Appeals Court Rules Florida Car Accident Victim’s PIP Benefits Subject to Contracted-For Deductible

DSC06084-B2-1 morguefile DodgertonSkillhauseIn Mercury Insurance Co. v. Emergency Physicians of Central Florida, a Florida woman was injured in a car accident. At the time of the traffic wreck, the woman carried $10,000 in personal injury protection (“PIP”) benefits that she purchased from her auto insurer. As part of the PIP policy, the woman elected a $500 deductible. Following the collision, the woman sought medical treatment from an emergency clinic. Within 30 days of the accident, the clinic submitted a bill for $191 to the woman’s PIP insurer. After that, no further bills were received by the insurance company.

More than two months later, the emergency clinic submitted a statutory demand letter seeking payment for the care it provided to the insured woman to her insurance company. The insurer ignored the demand letter, and the clinic filed a lawsuit against the company in a Florida county court. According to the insurance company, it was not required to pay the medical bill because the amount was well below the deductible provided for in the PIP policy.

Next, the emergency clinic filed a motion for summary judgment. In general, such a motion asks a court to rule in favor of a party to a lawsuit without proceeding to trial. Summary judgment is appropriate when no material facts are in dispute, and one party is entitled to judgment based on the law. According to the clinic, it was entitled to receive payment without regard to the woman’s deductible under Section 627.736(4)(c) of the Florida Statutes. The insurance company countered with its own motion for summary judgment and asserted that nothing in Section 627.739(2) precluded it from applying the PIP bill to the insured woman’s deductible.

The county court granted the emergency clinic’s motion and stated that to rule otherwise would go against the intent of the Florida Legislature. On appeal to a Florida circuit court, the insurer claimed the lower court committed error when it ruled in such a way as to provide the insured woman with greater PIP benefits than she contracted for. A circuit court panel comprised of three judges ultimately affirmed the county court’s decision, and the insurance company filed a petition for a writ of certiorari with Florida’s Fifth District Court of Appeal.

The appellate court stated Section 627.736(4)(c) failed to address the impact of a PIP deductible. In contrast, Section 627.739(2) specifically stated that a PIP deductible must be applied to 100 percent of the losses described in Section 627.736. The court added that the plain language of the law mandated that any deductible be applied to the losses described in Section 627.736, and it enumerated the benefits that may be recovered once the contracted-for deductible is met. In addition, the appellate court said such an interpretation was consistent with the purpose of an insurance deductible in the State of Florida. The court stated this purpose was to reduce an insured’s monthly payment in exchange for a specified self-insurance cost in the event of a loss.

Finally, Florida’s Fifth District Court of Appeal held that the plain language of the two statutes required it to quash the circuit court’s order affirming the county court’s grant of summary judgment in favor of the emergency clinic. The appellate court then remanded the case.

If you were hurt in a South Florida car accident, you should discuss your right to recover PIP and other benefits with a hardworking personal injury lawyer. To speak with an experienced Miami personal injury attorney, do not hesitate to call the caring advocates at Friedman, Rodman & Frank, P.A. at (305) 448-8585 or contact us through our website.

Additional Resources:

Mercury Insurance Co. v. Emergency Physicians of Central Florida, Fla: Dist. Court of Appeals, 5th Dist. 2015

More Blog Posts:

Southern District of Florida Allows First-Party Bad-Faith Action Against Insurer to Proceed, October 30, 2015, South Florida Personal Injury Lawyers Blog

Florida Appeals Court Reverses Workers’ Compensation Award On Legal Fees Issue, October 27, 2015, South Florida Personal Injury Lawyers Blog

Photo Credit: DodgertonSkillhause, MorgueFile

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