PROGRESSIVE SELECT INSURANCE COMPANY, PETITIONER,
v.
FLORIDA HOSPITAL MEDICAL CENTER A/A/O JOSE SANCHEZ, RESPONDENT.
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Progressive Select Insurance Company petitions for a writ of certiorari challenging the circuit court's affirmance that a PIP deductible should be applied to 100% of medical charges before applying the statutory reimbursement limitation. The Fifth District Court of Appeal denies the petition and certifies conflict with Fourth District decisions and a question of great public importance to the Florida Supreme Court regarding the proper order of applying deductibles and reimbursement limitations under Florida's PIP statute.
The Fifth District affirms the circuit court's decision that the deductible must be applied to 100% of the expenses before applying the reimbursement limitation, finding no divergence from correct law or violation of clearly established legal principles. The court declines to reverse the circuit court's ruling but certifies the issue as one of great public importance for resolution by the Florida Supreme Court.
[1] A personal injury protection (PIP) deductible must be applied to 100% of medical expenses and losses before applying statutory reimbursement limitations.
[2] When calculating PIP benefits, the deductible is subtracted from the total medical charges before applying the reimbursement limitation.
Previewing 2 of 6 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“Section 627.739(2)[, Florida Statutes (2014),] currently requires that the deductible be applied to 100% of the expenses and losses, and that is the version the circuit court properly applied.”
Establishes the court's interpretation that the deductible must be applied to the full amount of medical expenses before the reimbursement limitation
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Join FLexlaw to unlock all legal intelligenceJose Sanchez incurred personal injury protection (PIP) medical charges with Florida Hospital Medical Center. A dispute arose over whether Sanchez's PI…
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Progressive Select Insurance Company ("Progressive") petitions for a writ of certiorari regarding an order issued by the circuit court sitting in its appellate capacity in favor of Florida Hospital Medical Center ("Florida Hospital") a/a/o Jose Sanchez. Progressive seeks certiorari because of the circuit court's affirmance that Sanchez's personal injury protection ("PIP") deductible should be applied to 100% of Florida Hospital's total medical charges before reducing the amount paid by Progressive pursuant to the statutory reimbursement limitation provided in section 627.736(5)(a)1.b., Florida Statutes (2013).
This case is identical to our recent decisions in *780Progressive Select Insurance Co. v. Florida Hospital Medical Center a/a/o Parent, 236 So.3d 1183, 1192 (Fla. 5th DCA 2018), and Progressive Select Insurance Co. v. Florida Hospital Medical Center a/a/o Pena, 236 So.3d 1182, 1182 (Fla. 5th DCA 2018). In those cases, we denied Progressive's petitions for writs of certiorari, concluding:
Section 627.739(2)[, Florida Statutes (2014),] currently requires that the deductible be applied to 100% of the expenses and losses, and that is the version the circuit court properly applied. We see no divergence from the correct law in the circuit court's decision, and we see no violation of a clearly established principle of law that results in a miscarriage of justice.
Parent, 236 So.3d at 1192. We also certified a question of great public importance:
WHEN CALCULATING THE AMOUNT OF PIP BENEFITS DUE AN INSURED, DOES SECTION 627.739(2), FLORIDA STATUTES, REQUIRE THAT THE DEDUCTIBLE BE SUBTRACTED FROM THE TOTAL AMOUNT OF MEDICAL CHARGES BEFORE APPLYING THE REIMBURSEMENT LIMITATION UNDER SECTION 627.736(5)(a)1.b., OR MUST THE REIMBURSEMENT LIMITATION BE APPLIED FIRST AND THE DEDUCTIBLE SUBTRACTED FROM THE REMAINING AMOUNT?
Id. The Florida Supreme Court has accepted jurisdiction. Progressive Select Ins. Co. v. Fla. Hosp. Med. Ctr., No. SC18-278, 2018 WL 2064894, at *1 (Fla. Mar. 20, 2018). At the time of this opinion, it has not yet rendered its decision.
After we issued our opinions in Parent and Pena, the Fourth District Court reached a contrary result in several of its cases and certified conflict with our decisions. State Farm Mut. Auto. Ins. Co. v. Care Wellness Ctr., LLC, 240 So.3d 22, 31 (Fla. 4th DCA 2018) ; USAA Gen. Indem. Co. v. Gogan, 238 So.3d 937, 937 (Fla. 4th DCA 2018) ; Progressive Select Ins. Co. v. Blum, 238 So.3d 852, 853 (Fla. 4th DCA 2018). We accordingly certify conflict with Care Wellness Center, Gogan, and Blum and certify the same question that we previously certified in Parent as one of great public importance.
PETITION DENIED; CONFLICT CERTIFIED; QUESTION CERTIFIED.
SAWAYA, PALMER, and LAMBERT, JJ., concur.
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Citator
Cited By
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USAA Gen. Indem. Co. v. Fla. Hosp. Med. Ctr., 259 So. 3d 1013 (Fla. 5th DCA 2018)…in Progressive Select Insurance Co. v. Florida Hospital Medical Center a/a/o Melendez , --- So. 3d ----, ----, 43 Fla. L. Weekly D2463 (Fla. 5th DCA Nov. 2, 2018) ; Progressive Select Insurance Co. v. Florida Hospital Medical Center a/a/o Sanchez , 249 So. 3d 779 (Fla. 5th DCA 2018) ; Progressive Select Insurance Co. v. Florida Hospital Medical Center a/a/o Parent , 236 So. 3d 1183 (Fla. 5th DCA 2018) ; and Progressive Select Insurance Co. v. Florida Hospital Medical Center a/a/o Pena , 236 So. 3d 1182 (Fla.…
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USAA v. Fla. Hosp. Med. Ctr. (9th Cir. Ct. App. Div. 2014)
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Progressive Select Ins. Co. v. Fla. Hosp. Med. Ctr. (Fla. 5th DCA 2018)
Previewing 3 of 4 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- Progressive Select Ins. Co. v. Fla. Hosp. Med. Ctr., 236 So. 3d 1183 (Fla. 5th DCA 2018)
- USAA Gen. Indem. Co. v. William J. Gogan, M.D., 238 So. 3d 937 (Fla. 4th DCA 2018)
- State Farm Mut. Auto. Ins. Co. v. Care Wellness Ctr., LLC, 240 So. 3d 22 (Fla. 4th DCA 2018)
- Progressive Select Ins. Co. v. Fla. Hosp. Med. Ctr., 236 So. 3d 1182 (Fla. 5th DCA 2018)
- Knighton v. State, 238 So. 3d 852 (Fla. 4th DCA 2018)