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State Farm Mutual Automobile Insurance Co. v. MRI Associates of Tampa, Inc.

Florida Court of Appeals, Second District

May 18, 2018

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellant,
v.
MRI ASSOCIATES OF TAMPA, INC., d/b/a PARK PLACE MRI, Appellee.

         NOT FINAL UNTIL TIME EXPIRES TO FILE REHEARING MOTION AND, IF FILED, DETERMINED

          Appeal from the Circuit Court for Hillsborough County; Claudia Isom, Judge.

          D. Matthew Allen and Chris W. Altenbernd of Carlton Fields Jorden Burt, P.A., Tampa, and Marcy Levine Aldrich and Nancy A. Copperthwaite of Ackerman LLP, Miami, for Appellant.

          David M. Caldevilla of de la Parte & Gilbert, P.A.; Kristin A. Norse and Stuart C. Markman of Kynes, Markman, Felman, P.A.; Craig E. Rothburd of Craig E. Rothburd, P.A., John V. Orrick, Jr., of the Law Offices of John V. Orrick, P.L., Tampa, and Scott R. Jeeves of Jeeves Law Group, P.A., St. Petersburg, for Appellee.

          SLEET, JUDGE.

         State Farm Mutual Automobile Insurance Company appeals the final declaratory judgment denying its motion for summary judgment and entering final judgment in favor of MRI Associates of Tampa, Inc., d/b/a Park Place MRI (Park Place). The circuit court ruled that State Farm's Personal Injury Protection (PIP) policy failed to clearly and unambiguously elect to limit reimbursement payments to the schedule of maximum charges described in section 627.736(5)(a)(1)-(5), Florida Statutes (2013). Because the express language of State Farm's PIP policy does clearly and unambiguously elect to limit reimbursement payments for medical expenses to the schedule of maximum charges, we reverse.

         The facts are undisputed in this case. This action arises from nineteen individual PIP claims involving State Farm insureds who were injured in automobile accidents in 2013, received MRIs from Park Place, and subsequently executed assignments of benefits to Park Place. Park Place submitted the bills to State Farm under the insureds' PIP policies, and State Farm paid portions of each of the nineteen bills in accordance with its interpretation of its policy. Park Place disputed the amounts paid by State Farm, and State Farm filed an action seeking a declaration of its rights and obligations under its policy and the PIP statute, section 627.736. Park Place countersued, seeking a declaration of its rights and obligations under the State Farm policy and the PIP statute and an injunction to prevent State Farm from limiting its payments for charges to the schedule of maximum charges.[1]

         To calculate the amount payable to Park Place for the MRI charges at issue, State Farm relied on the following language from its policy:

We will pay in accordance with the No-Fault Act properly billed and documented reasonable charges for bodily injury to an insured caused by an accident resulting from the ownership, maintenance, or use of a motor vehicle as follows:
We will limit payment of Medical Expenses described in the Insuring Agreement of this policy's No-Fault Coverage to 80% of a properly billed and documented reasonable charge, but in no event will we pay more than 80% of the following No-Fault Act "schedule of maximum charges" including the use of Medicare coding policies and payment methodologies of the federal Centers for Medicare and Medicaid Services, including applicable modifiers.

         The policy defines a reasonable charge as follows:

Reasonable Charge, which includes reasonable expense, means an amount determined by us to be reasonable in accordance with the No-Fault Act, considering one or more of the following:
1. usual and customary charges;
2. payments accepted by the ...

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