CENTRAL FLORIDA MEDICAL & CHIROPRACTIC CENTER, INC. D/B/A STERLING MEDICAL GROUP A/A/O XAVIER BLANFORD
v.
MENDOTA INSURANCE COMPANY
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Central Florida Medical & Chiropractic Center appealed a summary judgment in a personal injury protection (PIP) insurance dispute with Mendota Insurance Company, challenging the underpayment of two claims by one cent each. The Fifth District Court of Appeal affirmed the judgment, holding that Mendota properly applied the 80% reimbursement limitation to the aggregate amount rather than to each individual item before rounding, as the statute does not require item-by-item rounding.
Mendota properly applied the 80% reimbursement limitation and the summary judgment in its favor was affirmed. The statute does not require rounding of individual items before calculating aggregate reimbursement; the plain language requires only reimbursement at 80% of the maximum charge using the exact amount for each item. Whether Mendota applied the 80% limitation to individual items or to the aggregate amount, the end result was the same, making any procedural error harmless.
[1] A statute requiring reimbursement at 80% of a maximum charge does not require an insurer to round each individual item before calculating the aggregate reimbursement amou…
[2] An insurer's calculation of an aggregate reimbursement amount is not improper if the same amount is reached whether the 80% limitation is applied to individual items or t…
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“either way Mendota ultimately complied with the statute. First, our record does not reveal exactly when Mendota applied the 80% reimbursement limitation. Second, at least in this case, the aggregate reimbursable amount is the same whether Mendota applied the 80% limitation to each item (some of the products would go to the thousandths place) and then calculated the aggregate amount without rounding each item first, or if Mendota calculated the aggregate amount and then applied the 80% limitation.”
Establishes that any procedural error in the timing or method of applying the 80% limitation was harmless because the mathematical result was identical either way.
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceSterling Medical Group submitted PIP claims to Mendota Insurance Company for reimbursement. Mendota reimbursed the claims at 80% of the maximum allowa…
The full statement of facts, procedural history, and disposition for this case are member content.
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FIFTH DISTRICT COURT OF APPEAL
STATE OF FLORIDA _____________________________
Case No. 5D2022-3078 LT Case No. 2020-40369-COCI
CENTRAL FLORIDA MEDICAL & CHIROPRACTIC CENTER, INC. d/b/a STERLING MEDICAL GROUP a/a/o XAVIER BLANFORD,
Appellant,
v. MENDOTA INSURANCE COMPANY,
Appellee.
_____________________________
On appeal from the County Court for Volusia County. Robert A. Sanders, Jr., Judge. Chad A. Barr, of the Law Office of Chad A. Barr, P.A., Altamonte Springs, for Appellant. Michael A. Rosenberg and Nicholas Bastidas, of Cole, Scott & Kissane, P.A., Plantation, for Appellee.
May 24, 2024 EISNAUGLE, J.
In this personal injury protection (“PIP”) case, Central Florida Medical and Chiropractic Center, Inc. d/b/a Sterling Medical Group a/a/o Xavier Blanford (“Sterling”), appeals a summary judgment in favor of Mendota Insurance Company (“Mendota”) on
Sterling’s complaint alleging that Mendota underpaid PIP benefits. We affirm.
On appeal, Sterling argues that Mendota underpaid two claims by one cent each. Specifically, Sterling asserts that Mendota improperly reimbursed 80% of the aggregate amount of Sterling’s claim when it should have applied the 80% reimbursement limitation to each individual item and then rounded each individual item before calculating the aggregate reimbursement amount. Sterling stresses that applying the 80% limitation to, and then rounding, each individual item results in an aggregate reimbursement of one additional cent per claim.
To support its legal position, Sterling relies primarily on section 627.736(5)(a)1.f., Florida Statutes (2019). That statute provides, in pertinent part:
1. The insurer may limit reimbursement to 80 percent of the following schedule of maximum charges:
. . . . f. For all other medical services, supplies, and care, 200 percent of the allowable amount under: (I) The participating physicians fee schedule of Medicare Part B . . . .
. . . . However, if such services, supplies, or care is not reimbursable under Medicare Part B . . . the insurer may limit reimbursement to 80 percent of the maximum reimbursable allowance under workers’ compensation . . . . We reject Sterling’s argument that Mendota improperly applied the 80% limitation to the aggregate amount in this case because, doing the math, either way Mendota ultimately complied with the statute. First, our record does not reveal exactly when Mendota applied the 80% reimbursement limitation. Second, at least in this case, the aggregate reimbursable amount is the same whether Mendota applied the 80% limitation to each item (some of the products would go to the thousandths place) and then calculated the aggregate amount without rounding each item first,
or if Mendota calculated the aggregate amount and then applied the 80% limitation. Therefore, Sterling’s argument as to the timing of Mendota’s application of the 80% reimbursement limitation is not established in the record, and even if it were, any error would be harmless because the end result is the same.
More importantly, we also reject Sterling’s argument that Mendota should have rounded each individual item before calculating the aggregate reimbursable amount. Even a cursory review of the statute confirms there is no requirement that an insurer round each individual item in a claim. In fact, the statute makes no mention of rounding at all.
Instead, the plain language of the statute simply requires reimbursement at 80% of the maximum charge—and the exact number (which could go beyond the hundredths place) is more precise than a rounded number. We fail to see how the statute’s language prohibits an insurer from calculating the aggregate amount based on the exact reimbursable amount for each item.
In conclusion, Sterling has failed to establish that Mendota improperly reimbursed Sterling’s claim in accordance with section 627.736(5)(a)1.f.
AFFIRMED. HARRIS and SOUD, JJ., concur.
_____________________________ Not final until disposition of any timely and authorized motion under Fla. R. App. P. 9.330 or 9.331.
_____________________________