27 Fla. L. Weekly Supp. 305a
Online Reference: FLWSUPP 2703PLATInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that limits reimbursement to 200% of allowable amount under Medicare Part B fee schedules clearly and unambiguously elects to limit reimbursement to statutory fee schedules
HALLANDALE BEACH ORTHOPEDICS (a/a/o Anne Platel), Plaintiff, v. IMPERIAL FIRE AND CASUALTY INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 2017-7246 SP 26. April 18, 2019. Lawrence D. King, Judge. Counsel: Richard Patino and Ryan A. Peterson, The Patino Law Firm, Hialeah, for Plaintiff. Anthony G. Atala, Kubicki Draper, Miami, for Defendant.
ORDER GRANTING DEFENDANT’S MOTIONFOR FINAL SUMMARY JUDGMENT ANDFINAL JUDGMENT IN FAVOR OF IMPERIAL FIREAND CASUALTY INSURANCE COMPANY
THIS CAUSE having come before the Court on April 18, 2019 for a hearing on the Defendant’s Motion for Final Summary Judgment, and the Court, having reviewed the Motion, the entire Court file, the relevant legal authorities, reviewed the entirety of the record, and having been sufficiently advised in the premises, the Court finds as follows:
Undisputed Facts
The Claimant, Anne Platel, received medical services from the Plaintiff, Hallandale Beach Orthopedics (“Plaintiff”) as a result of a Motor Vehicle Accident that occurred on October 29, 2015. Anne Platel (“Claimant”) was insured under a Policy of Insurance, issued by the Defendant, Imperial Fire and Casualty Insurance Company (“Defendant” or “Imperial”). The subject policy of insurance at issue in this litigation provided personal injury protection (“PIP”) benefits to Anne Platel as governed by the Florida No-Fault (“PIP”) Statute, section 627.736, Florida Statutes (2013).
The Plaintiff submitted medical charges to the Defendant/Insurer for the medical services allegedly rendered to Anne Platel. Imperial subsequently made reimbursement to the Plaintiff pursuant to the Schedule of Maximum Charges. The Claimant’s claim for PIP coverage is governed by the 209POL (01/13) policy. The Policy Period commenced on October 8, 2015.
The legal issue before the Court in this case is whether the Defendant, through its 209POL (01/13) policy of insurance, was permitted to limit reimbursement of Plaintiff’s claims pursuant to §627.736(5)(a)(1), Florida Statutes.
Analysis
Pursuant to Florida Statute § 627.736 (5)(a)(5) (emphasis added), “Effective July 1, 2012, an insurer may limit payment as authorized by this paragraph only if the insurance policy includes a notice at the time of issuance or renewal that the insurer may limit payment pursuant to the schedule of charges specified in this paragraph. A policy form approved by the office satisfies this requirement.” This provision was added to the PIP Statute by the Legislature in 2012.
Imperial’s policy language clearly and unambiguously elects to utilize the Schedule of Maximum Charges set forth in Florida Statute § 627.736(5)(a)(1). The relevant portion of Imperial’s policy appears under the “II Personal Injury Protection Coverage — Insuring Agreement Section of the Policy (page 9) and reads as follows:
A. Subject to the limits shown in the Schedule or Declaration, “we” will pay, in accordance wit the Florida Motor Vehicle No-Fault Law, Personal Injury Protection benefits to or for an “insured” who sustains “bodily injury”. The “bodily injury” must be caused by an “accident” arising out of the ownership, maintenance or use of a “motor vehicle”
B. Personal Injury Protection benefits consist of the following:
1. “Medical Expenses” means those expenses, which were incurred for “medically necessary” medical, surgical, x-ray, dental, and rehabilitative services, including prosthetic devices, and ambulance, hospital and nursing services only if 1) the “initial services and care” received were provided within the 14 days after the “motor vehicle” “accident”, or 2) the services and care are “follow up services and care” received beyond the 14 days after the “motor vehicle” “accident” if “initial services and care” had been previously received within the 14 days after the “motor vehicle” “accident”, specifically defined as 80 percent of the following schedule of maximum charges
* * * * * * * * *
f. For all other medical services, supplies, and care, 200 percent of the allowable amount under
1. the participating physicians’ fee schedule of Medicare Part B except as provided in subparagraphs (2) and (3).
