PROGRESSIVE AMERICAN INSURANCE COMPANY, PETITIONER,
v.
EMERGENCY PHYSICIANS OF CENTRAL FLORIDA, ETC., RESPONDENT
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Progressive Insurance challenged a circuit court decision requiring it to pay an emergency physician's bill in full despite the insured's deductible. The court held that emergency physicians' bills are subject to PIP deductibles like all other claims, consistent with statutory language requiring deductibles to apply to 100% of covered expenses.
Emergency physicians' bills are properly subject to PIP deductibles in the order received, and the $5,000 reserve created by statute for such providers is not exempt from deductible application. Progressive properly applied EPCF's claim to the deductible and owed no payment.
[1] A deductible in an insurance policy applies to 100 percent of expenses and losses described in section 627.736, Florida Statutes, without exception for emergency service…
[2] The purpose of a deductible is to alter the point at which an insurance company's obligation to pay arises, with the insured being responsible for the initial specified l…
Previewing 2 of 5 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“all claims, including EPCF's priority claim, are properly applied to a personal injury protection deductible in the order that they are received”
Establishes the controlling rule that emergency physician claims must be applied to deductibles sequentially with other claims
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Join FLexlaw to unlock all legal intelligenceAsmaa Karani was involved in a car accident and received emergency services from EPCF, an emergency physician provider. EPCF submitted its bill to Pro…
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This case arose after the insured, Asmaa Karani, was involved in a car accident and sought treatment from the respondent, Emergency Physicians of Central Florida, LLP, a/a/o Karani (“EPCF”). EPCF is an emergency services provider. It submitted its bill tc the petitioner, Progressive American Insurance Company (“Progressive”), in accordance with section 627.736(4)(c), Florida Statutes , (2011). However, its bill was applied to Karani’s deductible under section 627.739(2), Florida Statutes (2011). Therefore, Progressive did not. remit payment to EPCF.
EPCF, as Karani’s- assignee, initiated an action in county court against Progressive for breach of the insurance policy. The county court ruled in favor of EPCF, finding that EPCF was a member of a legislatively created and protected class of priority providers and therefore entitled to have its bill paid in full despite the existence of Karani’s deductible. The circuit court affirmed, holding that the deductible. was improperly applied to EPCF’s bill.
This matter comes before this court on second-tier certiorari review. In Mercury Insurance Company of Florida v. Emergency Physicians of Central Florida, LLP, 182 So.3d 661 (Fla. 5th DCA 2015), this court held that all claims, including EPCF’s priority claim, are properly applied 'to a personal injury protection deductible in the order that they are received. See also Metro. Cas. Ins. Co. v. Emergency Physicians of Cent. Fla., LLP, 178 So.3d 927 (Fla. 5th DCA 2015). Following Mercury, the circuit court in the instant appeal erred in holding that the benefits to be paid from the $5000 reserve imposed by section 627.736(4)(c) are not subject to an otherwise applicable deductible. Such an interpretation runs afoul of the plain language of section 627.739(2), which sets out that “[t]he deductible amount must be applied to 100 percent of the expenses and- losses described in s. 627.736.” Accordingly, EPCF is not entitled to payment from Progressive, as Progressive properly applied its claim to the deductible. We .grant Progressive’s petition for writ of certiorari and quash the circuit court’s order.
CERTIORARI GRANTED; ORDER QUASHED.
SAWAYA, COHEN and BERGER, JJ., concur.
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Citator
Cited By
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Progressive Express Ins. Co. v. Emergency Physicians OF Central Florida, 187 So. 3d 1278 (Fla. 5th DCA 2016)
Authorities Cited
- Mercury Ins. Co. OF Fla. v. Emergency Physicians OF Central, 182 So. 3d 661 (Fla. 5th DCA 2015)
- Metro. Cas. Ins. Co. v. Emergency Physicians of Cent. Fla., LLP, 178 So. 3d 927 (Fla. 5th DCA 2016)