A. Norse, Kynes, Markman & Felman, P.A., Tampa; Craig E. Rothburd, Craig E. Rothburd, P.A., Tampa; Scott R. Jeeves, The Jeeves Law Group, P.A., St. Petersburg; John V. Orrick, Law Offices of John V. Orrick, P.L., Tampa, for Plaintiff. Chris W. Altenbernd, D. Matthew Allen, Carlton Fields Jorden Burt, P.A., Tampa; Marcy Levine Aldrich, and Ross E. Linzer, Akerman LLP, Miami; Sandra L. Heller, Akerman LLP, Jacksonville; Kenneth P. Hazouri, de Beaubien Knight, Simmons, Mantzaris & Neal, LLP, Orlando, for Defendant.
FINAL DECLARATORY JUDGMENT
THIS MATTER came before the Court on August 3, 2016, concerning: (1) the “Motion for Summary Judgment and Incorporated Memorandum of Law” filed on June 8, 2016 by the Plaintiff/Counter-Defendant, State Farm Mutual Automobile Insurance Company (“State Farm”); and (2) the “Motion for Summary Judgment” filed on June 8, 2016 by the Defendant/Counter-Plaintiff, MRI Associates of Tampa, Inc., doing business as Park Place MRI (“Park Place MRI”), as assignee and individually. On August 18, 2016, the Court entered its “Order Granting MRI Associates, Inc.’s Motion for Final Summary Judgment, and Denying State Farm Mutual Automobile Insurance Company’s Motion for Final Summary Judgment.” Accordingly, the Court hereby
ORDERS AND ADJUDGES as follows:
1. With respect to the claims asserted in State Farm’s Amended Complaint for Declaratory Relief, final judgment is hereby entered against State Farm and in favor of Park Place MRI, and State Farm shall go hence without day.
2. With respect to Count I of Park Place MRI’s Second Amended Counterclaim seeking declaratory relief, final judgment is hereby entered in favor of Park Place MRI and against State Farm, and the Court hereby determines and declares as a matter of law:
(a) The issue identified in the Stipulated and Agreed Case Management Order dated April 25, 2016 (i.e. “Whether State Farm’s Policy Form 9810A lawfully invokes the Schedule of Maximum Charges and payment calculation methodology set forth in section 627.736(5)(a)1-5, Florida Statutes (2012-2015)”) is answered in the negative.
(b) Specifically, State Farm has failed to clearly and unambiguously elect the Medicare Fee Schedule Method in Policy Form 9810A, and has instead adopted an unauthorized hybrid method comprised of elements from both the Medicare Fee Schedule Method described in Section 627.736(5)(a)1-5, Florida Statutes (2012-2015) and the fact-dependent Reasonable Amount Method described in Section 627.736(5)(a), Florida Statutes (2012-2015).
(c) As a result, State Farm is required to pay Park Place MRI’s PIP claims at issue in this case in accordance with the Reasonable Amount Method by default, instead of the unauthorized hybrid method described in Policy Form 9810A or the Medicare Fee Schedule Method, and State Farm is not authorized to rely on Medicare’s limiting charge fee schedule.
3. The Court finds that the Park Place MRI has exercised its election of remedies under Count I, and Count II of Park Place MRI’s Second Amended Counterclaim seeking injunctive relief is moot.
4. This Court reserves jurisdiction to determine claims for reasonable attorney fees and costs as authorized by law and to grant any such other relief as the court deems necessary and proper.
