24 Fla. L. Weekly Supp. 888a
Online Reference: FLWSUPP 2410HUAIInsurance — Personal injury protection — Deductible — PIP insurer properly applied statutory fee schedule to reduce bills before applying those bills to deductible
MED-CARE MEDICAL CENTER, INC., a/a/o Maritza Huaitalla, Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County, Civil Division. Case No. CONO16003207 (71). December 7, 2016. Louis H. Schiff, Judge. Counsel: Sadie E. Naveo, Miami Gardens, for Plaintiff. Antonio Roldan, and Patrick J. Gerace, Progressive PIP House Counsel, Fort Lauderdale, for Defendant.
FINAL SUMMARY JUDGMENT FOR DEFENDANT
THIS CAUSE having come before the Court for hearing on November 30, 2016, on Defendant’s Motion for Final Summary Judgment, filed on October 31, 2016, and the Court having reviewed the Motion, the entire Court file, the relevant legal authorities; having heard argument of counsel; having made a thorough review of the matters filed of record; and being sufficiently advised in the premises, the Court finds as follows:
The Plaintiff brought this lawsuit against the Defendant over PIP benefits as assignee of the insured, Maritza Huaitalla. The policy provided $10,000.00 in PIP benefits with a $1,000.00 deductible. The issue in the case was whether the Defendant properly calculated the amount due to the Plaintiff from the insured for the portion of the charges which fell within the insurance policy deductible. The Defendant clearly and unambiguously elected to limit reimbursement of all charges to the schedule of maximum charges set forth in F.S. § 627.736(5)(a)(1)(a through f). Further, the Defendant clearly and unambiguously delineated in the policy of insurance that the deductible would be applied to expenses covered under PIP coverage. The pertinent provisions of the policy state:
“We will determine to be unreasonable any charges incurred that exceed the maximum charges set forth in Section 627.736(5)(a)(1) (a through f) of the Florida Motor Vehicle No-Fault Law, as amended. . .When a deductible applies, the deductible will be applied to 100% of the expenses and losses covered under Personal Injury Protection Coverage.” (Emphasis Supplied)
Plaintiff billed $4,130.00 for the first bill received in this claim. The Defendant adjusted the charges and determined that $2,669.68 was covered under the subject policy of insurance. Plaintiff failed to file any opposition evidence. The Defendant applied the $1,000.00 deductible to the $2,669.68 amount. Florida Statute § 627.739 Personal injury protection; optional limitations; deductibles, requires a cross-reference to F.S. § 627.736 which places the insured in the shoes of the insurance carrier for charges that fall within the deductible elected in the policy of insurance.1 This Court adopts the Defendant’s position that the deductible is a basic part of the insurance policy2, which requires a reasonableness analysis pursuant to the policy.3 Defendant appropriately applied the covered charges to the policy deductible.4 The undisputed facts and evidence demonstrate the Defendant properly applied the deductible and correctly paid Plaintiff entitling Defendant to Final Summary Judgment. See Glasspoole v. Konover Const. Corp. South, 787 So.2d 937 (Fla. 4th DCA 2001) [26 Fla. L. Weekly D1398c].
ORDERED AND ADJUDGED that Defendant’s Motion for Final Summary Judgment be, and the same is hereby GRANTED.
IT IS THEREFORE ORDERED AND ADJUDGED that Plaintiff, MED-CARE MEDICAL CENTER, INC., shall take nothing by this action. FINAL JUDGMENT is hereby entered in favor of the Defendant, PROGRESSIVE AMERICAN INSURANCE COMPANY, and it shall go hence forth without day. The Defendant is the prevailing party. The Court reserves jurisdiction to determine Defendant’s entitlement to reasonable attorney fees and costs.
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1See Mercury Ins. Co. of Florida v. Emergency Physicians of Cent., 182 So.3d 661 (Fla. 5th DCA 2015) [40 Fla. L. Weekly D2364a]
2See Digital Medical Diagnostics a/a/o Jesus Gaber, Miriam Gaber, and Lidice Soto v. United Auto. Ins. Co., 958 So.2d 505 (Fla. 3rd DCA 2007) [32 Fla. L. Weekly D1392a]
3See Progressive American Insurance Company v. Munroe Regional Health System, Inc., 14-11-AP (18th Judicial Circuit Appellate 2015) [23 Fla. L. Weekly Supp. 707a]; See also, Advanced Chiropractic and Medical Center, Corp., a/a/o Nethanel Dumesle v. Progressive American Insurance Company, COCE 13-12197 (52) (Fla. Brwd. Cty. 2016) [24 Fla. L. Weekly Supp. 766a]; See also, Florida Health Professionals Group a/a/o Sifontes, Idreinis, v. Progressive American Insurance Company, COCE-15-002261 (55) (Fla. Brwd Cty. 2016) [24 Fla. L. Weekly Supp. 732a]
4See General Star Indem. Co. v. West Florida Village Inn, Inc., 874 So.2d 26 (Fla. 2nd DCA 2004) [29 Fla. L. Weekly D1070b]
