9 Fla. L. Weekly Supp. 871a
Insurance — Personal injury protection — Preferred provider rates — Motion for partial summary judgment as to whether insurer can enter into PPO business relationships is denied where ruling on motion would be tantamount to an advisory opinion
CRAIG H. LICHTBLAU, M.D., P.A., Plaintiff, vs. NATIONWIDE GENERAL INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County, Civil Division. Case No. SS-02-8069-RD. October 25, 2002. Charles E. Burton, Judge. Counsel: Charles Kane, Kane & Kane, Boca Raton. Shannon Mahoney, West Palm Beach.
ORDER ON MOTION FOR SUMMARY JUDGMENT
THIS CAUSE came before the Court on October 22, 2002 upon the Defendant’s Motion for Partial Summary Judgment. Based on the proceedings before the Court, the Court finds as follows:
Joann Dalessandro was involved in an automobile accident and was insured by the Defendant. After the accident, she treated with Craig H. Lichtblau, M.D. for injuries she sustained and executed an assignment of her personal injury protection benefits to Dr. Lichtblau. It is alleged in the Motion that both the Plaintiff and the Defendant have executed contracts with Beech Street Preferred Provider Program (PPO). These contracts were attached to the Motion as Exhibits A and B. When Dr. Lichtblau billed the Defendant for medical services rendered, the Defendant paid the bills pursuant to rates established by the PPO program.
This issue has been raised throughout the county courts in the state. The Defendant claims it has the right to pay reduced rates because the Plaintiff has a Beech Street PPO contract. Clearly, the Defendant did not issue their insured a PPO policy, which is authorized by F.S. 627.736. Further, the only authority for the Plaintiff to bring this action is based upon an assignment executed by the insured. Therefore, the Plaintiff has the same rights as the insured had there been no assignment. Lanziser v. Progressive Express Insurance Co., 9 Fla. L. Weekly Supp. 63 (Fla. Manatee Cty Court 2001), Dukes Chiropractic Health Clinic P.A. v. Nationwide Mutual Fire Insurance Co., 9 Fla. L. Weekly Supp. 629 (Fla. Hillsborough Cty Court 2002), Dr. William Waters v. Nationwide Mutual Insurance Co., 9 Fla. L. Weekly Supp. 630 (Fla. Bay Cty Court 2001), Northwest Broward Orthopaedic Associates v. Progressive Express Insurance Co., 9 Fla. L. Weekly Supp. 723 (Fla. Broward Cty Court 2002), Salvatore Larusso, D.C. v. Nationwide Property and Casualty Insurance Co., 9 Fla. L. Weekly Supp. 63 (Fla. Palm Beach Cty Court 2001).
Here, the Defendant seeks partial summary judgment as to whether the Defendant can enter into these PPO business relationships, which they argue are not prohibited by F.S. 627.736(10). Assuming that answer is in the affirmative, they do not seek summary judgment as to whether they can take the PPO deductions if the Plaintiff physician has also entered into these PPO business relationships. As the Plaintiff points out, Exhibit B is a contract between Beech Street Corporation and Nationwide Mutual Insurance Company, a separate entity from the Defendant in this case. In connection with the affirmative defense raised by the Defendant, it appears that the real issue in this case is not whether the insurance company can enter into these contracts, but rather, if they do, can they pay PIP benefits at the PPO reduced rates. In ruling on the motion as drafted, it appears to the Court that it would tantamount to an advisory opinion. Santa Rosa County v. Administration Commission, Division of Administrative Hearings, 661 So.2d 1190 (Fla. 1995).Accordingly, it is
ORDERED AND ADJUDGED that the Defendant’s Motion for Partial Summary Judgment is DENIED.
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