26 Fla. L. Weekly Supp. 334a
Online Reference: FLWSUPP 2604GOODInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — Insurer properly reduced medical provider’s charges by application of statutory fee schedule before applying deductible
GOOD HEALTH MEDICAL REHAB, INC., a/a/o Margalie Frage, Plaintiff, v. INFINITY AUTO INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. COCE16020720. Division 54. June 14, 2018. Florence Barner, Judge. Counsel: Todd A. Landau, Todd Landau P.A., Hallandale Beach, for Plaintiff. Lillian H. Sanchez, Law Offices of Leslie M. Goodman & Associates, Hollywood, for Defendant.
AGREED ORDERGRANTING DEFENDANT’S MOTION FOR FINALSUMMARY JUDGMENT ANDENTERING FINAL JUDGMENT
THIS CAUSE came before the Court upon Defendant’s Motion for Final Summary Judgment as to Application of Deductible. The Court, having heard argument of the Parties on the 13th day of June, 2018, considered the court file and applicable case law, and being otherwise duly advised in the matter, makes the following findings of fact and conclusions of law.Background
Margalie Frage was involved in a motor vehicle accident on December 18, 2014. At the time of the accident, Margalie Frage, was covered under an automobile insurance policy issued by the Defendant which provided no-fault coverage in the amount of $10,000.00. The subject insurance policy contained a $1,000.00 policy deductible elected by the insured. Following the automobile accident, the insured received medical treatment from Good Health Medical Rehab, Inc., the Plaintiff. At that time, the insured executed an assignment of benefits, assigning any rights or benefits pursuant to its policy of insurance with Defendant to the Plaintiff. Upon review of the medical bills submitted, Defendant determined that $908.04 for dates of service 12/23/14-1/12/15 and $436.04 of the submitted bills for dates of service 1/16/15-1/21/15 were covered under the subject insurance policy. Infinity applied the $1,000 deductible elected by the insured to the compensable bills resulting in a payment of $0 for dates of service 12/23/14-1/12/15 and $275.26 for dates of service 1/16/15-1/21/15. Plaintiff then filed suit for breach of contract against Defendant.Material Facts
The instant case involves the Plaintiff’s dispute of the Defendant’s method of application of the deductible to its bills. In the instant case Defendant reduced the provider’s charges to the Medicare fee schedule Part B before applying the deductible to Plaintiff’s bills. On March 9, 2018, at the Court’s Lack of Prosecution hearing, the Parties stipulated in open Court which was then memorialized in writing in an executed Order by the Court that the deductible application was the sole dispositive issue in this case and thus, as deductible being the sole dispositive issue as stipulated to by the Parties, the Court granted a stay pending the ruling in the 4th DCA on deductible application. A copy of the March 9, 2018 hearing transcript was filed by Defendant with the Court on June 12, 2018. Subsequently, on March 14, 2018, the Fourth District Court of Appeal issued its opinion in State Farm Mutual Automobile Insurance Company v. Care Wellness Center, LLC (a/a/o Virginia Bardon-Diaz), Case No. 4D16-2254 (Fla. 4th DCA Mar. 14, 2018) [43 Fla. L. Weekly D573a]. The appellate court held that “an insurer must reduce the provider’s charges to the statutorily-approved permissive fee schedule before applying the deductible.” The appellate court heard argument on how an insurer is required to apply the deductible. Id. The Court interpreted the PIP deductible statute in favor of the Defendant’s position that the deductible applies after application of the fee schedule because the statute requires application of the deductible to covered losses. Id. The Court held:
Logically, the deductible only applies to losses covered under the policy of insurance, not simply the total bills submitted. As the Second District held in West Florida Villages, ‘[t]he notion that a deductible could be applied to loss that is not covered by the policy is fundamentally unreasonable.’ (citation omitted).
The Defendant then moved for final summary judgment as to deductible application.Conclusions of Law
This Court, having reviewed the Order executed on March 9, 2018 and the hearing transcript on same, finds that the sole dispositive is in this case is the method of deductible application per stipulation by the Parties. For the reasons following the Fourth District Court of Appeal in State Farm Mutual Automobile Insurance Company v. Care Wellness Center, LLC (a/a/o Virginia Bardon-Diaz), Case No. 4D16-2254 (Fla. 4th DCA Mar. 14, 2018) [43 Fla. L. Weekly D573a] which is controlling law in this jurisdiction Pardo v. State, 596 So. 2d 665 (Fla. 1992),
IT IS HEREBY ORDERED AND ADJUDGED that this Court GRANTS Defendant’s Motion for Final Summary Judgment and enters Final Judgment in favor of Defendant in this case. Plaintiff shall take nothing by this action, and Defendant shall go hence without day. This Court reserves jurisdiction to determine Defendant’s entitlement to and amount of attorney’s fees and costs. The Order referring this case to Arbitration issued by this Court on March 9, 2018 is hereby vacated as final judgment has been entered.
