27 Fla. L. Weekly Supp. 59a
Online Reference: FLWSUPP 2701HARRInsurance — Personal injury protection — Coverage — Declaratory judgment — Issue of whether policy language requires insurer to pay full amount of charges that are less than amount allowed under statutory fee schedules is appropriate for declaratory action — Fact that adequate alternative remedy exists at law does not preclude declaratory action — Motion to dismiss is denied
TLC CHIROPRACTIC, INC. a/a/o Alphonzo Harris, (“TLC CHIROPRACTIC”) Plaintiff, v. GEICO INDEMNITY COMPANY, (“GEICO”), Defendant. County Court, 2nd Judicial Circuit in and for Leon County. Case No. 2018 CC 002960. February 13, 2019. Augustus Aikens, Judge. Counsel: Adam Saben, Shuster & Saben, LLC, for Plaintiff. Brian Chojnowski and Kara Cosse, Kubicki Draper, P.A., for Defendant.
ORDER DENYING DEFENDANT’S MOTION TO DISMISS
THIS CAUSE having come for hearing on January 30, 2019 on Defendant’s Motion to Dismiss, the Court rules as follows:
Plaintiff, TLC CHIROPRACTIC, as the real party in interest pursuant to an Assignment of Benefits, filed a declaratory action seeking a judicial determination as to its coverage rights and an interpretation of the Defendant’s, GEICO, FLPIP (01-13) policy language. Specifically, the Plaintiff asks whether Geico’s policy affords greater coverage than that required pursuant to F.S. 627.736 regarding a claim for personal injury protection (“PIP”) benefits. The language at issue properly elects the “permissive” payment methodology of F.S. 627.736(5)(a)1(2012), but also includes the following language:
A charge submitted by the provider, for an amount less than the amount allowed, shall be paid in the amount of the charge submitted.
Plaintiff submitted charges in this case that were less than the amount allowed pursuant to the permissive payment methodology (80% of 200% of the current Medicare B Fee Schedule). Plaintiff’s position is that the subject language required Geico to pay the full submitted amount. The Defendant’s position is that this case is about an amount of money damages due under a contract and, therefore, the declaratory action should be dismissed and Plaintiff should only be permitted to bring this case as a breach of contract.
While there may ultimately be a legitimate issue over the amount of money owed under a contract, the legal question in this case fits squarely within the four corners of Chapter 86, Declaratory Judgments. Said statute reads (in pertinent part):
86.011 Jurisdiction of the trial court. — The circuit and county courts have jurisdiction within their respective jurisdictional amounts to declare rights, status, and other equitable or legal relations whether or not further relief is or could be claimed. No action or procedure is open to objection on the ground that a declaratory judgment is demanded. The court’s declaration may be either affirmative or negative in form and effect and such declaration has the force and effect of a final judgment. The court may render declaratory judgments on the existence, or nonexistence:
(1) Of any immunity, power, privilege, or right; or
(2) Of any fact upon which the existence or nonexistence of such immunity, power, privilege, or right does or may depend, whether such immunity, power, privilege, or right now exists or will arise in the future. Any person seeking a declaratory judgment may also demand additional, alternative, coercive, subsequent, or supplemental relief in the same action. (emphasis added).
Further, Chapter 86 also reads:
86.021 Power to construe. — Any person claiming to be interested or who may be in doubt about his or her rights under a . . . contract . . . or whose rights, status, or other equitable or legal relations are affected by a . . . contract . . . may have determined any question of construction or validity arising under such . . . contract . . . or any part thereof, and obtain a declaration of rights, status, or other equitable or legal relations thereunder. (emphasis added).
A legal determination pursuant to Chapter 86.021 is exactly what the Plaintiff seeks in this case. While the judicial determination of this legal question may affect an amount of benefits owed, the narrow question before this Court merely seeks clarification of the Plaintiff’s rights under a contract. Resolving narrow questions pursuant to Chapter 86 is precisely to avoid the paradigm that the Defendant seeks; to wit, prolonged litigation for both parties. As our Supreme Court stated in Higgins v. State Farm, 894 So.3d 5 (Fla. 2004) [29 Fla. L. Weekly S533a]:
We conclude that it is illogical and unfair to not allow insureds and insurers to have a determination as to whether coverage exists on the basis of the facts underlying a claim against an insurance policy. Why should an insured be placed in a position of having to have a substantial judgment against the insured without knowing whether there is coverage from a policy? Why should an insurer be placed in a position of either paying what it believes to be an uncovered claim or being in jeopardy of a bad faith judgment for failure to pay a claim? These are precisely the issues recognized by this Court in other contexts that are intended to come within the purpose of the declaratory judgment statute’s “relief from insecurity and uncertainty with respect to rights, status, and other equitable or legal relations”. Higgins, citing Coalition for Adequacy & Fairness in School Funding v. Chiles, 680 So.2d 400 (Fla. 1996) [21 Fla. L. Weekly S271a].
Like in Higgins, this Court asks why should the Plaintiff be exposed to a substantial judgment merely if seeking a determination of its rights under the policy? Why should the insurer be placed in a position of paying what it believes to be excessive PIP benefits if its policy language does not so mandate? These are precisely the issues recognized by this Court that render relief from insecurity and uncertainty with respect to rights pursuant to the Defendant’s policy. Thus, as phrased, a declaratory action is proper.
Furthermore, there is nothing within the four corners of Chapter 86 that precludes a party from bringing a declaratory action merely because a cause of action could have been brought under another medium, such as a breach of contract. To the contrary, declaratory actions were created by the Legislature as a mechanism to avoid actions at common law, if possible. As noted by the Second District:
The goals of the Declaratory Judgment Act are to relieve litigants of the common law rule that a declaration of rights cannot be adjudicated unless a right has been violated and to render practical help in ending controversies which have not reached the stage where other legal relief is immediately available. Bell v. Associated Independents, Inc., 143 So.2d 904 (Fla. 2d DCA 1962). To operate within this sphere of anticipatory and preventative justice, the Declaratory Judgment Act should be liberally construed. Bell. See Rigby v. Liles, 505 So.2d 598 (Fla. 1st DCA 1987). X Corp. v. Y Person, 622 So.2d 1098 (Fla. 2d 1993).
The Defendant’s argument has also been rejected when made by another PIP insurer in Plantation Spinal Care Center v. Direct General Ins. Co., 17-CV-61990 (S.D.Fla April 3, 2018)(“The Court rejects Defendant’s argument that Plaintiff cannot assert a claim for declaratory relief when an adequate alternative remedy exists at law.”). Although that case was applying Rule 57 of the Federal Rules of Civil Procedure, the same rationale comports with Chapter 86 of the Florida Rules. Applying a straight reading of Chapter 86 (which is to be liberally construed), as well as the persuasive authority cited above, and the binding authority of our Supreme Court in Higgins, Defendant’s Motion to Dismiss is DENIED.
