25 Fla. L. Weekly Supp. 910a
Online Reference: FLWSUPP 2510SZABInsurance — Personal injury protection — Coverage — Medical benefits — Statutory fee schedule — Notice provided by insurer at time policy was renewed was sufficient to limit reimbursement to schedule of maximum charges — Insurer complied with express directives of statute
BERMAN CHIROPRACTIC, a/a/o KRISTINA SZABO, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. CONO 16-1800 (71). October 23, 2017. Louis H. Schiff, Judge. Counsel: Ilya Torchinsky, PIP Legal Group, Davie, for Plaintiff. Melissa G. McDavitt, Conroy Simberg, West Palm Beach, for Defendant.
ORDER GRANTING DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT
This cause having been brought before the Court on September 25, 2017 on Defendant’s Motion For Summary Judgment as to whether State Farm could limit reimbursement to the schedule of maximum charges found at Fla.Stat.627.736(5)(A)(1), and the Court having consider the Motion, the argument of counsel(s) and the record, and being otherwise fully advised in the premises:
ORDERED AND ADJUDGED that Defendant’s Motion For Summary Judgment is GRANTED.
Prior to July 2012, if it insurance carrier desired to limit PIP reimbursement to the schedule of maximum charges, it was required to follow the dictates of Geico Gen. Ins. v. Virtual Imaging Services, Inc., 141 So.3d 147 (Fla. 2013) [38 Fla. L. Weekly S517a], because the PIP statue did not contain any directives as to how a carrier was to adopt do you fee schedule limitation that was first placed into the statutory scheme in 2008. However, in 2012 the Florida Legislature amended the PIP statute to include express directives as to how a carrier can I adopt the fee schedule limitations. This case is governed by the new were provisions (FLA. STAT. 627.736(5)(a)) which provides:
Effective July 1, 2012, an insurer may limit payment as authorized by this paragraph only if the insurance policy includes a notice at the time of issuance or renewal that the insurer may limit payment pursuant to the schedule of charges specified in this paragraph. A policy form approved by the office satisfies this requirement.
It is undisputed State Farm complied with these requirements. Additionally, it is undisputed that State Farm policy form 9810A was approved by the OIR. The 9810A policy explicitly states that State Farm a limit reimbursement based upon the application of the schedule of maximum charges. The “limits” section of the policy provides, and relevant part:
. . . In no event will we pay more than 80% of the following No- Fault Act “schedule of maximum charges”. . .
(Policy Form 9810A at 14-16)
Based upon the renewal notice provision in the unambiguous limitations found in the Policy, State Farm has both complied with the statutory requirements and advised the insured, in no uncertain terms, that it will reimburse for reasonable medical expenses, but in no event will pay more than 80% of the fee schedule1. Under the PIP statute as amended in 2012, a carrier is obligated to pay 80% of reasonable medical expenses, but it may limit reimbursement to the schedule of maximum charges if it complies with Florida statute 627.736(5)(a)(5). There is no disputed issue of material fact that State Farm complied with this requirement. It is therefore ORDERED AND ADJUDGED that Defendant’s Motion for Summary Judgment is GRANTED.
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1This Court agrees with the Florida Supreme Court’s directions not to apply the Virtual Imaging analysis to this case because the Supreme Court itself stated that the Virtual Imaging approach was not to be applied to policies issued after July 2012 as court were to follow the new fee schedule limitations procedures in Fla. Stat. 627.736(5)(a)5 Id. At 141 So. 3d 147.
