A Win for Insurance Providers: South Florida Court Finds No Obligation to Cover Complete PIP Expenditures|Daily Business Review – Law.com

23September 2020


The aftermath of a car crash. Bumper on the floor with people swapping information in the background. Photo: GITTI.NUNCHO/Shutterstock.com The combined appeals

involved injury security vehicle insurance. Picture: GITTI.NUNCHO/ Shutterstock.com A group of South Florida medical suppliers who challenged an insurance provider’s analysis of its auto accident protection lost its fight Wednesday when the Fourth District Court of Appeal discovered insurance companies aren’t bound to completely reimburse patients for post-crash medical expenditures.

It was an appeal including injury security, or PIP, insurance advantages, which cover medical expenditures after a Florida vehicle accident, despite who was at fault for the injury.

Wednesday’s ruling covers multiple cases combined prior to Broward Circuit Judges Robert W. Lee and Florence Taylor Barner, who agreed the insurance companies, but certified a question of terrific public value to Florida’s Fourth District Court of Appeal.

80% or full compensation?

The appellate court had to choose whether a PIP insurance coverage requires insurance provider to pay more than 80% of a statutory $10,000 charge limit, if that policy has a provision for the overall limit of advantages, based upon the distinction between a deductible and overall expenditures.

Health care suppliers Plantation Open MRI LLC, MR Services I Inc. and Upright Open MRI LLC claimed an unclear PIP insurance coverage implied their patients were entitled to full compensation for medical treatments.

The business highlighted a “limits of liability” area of the policy, which said:

“The amount of any deductible stated on the declarations page shall be subtracted from the overall amount of all loss and cost incurred by or on behalf of everyone to whom the deductible uses and who sustains bodily injury as the outcome of any one accident. If the overall amount of such loss and cost surpasses such deductible, the overall limit of advantages we are bound to pay shall then be based upon the distinction between such deductible amount and the overall amount of all loss and cost incurred, subject to the $10,000 limit of advantages.”

insurance companies Infinity Indemnity Insurance Co., Infinity Automobile Insurance Co. and Infinity Guarantee Insurance Co. argued Florida Statute area 627.736( 5 )(a)1 just needed them to conceal to 80% of the $10,000 limit for emergency services.

The appellate panel discovered Florida law requires it to translate insurance agreements “according to the whole of its conditions and terms.” It discovered that case law said that “true uncertainty does not exist simply because an agreement can possibly be analyzed in more than one manner.”

Under that reasoning, the viewpoint said the policy wasn’t uncertain.

“When the policy is read in its whole, the area in disagreement plainly discusses and limits the general liability how any relevant deductible is applied,” Wednesday’s viewpoint said. “It does not produce a different payment commitment.”

Evaluating the paragraph at problem in the contract, the appellate panel discovered that by focusing on the object word “advantages,” the suppliers had neglected that the adjective “overall” modified the noun “limit.”

“Rather, the suppliers assert an obscurity by reading this sentence as if the noun– limit– was not there, substituting the object– advantages– as if it was the noun,” the viewpoint said. “By doing so, the suppliers have actually added a significance that is not present in the policy’s text.”

Fourth District Court of Appeal Judge Edward Artau composed the ruling, with Judges Dorian Damoorgian and Alan Forst concurring.

Miami solo practitioner Douglas H. Stein represents the suppliers, while Gladys Perez Villanueva and Garrett A. Tozier of Shutts & & Bowen’s Miami and Tampa offices represent the insurance companies. Suzanne Y. Labrit also represented the insurance companies, but withdrew after oral argument. They did not immediately react to an ask for comment.

Read the viewpoint:

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Source: law.com

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