25 Fla. L. Weekly Supp. 361b
Online Reference: FLWSUPP 2504MATTInsurance — Personal injury protection — Coverage — Medical expenses — Provider’s suit against insurer not precluded by fact that amount due is de minimus — Statutory fee schedules — Policy clearly stated insurer’s intent to limit payment pursuant to statutory fee schedules
EXCEL MEDICAL IMAGING, P.L. As assignee of Mark Mattalina, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 6th Judicial Circuit in and for Pasco County. Case No. 51-2016-SC-001713CAXWS, Division W. May 17, 2017. Anne Wansboro, Judge.
ORDER ON DEFENDANT’SMOTION FOR SUMMARY JUDGMENT
This cause came before the Court on April 10, 2017 for a hearing on the above motion. There are two issues: whether the suit should be precluded because the amount due is de minimus, and whether the Defendant complied with the statutory requirement that its policy include a notice that the insurer may limit payment pursuant to the schedule of charges specified in Florida Statute Section 627.726(5)(a)(5). The Court heard argument from both sides and has reviewed the case law.De Minimis
The case law provided by the Defendant indicates that under some circumstances the amount due is so small that litigation is precluded. However, the circumstances in the case law [in United Auto. Ins. Co. v. Alfonso, 17 Fla. L. Weekly Supp. 887a (Fla. 11th Cir. Ct. 2010), the insurer paid the bills plus interest, but miscalculated the interest and thereby underpaid the interest by $2.53, and did not advise the insurer of the miscalculation; and in Katzell v. Mercury Ins. Co. of Amer., 18 Fla. L. Weekly Supp. 314a (Fla. 17th Cir. Ct. 2010), the insurer paid the bills plus interest but did not make the interest check payable to the provider’s attorney as requested and neither requested a new check nor obtained an assignment] are not present in the case at bar. Therefore, the Motion for Summary Judgment based on a de minimis amount is DENIED.
NOTICE
The Defendant advised the insured that “[t]he most we will pay for such reasonable medical expenses is 80% of the ‘schedule of maximum charges’ found in the Florida Motor Vehicle No-Fault Law and in the Limits section of the Florida Car policy’s No-Fault Coverage.” The Plaintiff argues that the policy refers to both the reasonableness method of calculation and to the Schedule, and is therefore ambiguous.
The Court agrees with the analysis in the Order Granting Defendant’s Amended Motion for Partial Summary Judgment and Denying Plaintiff’s Motion for Partial Summary Judgment, Lake Worth Chiro. Assoc., Inc., d/b/a Chiro. Assoc. of Lake Worth a/a/o Ana Hernandez v. State Farm Mutual Auto. Ins. Co., No. 50-2016-SC-006521 XXXX SB RS (Fla. Palm Beach Cty. Ct. March 6, 2017) [24 Fla. L. Weekly Supp. 964a], which indicates that an insurer is not at liberty to remove the “reasonableness” coverage mandate, and concludes that a policy which clearly states it will be using the Schedule satisfies the notice requirement. In the case at bar, the policy clearly states it will be using the Schedule; therefore, the Defendant has satisfied the notice requirement, and the Defendant’s Motion for Summary Judgment is GRANTED as to the notice requirement.
