27 Fla. L. Weekly Supp. 66b
Online Reference: FLWSUPP 2701JARVNOT FINAL VERSION OF OPINION
Subsequent Changes at 27 Fla. L. Weekly Supp. 389aInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Insurer correctly prioritized bill submitted by emergency services provider within 30-day reserve period for bills from such priority providers and, as a result, paid bill out-of-order of receipt; and if deductible was actually elected, insurer properly applied deductible to plaintiff’s bills
EMERGENCY PHYSICIANS, INC., d/b/a EMERGENCY RESOURCES GROUP, a/a/o Pricilla Jarvis, Plaintiff, v. USAA CASUALTY INSURANCE COMPANY, Defendant. County Court, 7th Judicial Circuit in and for Volusia County. Case No. 2016 21447 CONS, Division 73 (MILLER). March 7, 2019. A. Christian Miller, Judge. Counsel: K. Doug Walker, Bradford Cederberg, P.A., Orlando, for Plaintiff. Catherine V. Arpen, Dutton Law Group, Jacksonville, for Defendant.
SUBSTITUTED OPINION. FLWSUPP 2704JARVCORRECTED1SUMMARY DISPOSITIONREGARDING APPLICATION OF DEDUCTIBLE
This matter is before the court on the Defendant’s Motion for Summary Judgment Regarding Proper Application of Plaintiff’s Bills to the Deductible with Memorandum of Law (“Defendant’s Motion”) and Plaintiff’s Amended Motion for Final Summary Judgment (“Plaintiff’s Motion”). The court has reviewed the motions, conducted a hearing on both on January 23, 2019, and considered the arguments of the parties. Based upon the foregoing, the court finds as follows:
1. The issue before the court is whether or not Defendant properly paid Plaintiff’s bill out of order of receipt and applied the deductible2 to Plaintiff’s bill.
2. The resolution of this issue depends on the interplay of two Florida Statutes: 627.736(4)(c) and 627.739(2).
3. Florida Statute 627.736(4)(c) provides priority status to certain enumerated classes of health care providers, and requires insurance companies to hold $5,000 of PIP benefits in reserve for the payment of those priority providers’ bills received within the first 30 days after the insurance companies receive notice of the accident. This time period is referred to as the “30-day reserve period.”
4. Florida Statute 627.739(2) requires insurance companies to offer deductibles to applicants and policyholders at specified levels. The statute further requires that the deductible must be applied to “100 percent of the expenses and losses described in [the PIP statute].”
5. The parties agree that Plaintiff was a priority provider under 627.736(4)(c).
6. The parties further agree that Plaintiff’s bill was the fourth bill received by Defendant, the second bill paid by the Defendant, and that Plaintiff’s bill was received within the 30-day reserve period.
7. The parties likewise agree that of the other three bills received by Defendant before Plaintiff’s, only one was from a priority provider.
8. Lastly, the parties agree that Defendant moved up the Plaintiff’s bill for payment along with the priority provider’s bill, ahead of the non-priority providers. This resulted in the Plaintiff’s bill being applied to the alleged deductible.
9. Plaintiff argues that Defendant’s act of moving its bill up for payment, rather than paying its bill in the order it was received, was improper and they were denied benefits that should have been paid to them due to the application of the alleged deductible, which otherwise would have been satisfied by the bills received before its bill.
10. Defendant counters that it was required to prioritize Plaintiff’s bill for payment due to Plaintiff’s status as a 4(c) priority provider, and further the deductible must be applied to all bills received, not just non-priority providers’ bills.
11. The Fifth DCA has addressed this issue in Mercury Ins. Co. of Fla. V. Emergency Physicians of Central Fla., 182 So.3d 661 (Fla. 5th DCA 2015) [40 Fla. L. Weekly D2364a].
12. In Mercury, the court held,
“In sum, reading the two statutory provisions together leads to the inescapable conclusion that the . . . deductible was correctly applied to EPCF’s . . . bill. The plain language of the two sections is not in conflict and provides that, where an emergency service provider submits its claims within the 30 — day reserve period provided in section 627.736(4)(c), those claims will be prioritized for payment; however, any such payment will be subject to any deductibles that exist in the insurance contract between the insured and the insurer.
Id. at 668. (emphasis added)
13.This holding is quite clear. Priority providers get paid before non-priority providers when their bills are submitted within the 30-day period.
14. Unfortunately (for the provider), that also means any deductibles will be applied to its bill.
15. If the bills were to be paid in the order of receipt, regardless of whether the providers are priority or non-priority under 627.736(4)(c), what would be the point of designating certain providers as priority and reserving $5,000 of benefits for payment of their bills? Such an approach would effectively render that language in the statute meaningless.
16. The court finds that Defendant properly prioritized Plaintiff’s bill for payment because Plaintiff was a priority provider under 627.736(4)(c) and it submitted its bill within the 30-day reserve period. The court further finds that if a deductible was actually elected, Defendant properly applied the deductible to Plaintiff’s bills.
Based upon the foregoing, it is ORDERED AND ADJUDGED as follows:
A. Defendant’s Motion for Summary Judgment Regarding Proper Application of Plaintiff’s Bills to the Deductible with Memorandum of Law is GRANTED.
B. Plaintiff’s Amended Motion for Final Summary Judgment is DENIED.
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1Corrected only to reflect the accurate case style.
2Whether or not a deductible was actually elected by the policyholder in this case is the subject of a separate round of motions. Those motions were consolidated for hearing with these, and the court found there was a genuine issue of material fact and thus denied both parties’ motions. A separate order on those motions will be issued contemporaneously with this Order. [27 Fla. L. Weekly Supp. 67a]
