24 Fla. L. Weekly Supp. 640a
Online Reference: FLWSUPP 2408SANCInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer
JOSE CASTRO SANCHEZ, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, a Florida Corporation, Defendant. County Court, 11th Judicial Circuit in and for Dade County, General Jurisdiction Division. Case No. 11-13229 SP 25 (1). September 20, 2016. Laura A. Stuzin, Judge. Counsel: Walter A. Arguelles, Arguelles Legal, P.L., Miami, for Plaintiff. Rachel Minetree, Conroy Simberg, Miami, for Defendant.ORDER
THIS Cause, having come before the Court on September 20, 2016 upon Plaintiff’s Motion for Summary Judgment regarding Defendant’s Use and Application of the Medicare Part B and Workers’ Compensation Fee Schedules, and the court, having reviewed the file, motion, and having heard argument of counsel, it is hereby ordered and adjudged:
1. Plaintiff’s Motion for Summary Judgment regarding Defendant’s Use and Application of the Medicare Part B and Workers’ Compensation Fee Schedules is hereby GRANTED.
2. The Court finds as a matter of law that the Defendant’s policy form 9810.7 and amendatory endorsement 6910.3 does not clearly and unambiguously notify the insured patient and health care providers of the Defendant’s intention to pay pursuant to Fla. Stat. 627.736(5)(a)(2). Defendant’s policy of insurance does not expressly provide that it would pay 80% of 200% of the Medicare Part B Schedule or the maximum reimbursable allowance under workers compensation.
