Background of PIP Deductible DisputeThe case arose after a Florida insured driver was involved in an automobile accident, and sought treatment at Florida Hospital Medical Center. The medical bills to treat the injured victim exceeded the deductible amount, and the insured assigned his PIP benefits to the medical providers treating him, as is customary in these types of cases and permissible under Florida statute. The underlying dispute emerged after Florida Hospital Medical Center sent Progressive the bill for the patient's treatment. The controversy came about over contrasting methods of how to apply Florida's law regarding PIP reimbursement limitations. In other words, the two sides had different opinions on how the law should be applied. Progressive sought to apply the statutory limitations of the No-Fault law before subtracting the deductible. Florida Hospital Medical Center argues that, according to the statute, the deductible should be applied first and then insurance companies can apply the reimbursement limitations. As you might expect, Progressive's method resulted in a reimbursement of $200.00 less than the method utilized by Florida Hospital Medical Center.
What have the courts said so far?Florida Hospital Medical Center filed a lawsuit in the County Court seeking $200.00 plus interest. They also hope to set a legal precedent that could potentially amount to millions. Both parties filed motions for summary judgment, and the County Court entered a final summary judgment in favor of Florida Hospital Medical Center. Progressive, unhappy the ruling against them, appealed the judgment to the higher Circuit Court. The Circuit Court affirmed the County Court's judgment; again, in favor of Florida Hospital Medical Center. Progressive then petitioned an even higher court, the 5th District Court of Appeals, to review the lower court's ruling in order to “determine whether the county court utilized the correct law when interpreting sections §627.736(5)(a)1.b. and §627.739(2)” with regard to applying the deductible. The petition was denied. [Click here to read the full petition.]
What is next for the case?According to the Appellate Court's Case Docket, a review request for this case was sent to the Supreme Court. Unfortunately, there were no further details. It appears, at least at the moment, that the 5th District Court of Appeals certified the underlying issue in this case as one involving a ‘question of great public importance'. That question being “When calculating the amount of PIP benefits due to an insured, does Florida Statute Section 627.739(2) require that the deductible be subtracted from the total amount of medical charges before applying the reimbursement limitation under Section 627.736(5)(a)1.b.; or, must the reimbursement limitation be applied first and the deductible subtracted from the remaining amount?” A case in the 4th District Court of Appeals is currently being litigated over the same question of law. If that court expressly contradicts the 5th DCA, the Supreme Court may have a stronger incentive to hear the case, and unify the law. It should be noted the Florida Supreme Court has discretionary jurisdiction, which means the court can choose whether to review the case. It's not mandatory. If the Florida Supreme Court grants the petition for review, the case would be considered and decided on the merits.
What does this mean for Florida drivers?As this case is relatively new, it's likely that Progressive, and quite possibly other insurance companies, have incorrectly applied the deductible to many patient files. As such, these patients may be entitled to additional reimbursements. At Dolman Law Group Accident Injury Lawyers, PA, we will be paying close attention to this case and whether or not the Supreme Court decides to review it. If you are a medical provider or medical manager and have a PIP-related question, please do not hesitate to contact us. PIP suit clients of Dolman Law Group Accident Injury Lawyers, PA pay no out of pocket costs. All attorney fees earned are separate and apart from the benefits we seek on your behalf. We do not take a percentage of the outstanding bills for services rendered by your medical practice. The fees we obtain are carved out by statute and are paid by insurance companies when they force you to hire us to obtain reimbursement that is rightfully yours. We routinely perform audits for numerous medical providers and have the staff and resources to handle your PIP claims. Feel free to contact us ….. Send us your non-payments, denials, and improper reductions so we can start working to obtain the reimbursements that are rightfully yours. To schedule a free consultation with a Dolman Law Group Accident Injury Lawyers, PA attorney, please contact us at (727) 472-3909, complete our online form, or visit us at one of our three office locations in the Tampa area. We look forward to hearing from you and to vigorously advocating on your behalf. Dolman Law Group Accident Injury Lawyers, PA 1663 1st Ave S. St. Petersburg, FL 33712 (727) 472-3909 https://www.dolmanlaw.com/pip/