25 Fla. L. Weekly Supp. 363a
Online Reference: FLWSUPP 2504MARTInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Insurer did not properly elect permissive fee schedule method found in section 627.736(5)(a)(1) in its 9810A policy and, accordingly, improperly relied on the fee schedule methodology to limit reimbursement
PAN AM DIAGNOSTIC SERVICES, INC., d/b/a WIDE OPEN MRI, INC., a/a/o CHRISTINE MARTINEZ, Plaintiff, v. STATE FARM FIRE AND CASUALTY COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 14-SC-166-O. April 21, 2017. David P. Johnson, Judge. Counsel: Pamela Rakow-Smith, Eiffert & Associates, P.A., for Plaintiff. Matthew J. Corker, Conroy Simberg, Orlando, for Defendant.
RDER GRANTING PLAINTIFF’SMOTION FOR SUMMARY JUDGMENT
THIS MATTER came before the Court on April 7, 2017 on Plaintiff’s Response in Opposition to Defendant’s Amended Motion for Summary Judgment and Plaintiff’s Motion for Summary Judgment and, being considered by the Court and otherwise being fully advised of the premises; it is hereby ORDERED AND ADJUDGED that:
1. Plaintiff’s Motion for Summary Judgment is hereby GRANTED.
2. On March 7, 2017, The Court heard arguments on Defendant’s Amended Motion for Summary Judgment/Motion for Summary Disposition and Plaintiff’s Response in Opposition to Defendant’s Amended Motion for Summary Judgment.
3. On March 20, 2017, The Court entered an Order denying Defendant’s Amended Motion for Summary Judgment/Motion for Summary Disposition. See Order dated March 20, 2017.
4. On April 7, 2017, this Court after hearing arguments of counsel and considering Plaintiff’s Motion it is hereby Ordered and Adjudged that Plaintiff’s Motion for Summary Judgment is GRANTED and this Court further finds:
5.The parties do not dispute that Christine Martinez was involved in a motor vehicle accident on May 23, 2013 and sustained injuries as a result of the accident.
6. It is undisputed that Defendant issued a policy of insurance (Policy Form 9810A), which provided Personal Injury Protection benefits to Christine Martinez in the amount of $10,000,00 and the policy was in full force and effect on the date of the accident.
7. There is no dispute that on June 24, 2013, Christine Martinez received medical treatment in the form of an MRI of her cervical spine from Plaintiff for injuries sustained in the May 23, 2013 motor vehicle accident.
8. It is undisputed that Defendant received Plaintiff’s bill for date of service June 24, 2013 for the diagnostic services it provided to Christine Martinez in the amount of $2,150.00 on July 15, 2013 and Defendant reduced Plaintiff’s bill pursuant to 200% of the 2007 Participating Level of Medicare fee schedule and paid $939.87.
9. There is no dispute that the MRI provided by Plaintiff was medically necessary treatment for bodily injuries sustained in the May 23, 2013 motor vehicle accident.
10. Additionally, there is no dispute that the MRI was related to the May 23, 2013 motor vehicle accident.
11. Moreover, this Court finds, when reading State Farm’s 9810A policy as a whole, it fails to clearly and unambiguously elect the fee schedules found in Fla. Stat. §627.736(5)(a)(1) as its sole reimbursement methodology and the policy as written is subject to alternate interpretations as to how State Farm will issue payment for a PIP claim.
12. Further, this Court finds that approval of Defendant’s 9810A policy by the Office of Insurance Regulation does not validate the policy and notice or render it invulnerable to judicial interpretation.
13. Based on the foregoing reasons, the Court finds Defendant did not properly elect the permissive “fee schedule method” found in Fla. Stat. §627.736(5)(a)(1) in its 9810A policy of insurance and therefore, Defendant improperly relied on the fee schedule methodology to limit reimbursement of Plaintiff’s bill.
14. As such, Plaintiff’s Motion for Summary Judgment filed on February 8, 2017 is hereby GRANTED and the only issue remaining is whether Plaintiff’s charges were reasonable in price.