2. Medicare Part B, in the case of services, supplies, and care provided by ambulatory surgical centers and clinical laboratories;
3. The Durable Medical Equipment Prosthetics/Orthotics and Supplies fee schedule of Medicare Part B, in the case of durable medical equipment.
This policy language tracks the language utilized by the OIR in OIR Informational Memorandum OIR-12-02M (May 4, 2012) and the language of Florida Statute §627.736(5)(a)(1). This Court finds that this 209POL (01/13) policy language constitutes clear and unambiguous notice that Imperial elected to limit reimbursement to Plaintiff based upon the Schedule of Maximum Charges in Florida Statute § 627.736(5)(a)(1) (2013).
Courts have previously held that the interpretation of an insurance contract is bound by the plain meaning of the contract’s text and that the interpretation of an insurance policy is permissible in summary judgment. “If the language used in an insurance policy is plain and unambiguous, a court must interpret the policy in accordance with the plain meaning of the language used so as to give effect to the policy as it was written.” State Farm Mut. Auto. Ins. Co. v. Menendez, 70 So.3d 566 (Fla. 2011) [36 Fla. L. Weekly S469a] quoting Travelers Indem. Co. v. PCR Inc., 889 So.2d 779 (Fla. 2004) [29 Fla. L. Weekly S774a].
Precedent and binding case law has been presented where an endorsement limiting the liability to the provision of the Florida Motor Vehicle No-Fault law was sufficient to limit reimbursement at the fee schedule or schedule of maximum charges. Allstate Ins. Co. v. Orthopedic Specialists, 212 So.3d 973 (Fla. 2017) [42 Fla. L. Weekly S38a]. Similarly, this Court has previously ruled that language such as Imperial’s 209POL (01/13) clearly provides a limit of reimbursement to the fee schedule. In State Farm Mut. Auto. Ins. Co. v. MRI Assocs. of Tampa, 252 So.3d 773 (Fla. 2d DCA 2018) [43 Fla. L. Weekly D1149a], the Second DCA considered State Farm’s 9810A policy and found: “Because the State Farm policy includes mandatory language expressly limiting reimbursement for reasonable medical expenses to the schedule of maximum charges set forth in section 627.736(5)(a)(1)(a)-(f), we conclude that it is sufficient to place insureds and service providers on notice as required by section 627.736(5)(a)(5).”
Conclusion
Based on the above, the Court finds that Imperial’s policy clearly and unambiguously elected to limit reimbursement based on the application of the Schedule of Maximum Charges set forth in Florida Statute § 627.736 (5)(a)(1) (2013) and complied with all relevant statutes and requirements in order to limit reimbursement to same. Therefore it is,
ORDERED AND ADJUDGED:
1) Defendant’s Motion for Final Summary Judgment is hereby GRANTED.
2) This Court finds that Imperial Fire and Casualty’s 209POL (01/13) policy clearly and unambiguously elected to limit reimbursement based on the application of the Schedule of Maximum Charges set forth in Florida Statute § 627.736 (5)(a)(1) (2013).
3) Final Summary Judgment is entered in Favor of the Defendant, Imperial Fire and Casualty Insurance Company.
FINAL JUDGMENT IN FAVOR OF IMPERIAL FIREAND CASUALTY INSURANCE COMPANY
1. That Final Judgment is hereby entered in favor of Defendant, Imperial Fire and Casualty Insurance Company and against Plaintiff, Hallandale Beach Orthopedics (a/a/o Anne Platel).
2. That the Plaintiff, Hallandale Beach Orthopedics (a/a/o Anne Platel) take nothing by this action and that Defendant, Imperial Fire and Casualty Insurance Company shall go hence without day.
3. That by agreement of the parties, each party agrees to bear their own fees and costs. In exchange, the Plaintiff agrees to waive their right to appeal this Order and Final Judgment.
