24 Fla. L. Weekly Supp. 467a

Online Reference: FLWSUPP 2406EADAInsurance — Personal injury protection — Coverage — Deductible — Insurer improperly applied fee schedule reductions to medical provider’s charges prior to applying deductible to charges — Insurer should have applied deductible to total charges billed

WASSERMAN CHIROPRACTIC, INC. (Patient: Emma Adams), Plaintiff, vs. MERCURY INDEMNITY COMPANY OF AMERICA, Defendant. County Court, 17th Judicial Circuit in and for Broward County, Civil Division. Case No. 15-000937 CONO 72. April 18, 2016. John D. Fry, Judge. Counsel: Chad Christensen, Ellis, Ged & Bodden, P.A., for Plaintiff. Robert M. Albert, Law Offices of Shirejian & O’Hara, Aventura, for Defendant.

ORDER ON PLAINTIFF’S MOTIONFOR PARTIAL SUMMARY JUDGMENTREGARDING DEFENDANT’S APPLICATIONOF THE DEDUCTIBLE

THIS CAUSE came before the Court on March 23, 2016, for hearing on Plaintiff’s Motion for Partial Summary Judgment Regarding Defendant’s Application of the Deductible and the Court having reviewed the Motions, the entire Court file, and the relevant legal authorities; having heard argument of counsel; and having been sufficiently advised in the premises, the Court finds as follows:

This case involves a medical provider’s breach of contract claim to recover PIP benefits from an insurer and the issue presented is whether the insurer properly applied the deductible to charges submitted by Plaintiff. The Court finds that the Defendant improperly applied the fee schedule reductions prior to subtracting the deductible.

In this case, the Defendant first reduced Plaintiff’s charges to the “schedule of maximum” charges referenced in F.S. 627.736 and applied the deductible to the allowable amount rather than applying the deductible to the total charges billed by Plaintiff. This Court finds that this practice violates F.S. 627.739, F.S. 627.736, and the Defendant’s policy language.

Pursuant to the analysis, reasoning, and legal authority in this Court’s previous Order dated January 6, 2016, Granting Plaintiff’s Motion for Summary Judgment in Care Wellness Center, LLC (a/a/o Virginia Bardon-Diaz) vs. State Farm (Broward Case no. 14-07576 CONO 70) [23 Fla. L. Weekly Supp. 985a; amended order at 24 Fla. L. Weekly S383a], it is hereby ORDERED AND ADJUDGED:

1. Plaintiff’s Motion for Partial Summary Judgment is GRANTED.