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AA Suncoast Chiropractic Clinic v. Progressive American Insurance Co.

United States Court of Appeals, Eleventh Circuit

September 12, 2019

AA SUNCOAST CHIROPRACTIC CLINIC, P.A., et al., on behalf of themselves and others similarly situated, Plaintiffs-Appellees,
v.
PROGRESSIVE AMERICAN INSURANCE COMPANY, et al., Defendants-Appellants.

          Appeal from the United States District Court No. 8:15-cv-02543-RAL-MAP for the Middle District of Florida

          Before JORDAN, GRANT, and HULL, Circuit Judges.

          GRANT, CIRCUIT JUDGE

         A trio of healthcare providers brought a class action against an insurance company over a claims-handling process that they argue is illegal under Florida law. The district court certified an injunction class under Federal Rule of Civil Procedure 23(b)(2), but it refused to certify a damages class under Rule 23(b)(3). On interlocutory appeal, the question is whether the injunction class should have been certified.

         We have no occasion today to disapprove-or approve-of complaints or classes that are not before us. In this interlocutory appeal, we consider only whether the class as certified, proceeding on the complaint as alleged, is viable. And because what this "injunction" class really wants is damages-and more precisely, because the injunctive remedy that this class seeks would be improper- the answer to that question is no.

         I.

         Under Florida law, car insurance policies must provide personal injury protection (PIP) benefits up to $10, 000. Fla. Stat. § 627.736(1). But under a 2012 amendment to that law, not every injured motorist will be eligible to access all $10, 000 in benefits. See 2012 Fla. Laws Ch. 2012-197 § 10. If a person has an "emergency medical condition" (EMC), [1] he is eligible for all $10, 000 in benefits. Fla. Stat. § 627.736(1)(a)(3). If not, his coverage is capped at $2, 500. Id. § 627.736(1)(a)(4). And we have held that in cases where no EMC determination is made one way or the other, the default is the $2, 500 cap. Robbins v. Garrison Prop. & Cas. Ins. Co., 809 F.3d 583, 588 (11th Cir. 2015).

         This case is a dispute about who is allowed to make the negative EMC determination. The plaintiffs-two chiropractic providers and a medical provider that treated injured motorists insured by Progressive who thereafter assigned their insurance benefits to the providers (collectively, "Suncoast")-allege that the defendants-the Progressive Corporation and two of its insurance underwriters, Progressive American Insurance Company and Progressive Select Insurance Company (collectively, "Progressive")-have denied PIP insurance benefits in an illegal manner. Specifically, Suncoast alleges that Progressive relied on negative EMC determinations from non-treating healthcare providers to limit coverage to $2, 500, and that Florida law allows only treating providers to make negative EMC determinations.

         Suncoast sued Progressive in Florida state court and sought class-action status. Progressive removed the case to federal court under the Class Action Fairness Act, which grants federal jurisdiction over certain class actions where the amount in controversy exceeds $5 million and there is minimal diversity. In its second amended complaint, Suncoast asserted two counts: one for declaratory and injunctive relief and another for damages based on breach of contract. The requested declaration would 1) declare unlawful Progressive's policy provision purporting to allow reductions in coverage based on negative EMC determinations by non-treating physicians, 2) declare unlawful Progressive's practice of relying on such determinations, and 3) find that Progressive is not permitted to disregard an affirmative EMC determination. The requested injunction would 1) restore coverage limits to $10, 000 for affected policies, 2) enjoin Progressive from including policy provisions that the declaration found unlawful, 3) notify affected policyholders and providers, and 4) award costs and attorneys' fees. The breach- of-contract claim sought damages for underpaid benefits along with interest, costs, and attorneys' fees.

         Suncoast moved to certify two classes: an injunction class under Federal Rule of Civil Procedure 23(b)(2) for count one, and a damages subclass under Rule 23(b)(3) for count two. The proposed injunction class was defined to include:

A. All Qualified Providers who: (i) received an assignment of benefits from a Claimant under a Progressive PIP policy, (ii) provided initial or follow up medical services to a Claimant after January 1, 2013, and (iii) were given notice by Progressive that available PIP benefits were reduced to $2, 500 because of a Negative EMC Determination that Progressive obtained from a Non-treating Provider; and
B. All Claimants who were notified that Progressive reduced available PIP benefits to $2, 500 because of a Negative EMC Determination Progressive obtained from a Non-treating Provider.

         The damages subclass was defined to include:

All Qualified Provider Class Members: (i) who were not paid in full for their services, (ii) who made a pre-suit demand to Progressive for payment pursuant to § 627.736(10), and (iii) where Progressive received documentation from a duly licensed physician, dentist, physician's assistant or advanced registered nurse practitioner that the Claimant had an Emergency Medical Condition.

         The district court refused to certify the damages subclass-which, under Rule 23(b)(3), would require the court to find predominance and superiority-because doing so would necessitate individualized assessments and case management. But it certified the injunction class, in part because Suncoast "assured" it that "once the legal issue is determined, there will be no more supervision required to determine individual damages."

         Progressive sought permission for an interlocutory appeal of the injunction class certification. See Fed. R. Civ. P. 23(f) ("A court of appeals may permit an appeal from an order granting or denying class-action certification under this rule . . . ."). A panel of this Court granted that request. The only issue on interlocutory appeal is whether the injunction class should have been certified-Suncoast has not appealed the denial of certification of the damages subclass, and the merits are not yet at issue.

         II.

         We review a class certification decision for abuse of discretion. Brown v. Electrolux Home Prods., Inc., 817 F.3d 1225, 1233 (11th Cir. 2016). "But abuse of discretion is a continuum, and in the context of class actions, review for abuse of discretion often does not differ greatly from review for error." Id. (internal quotation marks and citations omitted). In conducting this analysis, we review the district court's factual determinations for clear error and its legal determinations de novo. Vega v. T-Mobile USA, Inc., 564 ...


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