DCI MRI, INC., APPELLANT,
v.
GEICO INDEMNITY COMPANY AND GEICO CASUALTY COMPANY, APPELLEES

Fla. 4th DCA | 2012-01-18
Nos. 4D10-1458, 4D10-1459
HAZOURI and DAMOORGIAN, JJ., concur.
79 So. 3d 840 Florida District Court of Appeal, Fourth District (2012) Negative Treatment
Cited by 6 cases

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

A medical provider appeals summary judgment in consolidated cases involving PIP benefits under Florida's 2008 no-fault law. The court held that when an insurance policy provides greater coverage than the statutory minimum, the policy terms control, and the insurer cannot unilaterally reduce reimbursement to amounts permitted by the statute despite the policy's incorporation of the law "as amended."


Holding

No. When an insurance policy provides greater coverage than the statutory minimum, the policy terms control. A policy provision stating the insurer will pay in accordance with the law "as amended" is insufficient to place the insured on notice of intent to pay less than the 80% of reasonable expenses specifically stated in the policy. Ambiguities in insurance contracts are resolved in favor of the insured.


Headnotes

[1] When an insurance policy provides greater coverage than required by statute, the terms of the policy control.

[2] A statement in an insurance policy that benefits will be paid in accordance with the law "as amended" is insufficient to put the insured on notice of the insurer's intent…

Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.

Join FLexlaw to unlock all legal intelligence

Key Quotes

“when the insurance policy provides greater coverage than the amount required by statute, the terms of the policy will control”

Establishes the core holding that policy terms supersede statutory minimums when more favorable to the insured

Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.

Join FLexlaw to unlock all legal intelligence

Facts & Procedural History

DCI MRI, a medical provider and assignee of two insureds' PIP benefits, sued GEICO for unpaid medical expenses. Both insureds had policies in effect b…

The full statement of facts, procedural history, and disposition for this case are member content.

Join FLexlaw to unlock all legal intelligence

© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.


Opinion of the Court
MAY, C.J.

*842MAY, C.J.

In these consolidated appeals, a medical provider, the assignee of two independent insureds, appeals a final summary judgment concerning the application of the 2008 PIP statute to two policies that were in existence at the time of the statute’s enactment. The county court granted summary judgment for the insurer, finding that the 2008 PIP statute allowed the insurer to pay less than 80% of the fee charged. The court then certified the following question:

Whether the fee schedules included in the legislature’s January 1, 2008 reenactment/revision to the Florida no-fault law apply to policies which were in force on January 1, 2008, and which contained no-fault endorsements issued prior to the insured’s date of accident.

This court accepted discretionary review, pursuant to Florida Rule of Appellate Procedure 9.030(b)(4)(A). We answer the question in the negative. We therefore reverse and remand the case to the county court.

The healthcare provider filed two separate lawsuits against the insurer for unpaid PIP benefits. In both cases, the insureds had assigned their PIP benefits to the healthcare provider. Each insured had an insurance policy in effect prior to the enactment of the 2008 PIP statute, section 627.736, Florida Statutes (2008). Each insured sustained injuries after the statute was enacted.

Each policy stated that the Insurance Company “will pay, in accordance with the Florida Motor Vehicle No-Fault Law, as amended ... 80% of medical expenses.” The insurer reimbursed the medical expenses in an amount equal to 200% of the Medicare fee schedule in accordance with the formula set forth in section 627.736(5)(a)2.f, Florida Statutes (2008).

Both parties moved for summary judgment. The insurer argued that the 2008 PIP statute enabled it to use the Medicare fee schedule to calculate the reimbursement owed to the healthcare provider. The provider argued that it was entitled to receive payment in accordance with the terms of the policy. The county court entered summary judgment for the insurer, concluding that, because the insurance policy incorporated the 2008 No-Fault Law, the insurer could reimburse the provider pursuant to the fee schedule in section 627.736(5)(a)2.f. The county court then certified the question to us.

The answer to the certified question is dictated by our recent opinion in Kingsway Amigo Insurance Co. v. Ocean Health, Inc., 63 So.3d 63 (Fla. 4th DCA 2011). In Kingsway, we held “when the insurance policy provides greater coverage than the amount required by statute, the terms of the policy will control.” Id. at 68. As in Kingsway, the policy here provided that it would pay 80% of reasonable medical expenses. The fact that the 2008 statute would allow the insurer to opt for another lesser amount does not permit the insurer to do so when the policy specifically provides for payment of 80% of reasonable expenses incurred. Simply indicating that the insurer would pay in accordance with the law “as amended,” is insufficient to place the insured on notice of its intent to pay less than 80% of reasonable expenses incurred as stated in the policy.

Further, as noted recently by the Third District Court of Appeal: “A policy indicating that an insurer may distribute reimbursements according to one method without clarifying alternative methods or identifying the factors to be considered in selecting among methods is ambiguous. Ambiguities in insurance contracts are resolved in favor of the insured.” Geico Indem. Co. v. Virtual Imaging Servs., Inc., *84379 So.3d 55, 58 (Fla. 3d DCA 2011) (citing State Farm Mut. Auto. Ins. Co. v. Menendez, 70 So.3d 566, 570 (Fla.2011)).1

For these reasons, we reverse and remand the case to the county court.

Reversed and Remanded.

HAZOURI and DAMOORGIAN, JJ., concur.


Cases With Similar Vibessemantic neighbors from the corpus


Citator

Cited By

  • …ments without providing notice through an election in its policy. The Third District’s conclusion was consistent with the holdings of three previous district court of appeal cases that addressed the same issue. See DCI MRI, Inc. v. Geico Indem. Co., 79 So. 3d 840, 842 (Fla. 4th DCA 2012); Geico Indem. Co. v. Virtual Imaging Servs., Inc. (“Virtual I”), 79 So. 3d 55, 58 (Fla. 3d DCA 2011); Kingsway Amigo Ins. Co. v. Ocean Health, Inc., 63 So. 3d 63, 67 (Fla. 4th DCA 2011). Because the Third District determine…
    1 / 2
  • GEICO Gen. Ins. Co. v. Virtual Imaging Servs., Inc., 90 So. 3d 321 (Fla. 3d DCA 2012)
    …rder below, the county court judge relied upon the Department of Highway Safety and Motor Vehicles estimates. . In this case, the insurer’s petition for certio-rari was denied in an unreported order. . See, e.g., DCI MRI, Inc. v. Geico Indem. Co., 79 So. 3d 840 (Fla. 4th DCA 2012).…

Authorities Cited

Full citator, related cases, and AI research tools

Open in FLexlaw