25 Fla. L. Weekly Supp. 815a
Online Reference: FLWSUPP 2509CHANInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Insurer erred by applying claim from emergency service provider to deductible before earlier-received claim from hospital — Insurer was required to apply all claims, including claim from emergency service provider, to deductible in order in which they were received — Insurer waived right to challenge reasonableness of charge where corporate representative testified that insurer was not challenging reasonableness, relatedness, or medical necessity of services
EMERGENCY MEDICAL ASSOCIATES OF TAMPA BAY, L.L.C., as assignee of Shawn Chandler, Plaintiff, v. USAA GENERAL INDEMNITY COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2015-SC-010419-O. November 6, 2017. Eric H. DuBois, Judge. Counsel: William S. England, Bradford Cederberg, P.A., Orlando, for Plaintiff. Scharome Wolfe, Orlando, for Defendant.
ORDER
This cause having come before this Court for consideration of Plaintiff’s Motions for Summary Judgment; Defendant’s Motions for Summary Judgment; and Defendant’s Motion to Stay on October 24, 2017, and this Court having heard arguments of counsel and being otherwise fully advised in the premises, finds as follows:
FINDING OF FACT
This is a claim for PIP benefits arising out of a motor vehicle collision that occurred on February 28, 2015. At the time of the crash, Shawn Chandler (hereinafter “insured”) was insured under a policy of insurance issued by the Defendant, USAA GENERAL INDEMNITY COMPANY (hereinafter “USAA”), which provided $10,000 in Medical Payments coverage and $10,000 in PIP benefits and purportedly contained a $250 deductible.
The Plaintiff, EMERGENCY MEDICAL ASSOCIATES OF TAMPA BAY, L.L.C., (hereinafter “EMATB”) are licensed physicians under chapters 458 or 459 who provide emergency services and care, as defined in s. 395.002(9). Following the accident, the insured presented to St. Joseph’s Hospital, where she received emergency services and care from EMATB. The insured executed a consent to treatment and assignment of benefits, which provided Plaintiff with standing to pursue payment for the services provided.
USAA received two bills for the insured’s care. The FIRST medical bill was received by USAA on March 13, 2015, from St. Joseph’s Hospital for $946.77. USAA applied $33 of this bill to the insured’s $250 deductible and issued payment in the amount of $679.55, which included interest. The SECOND medical bill was received by USAA on March, 26, 2015, from EMATB for $217.00. USAA approved EMATB’s charge at the fee schedule amount of $217.00 and applied the insured’s $250 deductible, resulting in no payment to Plaintiff.
CONCLUSION OF LAW
Both sides look to Mercury Insurance Company of Florida v. Emergency Physicians of Central Florida, LLP, 182 So.3d 661 (Fla. 5th DCA 2015) [40 Fla. L. Weekly D2364a] for their arguments. EMATB argues that Mercury requires all compensable bills to be applied to the purported deductible in the order they are received. USAA argues that Mercury and the Florida PIP statute requires priority providers, like EMATB, to be paid within thirty days, therefore their bills must be processed before non-priority providers.
The Court looks to the line of cases following Mercury from the Fifth District Court of Appeals in concluding that USAA’s position is incorrect. The Fifth District Court of Appeals wrote, “in [Mercury], this Court held that all claims, including EPCF’s priority claim, are properly applied to a personal injury protection deductible in the order that they are received.” See Progressive American Insurance Company v. Emergency Physicians of Central Florida, etc., 187 So.3d 898, 899 (Fla. 5th DCA 2016) [41 Fla. L. Weekly D888b]. In Progressive, the Fifth District Court of Appeals clarified its holding in Mercury, which is why this Court finds that Defendant’s method of processing compensable medical bills out of order is in derogation of binding law. This Court finds the assignment of benefits executed by the insured provides EMATB standing.
The Court finds that the Defendant WAIVED its right to challenge reasonableness when the Corporate Representative testified that USAA was not challenging the reasonableness of the charge, relatedness of the services and the medically necessity of the services. The Court recognizes that the Defendant has the right to challenge at anytime, but such right can be waived as it was in this case.
Accordingly, it is hereby ORDERED AND ADJUDGED:
1.
Defendant’s Motion to Stay is Denied.
2.
Plaintiff’s Motion for Summary Judgment on Standing is Granted.
3.
Defendant’s Motion for Summary Judgment on Standing is Denied.
4.
Plaintiff’s Motion for Summary Judgment on application of the deductible is Granted.
5.
Defendant’s Motion for Summary Judgment on application of the deductible is Denied.
6.
Plaintiff shall recover from Defendant the sum of $217.00 in benefits and accrued interest at 4.75% for which sum let execution issue.*
7.
The Court finds Plaintiff is entitled to its reasonable attorneys’ fees and costs. The Court reserves jurisdiction to determine the amount of attorneys’ fees and costs to Plaintiff pursuant to Fla. Stat. §§627.736, 627.428 and 57.041.
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* Post judgment interest shall accrue at the current statutory interest rate on this judgment pursuant to Fla. Stat. § 55.03.
