25 Fla. L. Weekly Supp. 108a
Online Reference: FLWSUPP 2501PWILNOT FINAL VERSION OF OPINION
Subsequent Changes at 25 Fla. L. Weekly Supp. 376aInsurance — Personal injury protection — Coverage — Medical expenses — Where definition of “reasonable charge” in PIP policy is hybrid of factors found in reasonable amount method of reimbursement and provisions from fee schedule method of reimbursement, policy is ambiguous as to reimbursement method and did not specifically elect fee schedule method of reimbursement
HESS SPINAL & MEDICAL CENTERS OF PLANT CITY, P.L., a/a/o Pamela Williams, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 14-CC-027011, Division I. February 22, 2017. Joelle Ann Ober, Judge. Counsel: Alyson M. Laderman, Morgan & Morgan, P.A., Orlando; Helene Daniel, Daniel Law Group PA, Valrico; David M. Caldevilla, de la Parte & Gilbert, P.A., Tampa, for Plaintiff. Bart R. Valdes and Kendra McCan, De Beaubien Knight, Simmons, Mantzaris & Neal, LLP, Tampa, for Defendadnt.
Motion for Reconsideration Denied 7/19/2017ORDER ON COMPETING MOTIONSFOR SUMMARY JUDGMENT
THIS CAUSE came before the Court on January 24, 2017 concerning: (1) “Defendant’s Motion for Partial Summary Judgment” dated November 9, 2015, and (2) “Plaintiff’s Amended Motion for Summary Judgment on State Farm’s Policy 9810A” dated October 17, 2016. After considering the motions, the admissible evidence in the record, the arguments of counsel, and being otherwise advised in the premises, this Court
ORDERS AND ADJUDGES as follows:
1. This is an action concerning personal injury protection (“PIP”) insurance benefits for health care services provided by the Plaintiff to a patient insured by the Defendant pursuant to its Insurance Policy Form 9810A.
2. The issues and arguments raised in the parties’ competing motions for summary judgment are, for all intents and purposes, identical to the issues and arguments previously decided by this Court in Crespo & Associates, P.A., a.a.o. Debra Thompson v. State Farm Mut. Auto. Ins. Co., Case No. 16-CC-3030, “Order Granting Plaintiff’s Motion for Summary Judgment as to Count I of Complaint” (Sept. 19, 2016), which this Court continues to follow.
3. On January 30, 2017, after the conclusion of the summary judgment hearing, State Farm’s counsel filed a notice of supplemental authority, along with a copy of the Florida Supreme Court’s decision in Allstate Insurance Co. v. Orthopedic Specialists,__So.3d__, 2017 WL 372092 [42 Fla. L. Weekly S38a] (Fla. January 26, 2017). This Court concludes that this recent Allstate decision does not alter the result in this case. As explained in this Court’s above-cited decision in Crespo:
34. In support of its argument, State Farm cites to the decisions holding that an Allstate PIP insurance policy properly elects the Medicare Fee Schedule Method. See, Allstate Fire & Cas. Inc. Co. v. Stand-Up MRI of Tallahassee, P.A., 188 So. 3d 1 [40 Fla. L. Weekly D693b] (Fla. 1st DCA 2015); Allstate Indemnity Co. v. Markley Chiro. & Acupuncture, LLC,__So. 3d__, 2016 WL 1238533 (Fla. 2d DCA Mar. 30, 2016); Florida Wellness & Rehab. v. Allstate Fire & Cas. Ins. Co.,__So.3d__, 2016 WL 3745527 (Fla. 3d DCA July 13, 2016) [41 Fla. L. Weekly D793b]; South Fla. Wellness, Inc. v. Allstate Ins. Co., 89 F.Supp.3d 1338 (S.D. Fla. 2015). To the extent that State Farm contends that Virtual III only applies to the 2008 version of the PIP statute, it should be noted that these Allstate cases also involve the 2008 version of the PIP statute and not the 2012 version. In any event, the Allstate policy does not include a “reasonable charge” definition like the one in State Farm Policy 9810A, which expressly commingles the various elements of the Reasonable Amount Method and the Medicare Fee Schedule Method. And, in all of the Allstate cases, that insurance company consistently paid the Medicare Fee Schedule Method amount. In contrast, State Farm sometimes pays less and sometimes pays more than the Medicare Fee Schedule Method, depending on what factors State Farm decides to apply.
These same distinctions continue to apply.
4. For the reasons set forth in this Court’s above-cited decision in Crespo, this Court hereby DENIES theDefendant’s Motion for Partial Summary Judgment, and GRANTS the Plaintiff’s Amended Motion for Summary Judgment on State Farm’s Policy 9810A, as follows:
(a) State Farm has failed to clearly and unambiguously elect the Medicare Fee Schedule Method in Policy Form 9810A, and has instead adopted an unauthorized hybrid method comprised of elements from both the Medicare Fee Schedule Method described in Section 627.736(5)(a)1-5, Florida Statutes (2012-2015) and the fact-dependent Reasonable Amount Method described in Section 627.736(5)(a), Florida Statutes (2012-2015).
(b) With respect to the Plaintiff’s PIP claims submitted under Policy Form 9810A, the Defendant is required to pay such claims in accordance with the default Reasonable Amount Method, instead of the unauthorized hybrid method described in Policy Form 9810A or the Medicare Fee Schedule Method.
5. This is a non-final order. This Court reserves jurisdiction to determine all other issues raised in the complaint, and any claims for reasonable attorneys’ fees and costs.
