4 Fla. L. Weekly Supp. 440a
NOT FINAL VERSION OF OPINION
Subsequent Changes at 4 Fla. L. Weekly Supp. 585a
Insurance — Personal injury protection — Insured alleging insurer acted against her rights when it settled physician’s bill for amount less than eighty percent of the amount originally billed — Nothing in record supports insured’s contention that she was required to make co-payment in amount equalling twenty percent of original bill, rather than twenty percent of lower bill negotiated by insurer
HORTENCIA BOTERO, Appellant, v. FIDELITY NATIONAL INSURANCE COMPANY, Appellee. 11th Judicial Circuit in and for Dade County, Appellate Division. Case No. 96-045 AP. County Court Case No. 95-7190 CC 05. Opinion filed December 20, 1996. Appeal from a Final Judgment of the County Court in and for Dade County, Harvey L. Goldstein, Judge. Counsel: Carlos Lidsky, Juan C. Montes, and Lidsky & Vacarro, for appellant. Gilda M. Chavez, for appellee.
(Before AMY STEELE DONNER, STEVEN D. ROBINSON and LAUREN LEVY MILLER, JJ.)
(STEVEN D. ROBINSON, Judge.) The plaintiff, HORTENCIA BOTERO, brought suit against her insurance company, FIDELITY NATIONAL INSURANCE COMPANY (Fidelity) under her policy for personal injury protection benefits (PIP) which she suffered in an automobile accident on or about July 15, 1993. Under her policy the insurance pays 80 percent of the cost of her medical expenses, and she must make a 20 percent co-payment. After delayed negotiations and failed mediation, Fidelity settled with one of her physicians, Dr. Howard Hoffman, less than 80 percent of the amount he billed. Botero asserts that she owes Dr. Hoffman 20% of the original amount. That is a shade above 20 percent of what the insurance company settled with the physician, and, therefore she asserts that the insurance company acted against her rights under the insurance policy.
Eighty percent of the bill claimed by the physician was $2320. The company settled with the doctor for $2250.1 (The physician was not a party in the proceedings below, so his position is unknown except for what he asserts on Exhibit D as described below.) The trial court found that she properly owes 20 percent of $2,900 or $580. Five hundred eighty dollars are still more than 20 percent of the renegotiated bill, which can be constructed by dividing $2,250 by .08 or $2,812.50. Because she signed that what she characterizes an authorization for payment and not an assignment of benefits, Botero claims that the insurance company had no right to settle contrary to her rights.
We find no error. There is nothing in the record that the physician is seeking the 20 percent of $2,900. According to the record in composite exhibit D, the physician agreed with Fidelity to bill only for the “co-payment” which by our definition is 20 percent of the amount he agreed with the insurance company to be reasonable, i.e., $2,812.50. Section 627.736(1)(b), Florida Statutes, uses the adjective “reasonable” to limit medical expenses. After first stating that she was only responsible for a 20 percent co-payment, the trial judge mistakenly accepted the plaintiff’s counsel’s argument that the co-payment had to be calculated from 20 percent of the original bill. We can only interpret what a co-payment is by logically applying section 627.736(1)(b). We define co-payment to mean no more than 20 percent of the reasonable amount, subsequently agreed, and not the first billed amount. Therefore, Fidelity complied fully with the terms of the policy, in fact, to the benefit of the insured as well as itself.
We also affirm the trial court’s denial of the plaintiff’s claim for pre-trial interest.
AFFIRMED. (AMY STEELE DONNER AND LAUREN LEVY MILLER, JJ., concur.)
— — — —
1The argument at summary judgment reflects assertions of slightly different calculations and numbers than we found in the record exhibits.
* * *
