25 Fla. L. Weekly Supp. 489a
Online Reference: FLWSUPP 2505CHARInsurance — Personal injury protection — Coverage — Medical expenses — Declaratory action — PIP policy, when read in conjunction with PIP statute limiting benefits to $2,500 in absence of determination of emergency medical condition and extending benefits to $10,000 when emergency medical condition has been determined to exist, is deemed to provide $2,500 in benefits that are subsumed in total aggregate of $10,000 in benefits when emergency medical condition is determined to exist, not total aggregate of $12,500 in benefits
SEA SPINE ORTHOPEDIC INSTITUTE, LLC, (a/a/o Carmen Charriez), Petitioner, v. LIBERTY MUTUAL INSURANCE COMPANY, Respondent. County Court, 17th Judicial Circuit in and for Broward County. Case No. CONO 16-006781 (70). June 30, 2017. John D. Fry, Judge. Counsel: Thomas J. Wenzel, Cindy A. Goldstein, P.A., Coral Springs, for Petitioner. Keith Hernandez, ROIG Lawyers, Deerfield Beach, for Respondent.
REVERSED; FLWSUPP 2806CHAR
ORDER ON PETITIONER’S MOTION FOR SUMMARYJUDGMENT REGARDING PETITIONER’S PETITIONFOR DECLARATORY RELIEF AND RESPONDENT’SCROSS MOTION FOR DECLARATORY RELIEF
THIS CAUSE having come before the Court on May 4, 2017 on Petitioner’s Motion for Summary Judgment Regarding Petitioner’s Petition for Declaratory Relief and Respondent’s Cross Motion for Declaratory Relief and the Court having reviewed the Motions, the entire court file, and the relevant legal authorities; having heard argument, having made a thorough review of the matters filed of record; and having been sufficiently advised in the premises, the Court finds as follows:
INTRODUCTION
The Respondent, Liberty Mutual Insurance Company, issued a policy of insurance to Lourdes Godinez and Manuel Colon, which provided Personal Injury Protection Benefits pursuant to the terms of the policy and Florida Statute 627.736. The subject policy of insurance provided Personal Injury Protection benefits to Carmen Charriez for injuries sustained in a motor vehicle accident on October 28, 2015. On July 14, 2016, Respondent issued payment in the amount of $1,000.30 to Petitioner, Sea Spine Orthopedic Institute, LLC, on July 14, 2016. Respondent alleged that the payment to Petitioner exhausted Personal Injury Protection medical and disability benefits available under the subject policy in the amount of $10,000.00 in payments issued.
The issue before the Court is whether the policy of insurance issued by Respondent affords a total aggregate of $10,000 or $12,500 for Personal Injury Protection medical and disability benefits.1UNDISPUTED FACTS
The undisputed evidence before the Court reflects that the Policy Declarations for policy of insurance issued by Respondent does not reference the amount of Personal Injury Protection coverage extended to an insured. The coverages are contained in the “Schedule” provided on the Personal Injury Protection Coverage Endorsement (form AS 2090 01 13). The “Schedule” is divided in two columns, “Benefits” and “Limits Of Liability”. The “Benefits” provided are Medical Expenses, Work Loss, Replacement Services, Accidental Death, Maximum Limit For the Total of All Personal Injury Protection Benefits for an “Emergency medical condition”, and Maximum Limit For the Total of All Personal Injury Protection Benefits for all other “bodily injury”. The “Limits Of Liability” for Accidental Death is $5,000, for Maximum Limit For the Total of All Personal Injury Protection Benefits for an “Emergency medical condition” is $10,000, and Maximum Limit For the Total of All Personal Injury Protection Benefits for all other “bodily injury” is $2,500.
