PROGRESSIVE SELECT INSURANCE
v.
DAVID A. BLUM, M.D., P.A. A/A/O VANESSA MORENO
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An insurer is not required to apply a policy deductible to 100% of an insured's expenses prior to applying a permissive fee schedule payment limitation under Fla. Stat. §§ 627.736 and 627.739.
[1] Under Florida insurance statutes sections 627.736 and 627.739, a policy deductible need not be applied to the full amount of a provider's invoices before applying a permi…
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Join FLexlaw to unlock all legal intelligenceProgressive Select Insurance Company appealed a county court summary judgment regarding the order of applying deductibles and fee schedule limitations…
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Appeal from the County Court for the Seventeenth Judicial Circuit, Broward County; John D. Fry, Judge; L.T. Case No. 14-12198(70).
Douglas H. Stein of Association Law Group, P.L., Miami, for appellant. Marlene S. Reiss, Miami, and Thomas J. Wenzel of Cindy A. Goldstein, P.A., Coral Springs, for appellee.
KUNTZ, J. We are presented with the following question, certified by the county court to be of great public importance:
PURSUANT TO FLA. STAT. § 627.739, IS AN INSURER REQUIRED TO APPLY THE DEDUCTIBLE TO 100% OF AN INSURED’S EXPENSES AND LOSSES PRIOR TO APPLYING ANY PERMISSIVE FEE SCHEDULE PAYMENT LIMITATION FOUND IN § 627.736(5)(A)(1), FLA. STAT. (2013)? We rephrase the certified question as follows:
PURSUANT TO SECTIONS 627.736 AND 627.739, FLORIDA STATUTES (2013), IS AN INSURER REQUIRED TO APPLY A POLICY DEDUCTIBLE TO THE TOTAL AMOUNT OF A PROVIDER’S INVOICES TO AN INSURED PRIOR TO APPLYING ANY FEE SCHEDULE FOUND IN § 627.736, FLA. STAT.?
2
For the reasons explained in our opinion in State Farm Mutual Automobile Insurance Co. v. Care Wellness Center, LLC a/a/o Bardon-Diaz, No. 4D16-2254 (Fla. 4th DCA Mar. 14, 2018), also issued today, we answer the rephrased certified question in the negative, reverse the county court’s summary judgment, and remand for further proceedings consistent with our opinion in case number 4D16-2254. We also certify conflict with Progressive Select Insurance Co. v. Florida Hospital Medical Center a/a/o Jonathan Parent, 43 Fla. L. Weekly D318 (Fla. 5th DCA Feb. 9, 2018).
Reversed and remanded; conflict certified. FORST, J., concurs. GROSS, J., dissents with opinion. GROSS, J., dissenting.
I dissent for the reasons set forth in my dissent to the Court’s opinion in USAA Gen. Indem. Co. v. Gogan a/a/o Tara Ricks, No. 4D16-3313 (Mar. 14, 2018).
* * * Not final until disposition of timely filed motion for rehearing.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By
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Progressive Select Ins. v. David A. Blum, M.D., P.A., 238 So. 3d 852 (Fla. 4th DCA 2018)
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Progressive Select Ins. Co. v. Fla. Hosp. Med. (Fla. 5th DCA 2018)
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USAA v. Fla. Hosp. Med. Ctr. (9th Cir. Ct. App. Div. 2014)
Authorities Cited
- Progressive Select Ins. Co. v. Fla. Hosp. Med. Ctr., 236 So. 3d 1183 (Fla. 5th DCA 2018)
- Progressive Select Ins. v. David A. Blum, M.D., P.A., 238 So. 3d 852 (Fla. 4th DCA 2018)