8 Fla. L. Weekly Supp. 246b
Insurance — Personal injury protection — Medical bills — Reduction — Insurer had no privity of contract and no standing to reduce medical bills submitted by medical provider for treatment of insured, pursuant to contract in which insurer was not a party or “Third Party Payor” as defined by contract — Insurer could not reduce plaintiff’s medical bills as it did not have a preferred provider policy as required by statute — Section 627.736(10) allows a specific method for insurers to take Preferred Provider reductions, and insurer’s failure to follow this methodology prohibits the taking of preferred provider reductions
DR. JEFFREY N. SHEBOVSKY d/b/a SOUTH ORANGE CHIROPRACTIC CENTER (Glenn Jeffers), Plaintiff v. PEACHTREE CASUALTY INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. CCO 99-9723 DIV 71. December 20, 2000. Jerry L. Brewer, Judge. Counsel: Laura M. Watson, Watson & Lentner, Ft. Lauderdale. David A. Finley.
ORDER ON PLAINTIFF’S MOTION FOR PARTIALSUMMARY JUDGMENT
THIS CAUSE having come on to be heard on Plaintiff’s Motion for Partial Summary Judgment as to Count I, Declaratory Judgment Count, and the Court having reviewed the Motion and being otherwise advised in the Premises, it is hereupon,
ORDERED AND ADJUDGED that the contract entered into between Jeffrey N. Shebovsky, D.C. and MedView Services, Inc., which was attached to the motion as Exhibit “A”, is not ambiguous and the court interprets the contract in accordance with its plain meaning and finds that the contract does not apply to Personal Injury Protection claims under the No Fault Statute, but rather the terms and conditions of the contract applies to Group Health Benefits, and Worker’s Compensation Programs. The Court further finds that Peachtree Casualty Insurance Company was not a party to this contract and not a “Third Party Payor” as defined in the agreement. Therefore, Peachtree Casualty Insurance Company had no privity of contract and no standing to reduce the medical bills submitted by the Plaintiff, for the treatment of Glenn Jeffers, pursuant to this contract. In addition, the Court finds that Peachtree Casualty did not follow the dictates of F.S. 627.736(10), and could not reduce the Plaintiff’s medical bills as it did not have a preferred provider policy as required by that statute. The No Fault Statute is unique and is to be construed in favor of the insured and not the insurer. Florida Statute 627.736(10) allows a specific method for insurers to take Preferred Provider reductions and this methodology must be followed by the insurer if the insurer wants to take Preferred Provider reductions. Peachtree’s failure to comply with subsection (10) prohibits the taking of these reductions.
As further relief, the Court finds that Peachtree Casualty Insurance Company does not have the right to tender in evidence the MedView agreement marked as Exhibit “A”, or any evidence as to Preferred Provider rates or any other rates pertaining to group insurance, worker’s compensation insurance program, or any other insurance or program referred to in the MedView agreement as said agreement is not relevant and material to this case. Accordingly, the Court grants Plaintiffs Motion for Partial Summary Judgment as to Count I of the Complaint and denies the Defendant’s Motion for Summary Judgment. The Court reserves jurisdiction to award reasonable attorney’s fees and costs.
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