The Personal Injury Protection Coverage Endorsement provides the following under the section titled “LIMIT OF LIABLITY”:
A. The limits of liability shown in the Schedule or Declarations for Personal Injury Protection Coverage are the most we will pay to or for each “insured” injured in any one accident, regardless of the number of:
1. “Insureds”;
2. Policies or bonds applicable;
3. Vehicles involved; or
4. Claims made.
The maximum limit of liability for the total of all personal injury protection benefits shown in the Schedule or Declarations is the total aggregate limit for personal injury protection benefits available, to or for each “insured” injured in any one accident, from all sources combined, including this policy if the insured receives initial services and care within 14 days after the motor vehicle accident.
The instant motion presents a pure issue of contractual interpretation. There are no disputed issues of fact relevant to the disposition of the question concerning the amount of coverage afforded by the policy. The parties only disagree regarding the proper interpretation of the contract and whether the relevant contractual provisions are ambiguous as to the total aggregate of Personal Injury Protection medical and disability benefits available to any insured.
ANALYSIS
No-Fault insurance is a creature of statute that only provides the minimum thresholds for coverage and benefits which an insurer cannot restrict or negate. Nunez v. Geico Gen. Ins. Co., 117 So. 3d 388 (Fla. 2013) [38 Fla. L. Weekly S440a]. See also Salas v. Liberty Mut. Fire Ins. Co., 272 So. 2d 1 (Fla. 1972) and Mullis v. State Farm Mut. Auto. Ins. Co., 252 So.2d 229 (Fla. 1971).
With the passage of HB 119, Chapter 2012-197, Laws of Florida, effective January 1, 2013, the legislature added the requirement to Florida Statute 627.736 that an insured sustain an emergency medical condition in order to receive $10,000.00 in Personal Injury Protection medical and disability benefits. The sections of the statute read as follows:
3. Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. up to $10,000 if a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced registered nurse practitioner licensed under chapter 464 has determined that the injured person had an emergency medical condition.
Section 627.736(1)(a)(3), Florida Statutes.
4. Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. is limited to $2,500 if a provider listed in subparagraph 1. or subparagraph 2. determines that the injured person did not have an emergency medical condition.
Section 627.736(1)(a)(4), Florida Statutes. The Courts have already determined that F.S. 627.736 “limits an insurer’s obligation to provide personal injury protection benefits to $2,500, unless one of the medical providers listed in subparagraph (1)(a)(3) has determined that the injured person had an emergency medical condition.” Medical Ctr. of the Palm Beaches v. USAA Cas. Ins. Co., 202 So. 3d 88 at 92 (Fla 4th DCA 2016) [41 Fla. L. Weekly D2018b] (citing Robbins v. Garrison Property & Casualty Insurance Co., 809 F.3d 583 (11th Cir. 2015) [25 Fla. L. Weekly Fed. C1900a]. Once an emergency medical condition has been determined, the insurer’s obligation is to provide personal injury protection benefits to $10,000.00 as defined in F.S. 627.736(1) and F.S. 627.736(3) Id.
CONCLUSION
The Court finds based upon the specific language as written it does not clearly carve out an “and” or an “or.” Having said that, the Court also finds that in and of itself it’s insufficient to grant the Plaintiff’s motion. In its plain reading the Court finds the $2,500 to be part of the $10,000, which is what the statute says. However, the Court does agree that it specifically does not differentiate the differences in the documents that Liberty Mutual prepared. And it does not say that it is a portion thereof. However, combined with the statute and what the statute says the Court finds it to be legally sufficient and not ambiguous, when contemplating the statute and its verbiage.
Accordingly, based on the foregoing analysis, Petitioner’s Motion for Summary Judgment Regarding Petitioner’s Petition for Declaratory Relief is hereby DENIED and Respondent’s Cross Motion for Declaratory Relief is hereby GRANTED. The subject policy is deemed to provide $2,500 in Personal Injury Protection benefits, which is subsumed into the total aggregate of $10,000 in Personal Injury Protection benefits when it has been determined that the injured person has sustained an emergency medical condition. Petitioner shall take nothing by way of this action and Respondent shall go hence without day. The Court reserves jurisdiction to award attorney fees and costs.
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1It is undisputed that the policy provides $5,000 in Personal injury Protection Death Benefits. Death Benefits were not at issue in the subject claim.
