24 Fla. L. Weekly Supp. 707a
Online Reference: FLWSUPP 2409ALFAInsurance — Personal injury protection — Med pay — Declaratory actions — Motion to dismiss complaint seeking declaration as to whether insurer paid claims pursuant to hybrid method rather than reasonable amount method of reimbursement or statutory fee schedule and was entitled to do so and whether insurer was authorized to rely on Medicare Multiple Procedure Payment Reduction is denied — No merit to argument that medical provider has failed to specify any right under policy in doubt and is actually seeking advice from court on what course of action to employ to enforce its rights — Provider is entitled to have threshold legal question as to its rights under policy and PIP statute answered where answer may resolve case without expenditure of resources on litigating issues of reasonableness, relatedness and necessity of charges that may become moot
PRESGAR IMAGING OF CMI NORTH, L.C. a/a/o Geminis Garcia-Alfaro, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 2016-009560-SP-23. October 26, 2016. Jason Emilios Dimitris, Judge. Counsel: Howard W. Myones, Law Offices of Anidjar & Levine, P.A., Fort Lauderdale, for Plaintiff. Deborah Braile, Andrea Mack Drawas, Goldstein Law Group, Fort Lauderdale, for Defendant.
ORDER ON AMENDED MOTION TODISMISS PLAINTIFF’S COMPLAINTFOR DECLARATORY RELIEF
THIS CAUSE, having come before the Court, regarding Defendant’s Amended Motion to Dismiss Plaintiff’s Complaint for Declaratory Relief, and the Court having reviewed the complaint, the motion, the entire court file, and all relevant legal authorities, and otherwise having been fully advised in the premises, the Court finds as follows:
Plaintiff’s Complaint requests a declaratory judgment on five issues: (i) With respect to Plaintiff’s submitted PIP and Med Pay claims, did State Farm pay the Plaintiff’s claims pursuant to the Hybrid Method, instead of the Reasonable Amount Method described in Section 627.736(1)(a) and (5)(a); (ii) With respect to Plaintiff’s submitted PIP and Med Pay claims, was State Farm lawfully permitted to use the Hybrid Method? (iii) With respect to Plaintiff’s submitted PIP and Med Pay claims, was State Farm required to pay such claims in accordance with the Reasonable Amount Method described in Section 627.736(1)(a) and (5)(a), instead of the Hybrid Method or the Fee Schedule Method described in Section 627.736(5)(a)1-5?; (iv) With respect to Plaintiff’s submitted PIP and Med Pay claims, was State Farm required to pay such claims in accordance with the Fee Schedule described in Section 627.736(5)(a)1-5, instead of the Hybrid Method? (v) With respect to Plaintiff’s submitted PIP and Med Pay claims, was State Farm authorized to rely on MPPR, or is MPPR prohibited by Section 627.736(5)(a)(3) as a limitation on the number of treatments or other type of utilization limit?
In determining how to rule on a motion to dismiss a petition for declaratory relief, a court may only determine whether the petitioner is entitled to seek such relief, not the merits of the argument or whether the Petitioner will succeed in obtaining relief. Efforts Enters of Fla. v. Lexington Insurance Company, 666 So.2d 930 (Fla. 4th DCA 1995) [20 Fla. L. Weekly D2442b].
The Defendant, State Farm, argues that the Plaintiff has not stated any contractual, statutory or other basis from which to properly assert this cause of action within the four corners of its Complaint. Furthermore, the Defendant alleges that the Plaintiff has failed to specify any right under the policy or specific policy provision under the policy of which it is in doubt. The Defendant alleges that the Plaintiff’s Complaint is solely a mechanism for the Plaintiff to seek legal advice on how to proceed and that the only basis for the Plaintiff’s Complaint is actually to attempt to litigate and recover PIP benefits. The Defendant argues that because a breach of contract action would be a more effective remedy to resolve this case, the Court should dismiss this declaratory relief action. Defendant alleges that this is not a coverage issue or factual issue upon which coverage issues turn as coverage was afforded in this claim. Finally, the Defendant alleges that regardless of what the Court rules, the judicial action would not be completed in this Case.
Pursuant to Florida Statute Section 86.011, the court may render declaratory judgment on the existence, or nonexistence of any immunity, power, privilege or right. Here, based on the clear, sufficient language of the Plaintiff’s Complaint, the Plaintiff more than adequately sets out a short and plain statement of the ultimate facts the Plaintiff is alleging in the Petition. When reviewing a motion to dismiss, the Court must view the complaint in the light most favorable to the Plaintiff and the court is limited to the facts alleged within the four corners of the Complaint. Minor v. Brunetti, 43 So.3d 178, 179 (Fla. 3d DCA 2010) [35 Fla. L. Weekly D2013a]; Swerdlin v. Florida Municipal Insurance Trust, 162 So.3d 96, 97 (Fla. 4th DCA 2014) [39 Fla. L. Weekly D2164c].
The Defendant relies on Kelner v. Woody, 399 So.2d 35 (Fla. 3d DCA 1981). In Kelner, the 3rd DCA held that the appellants were seeking legal advice from the lower court as to the correct procedure to follow in litigating the case. They held that the appellants were not actually in doubt, just uncertain as to what course of action they should employ to enforce their rights. Id. at 38. This Court disagrees with the Defendant as this Court finds that the Plaintiff is not seeking advice from the court on how to proceed with this case. In fact, this Court believes the Plaintiff has the right to choose its legal strategy and this Court is unwilling to deny the Plaintiff the legal right to pursue its chosen legal strategy.
In response to the Defendant’s motion, the Plaintiff presented the Court with the case of Orange County vs. Expedia, Inc., 985 So.2d 622 (Fla. 5th DCA 2008) [33 Fla. L. Weekly D1549c]. In Orange County, the appellant, Orange County, Florida, filed a petition for declaratory relief against multiple travel wholesale websites to determine the correct basis for calculating and collecting a tourist development tax. Despite the lower court’s dismissal of the petition for declaratory relief, the 5th DCA held that the county was allowed to bring the petition for declaratory relief to present a threshold legal question, the answer to which may render further proceedings moot. Id. at 629. The 5th DCA further held that it would be illogical to require the parties to submit to a cumbersome process when the process may prove to be entirely unnecessary.
This Court finds this ruling analogous to the instant Case. In the instant action, the Plaintiff is seeking a determination of its rights under both the Florida PIP Statute and the Defendant’s insurance policy. Should this Court rule in the Defendant’s favor, despite the Defendant’s prior assertion, the judicial action in this action would be complete. Therefore, this Court finds that the Plaintiff is entitled to bring this action as a petition for declaratory relief and to have its threshold legal question answered prior to expending the time and effort necessary to pursue its burden of proving reasonableness, relatedness and necessity when each of those would be moot if this Court finds that the Defendant’s insurance policy properly elects the manner in which the Defendant reimbursed the Plaintiff. This Court believes the Plaintiff is correct in its assertion that this Petition for declaratory relief is in fact not a waste of judicial economy as the Court’s ruling on the threshold legal question may resolve this Case without wasting the parties’, their counsel and the Court’s time and energy litigating factual matters which have no bearing on the Court’s determination of the legal sufficiency of the Defendant’s policy language.
As such, it is therefore ORDERED AND ADJUDGED that Defendant’s Amended Motion to Dismiss Plaintiff’s Complaint for Declaratory Relief is DENIED without prejudice. Defendant shall respond to the Plaintiff’s Amended Complaint within 30 days of this Order. Notwithstanding the above, the Court may entertain a motion for reconsideration filed on behalf of the Defendant if timely filed prior to the Defendant’s Answer becoming untimely.
