INTERNATIONAL BANKERS INSURANCE COMPANY, APPELLANT/CROSS APPELLEE,
v.
WAYNE GOVAN, APPELLEE/CROSS APPELLANT

Fla. 4th DCA | 1986-12-17
No. 85-2661
GLICKSTEIN, J., and WARNER, MARTHA C., Associate Judge, concur.
502 So. 2d 913 Florida District Court of Appeal, Fourth District (1986) Positive Treatment
Cited by 16 cases

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Holding

The court held that the 80% calculation of medical expenses should be made before subtracting the $2,000.00 deductible, interpreting 'benefits otherwise due' to mean the total payable expenses before the deductible is applied.


Headnotes

[1] In determining no-fault benefits, the statutory deductible is subtracted from the total amount of medical expenses payable under the policy before applying any percentage…

[2] The phrase "benefits otherwise due each person subject to the deduction" refers to the total amount of medical expenses payable under the policy before the application of…

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Facts & Procedural History

An insured incurred $5,887.45 in medical bills after an auto accident. The insurance policy covered 80% of medical expenses up to $10,000, with a $2,0…

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Opinion of the Court
ANSTEAD, Judge.

ANSTEAD, Judge.

At issue in this appeal is the proper method for determining no-fault medical and wage loss benefits in accord with the provisions of Section 627.739(2), Florida Statutes (1985).

Wayne Govan was injured in an automobile accident and incurred medical bills in the amount of $5,887.45. Pursuant to the provisions of section 627.736(l)(a), Florida Statutes (1985), International Bankers insured Govan for 80% of his medical expenses up to a maximum amount of $10,-000.00 for any single accident. However, the policy also contains a $2,000.00 “deductible” provision. That provision is authorized by section 627.739(2) which provides in part:

Insurers shall offer to each applicant and to each policyholder, upon the renewal of an existing policy, deductibles, in amounts of $250, $500, $1,000, and $2,000, such amount to be deducted from the benefits otherwise due each person subject to the deduction.

At issue is whether the claim for medical bills should be reduced by 80% before the $2,000.00 deductible is subtracted from the claim.

We hold that the 80% calculation should be made before the deductible is subtracted and reverse the summary final judgment holding to the contrary. The parties agree that the answer to the issue lies in the meaning of the phrase “benefits otherwise due each person subject to the deduction” contained in section 627.739(2).

They agree that if the company were liable for 100% of the medical bills, instead of 80%, there would be no problem. In such a case the deductible would come off the top of the medical bills and thereby create a $2,000.00 threshold before any claim was payable. In our view “benefits otherwise due” means the total amount of the medical expenses payable under the policy before application of the deductible. In other words, it refers to the amount that an insured would receive in benefits but for the application of the deductible. If the “benefits otherwise due” refers to 100% of the medical expenses under' a policy paying full benefits, such language would logically also apply to the limited benefits provided in a policy only covering 80% of the expenses.

Accordingly, we believe a plain reading of the statute calls for the application of the 80% reduction in order to determine the “benefits otherwise due” under the policy before application of the deductible. See Kwechin v. Industrial Fire & Casualty Co., 409 So. 2d 28, 30 n. 3 (Fla. 3d DCA 1981), approved, 447 So. 2d 1337 (Fla. 1983).

We acknowledge that our holding appears to conflict with the opinions of two of our sister courts. See Thibodeau v. Allstate Insurance Co., 391 So. 2d 805 (Fla. 5th DCA 1980); Industrial Fire & Casualty Insurance Co. v. Cowan, 364 So. 2d 810 (Fla. 3d DCA 1978).

Those cases appear to hold that “benefits otherwise due” refers to the no-fault benefit limits, such as the $10,000.00 limit involved herein. If that were true the “deductible” would not be a deductible at all in the manner that word is normally used, i.e., as an amount to be deducted from the claim, but rather would simply be a means of providing for lower policy limits. We do not believe the legislature would have authorized lower policy limits in such an indirect and unusual fashion, especially since section 627.736(l)(a) specifically mandates coverage in the amount of at least $10,000.00. We are not aware of any statutory provision authorizing lesser limits. The International Bankers no-fault policy at issue in this case does contain a provision which, consistent with the holdings of Cowan and Thibodeau, reduces the policy limit by $2,000.00.1 We are concerned with this provision in that it appears to utilize the $2,000.00 deductible a second time, after it has already been used in the traditional manner discussed above as a threshold to recovery. While we question the validity of such a provision under the statutorily mandated no-fault coverage, we do not have that issue before us.

We also reverse that portion of the final order which allowed this action to proceed as a class action. It appears that the appellee did not file a motion for class certification until after he had obtained a favorable ruling on the merits.

Accordingly, we reverse the summary final judgment and remand this cause for further proceedings in accord herewith.

GLICKSTEIN, J., and WARNER, MARTHA C., Associate Judge, concur. . The policy provides in part that "if the total amount of such loss and expense exceeds such deductible, the total limit of benefits the Company is obligated to pay shall then be the difference between such deductible amount and the applicable limit of the Company’s liability."


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Citator

Cited By

  • Int'l Bankers Ins. Co. v. Arnone, 552 So. 2d 908 (Fla. 1989)
    …and $2,000, such amount to be deducted from the benefits otherwise due each person subject to the deduction. (Emphasis added.) The Fourth District recently construed this provision in its opinion in International Bankers Insurance Company v. Govan, 502 So. 2d 913 (Fla. 4th DCA 1986), approved, 521 So. 2d 1086 (Fla.1988). The issue presented in Govan was whether the deductible amount was to be deducted from the total medical expenses incurred before or after calculating the eighty percent figure authorized un…
  • …1988), we construed the earlier version of the statute. We determined that "benefits otherwise due" referred to the "amount of ... medical expenses payable under the policy." Id. at 1087 (emphasis omitted) (quoting Int'l Bankers Ins. Co. v. Govan , 502 So. 2d 913, 914 (Fla. 4th DCA 1986) ). Because coverage was limited to 80% of medical expenses, id. , we found that the deductible should be applied to the medical provider's charges after the 80% reduction. Id. at 1088. In so ruling, we recognized that we la…
  • Govan v. Int'l Bankers Ins. Co., 521 So. 2d 1086 (Fla. 1988)
    …OVERTON, Justice. This is a petition to review International Bankers Insurance Co. v. Govan, 502 So. 2d 913 (Fla. 4th DCA 1986), in which the district court of appeal determined the proper method to compute the deductibility provisions for medical and wage-loss benefits under section 627.739(2), Florida Statutes (1983). The district court acknowledged con…

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