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Geico Indemnity Co. v. Accident & Injury Clinic, Inc.

Florida Court of Appeals, Fifth District

December 20, 2019

GEICO INDEMNITY COMPANY, ET AL., Petitioners,
v.
ACCIDENT & INJURY CLINIC, INC. A/A/O FRANK IRIZARRY, ET AL., Respondents.

         NOT FINAL UNTIL TIME EXPIRES TO FILE MOTION FOR REHEARING AND DISPOSITION THEREOF IF FILED

          Petition for Certiorari Review of Order from the Circuit Court for Volusia County, Randell H. Rowe, III, Judge, Kathryn D. Weston, Judge, Michael S. Orfinger, Judge, Matthew M. Foxman, Judge, Steven C. Henderson, Judge, Elizabeth A. Blackburn, Judge, Karen A. Foxman, Judge, Dawn D. Nichols, Judge, Raul A. Zambrano, Judge, Sandra C. Upchurch, Judge, Dennis Craig, Judge, James Robert Clay, Judge.

          Peter D. Weinstein, Thomas L. Hunker, Michael A. Rosenberg of Cole, Scott & Kissane, P.A., Plantation, and Rebecca O'Dell Townsend, Louis Schulman, and Scott W. Dutton, of Dutton Law Group, P.A., Tampa, for Petitioners.

          Mark K. Delegal and Tiffany A. Roddenberry, of Holland & Knight L.L.P., Tallahassee, Amicus Curiae Brief for Personal Insurance Federation of Florida and American Property Casualty Insurance Association, in support of Petitioners.

          Douglas H. Stein, of Douglas H. Stein, P.A., Miami, and Brooke Boltz, of Boltz Legal, Oviedo, for Respondents.

          GROSSHANS, J.

         In its petition for writ of certiorari in case number 5D19-1409, Geico Indemnity Company ("Geico") seeks to quash a decision of the circuit court sitting in its appellate capacity. That decision affirmed a final summary judgment entered in county court in favor of one of the Respondents pursuant to Florida's personal injury protection ("PIP") statute. See § 627.736, Fla. Stat. (2017). For the reasons expressed below, we grant Geico's petition and quash the circuit court's decision.

         Background

         The PIP statute authorizes an insurer to limit reimbursement to a provider for certain charges resulting from the rendering of care and services to an insured. Specifically, the PIP statute authorizes an insurer to limit reimbursement to 80% of a schedule of maximum charges if it provides an appropriate notice in its policy. See § 627.736(5)(a)1. ("subparagraph 1"); see also § 627.736(5)(a)5. ("subparagraph 5").

         Geico issued a PIP insurance policy to Frank Irizarry. Following an automobile collision, Irizarry received medical care from the Accident & Injury Clinic, A/A/O Frank Irizarry ("the Clinic"). The Clinic sought payment from Geico for reimbursement based on an assignment of Irizarry's benefits under the Geico policy. The amount billed by the Clinic was less than the maximum listed in the policy's schedule of fees and charges. After reviewing the claim, Geico remitted 80% of the billed amount pursuant to the policy. Subsequently, the Clinic filed a complaint, claiming that it was entitled to full reimbursement of the billed amount based upon the plain language of Geico's policy, which states as follows:

The Company will pay in accordance with the Florida Motor Vehicle No Fault Law (as enacted, amended, or newly enacted), and where applicable in accordance with all fee schedules contained in the Florida Motor Vehicle No Fault Law, to or for the benefit of the injured person:
(A) Eighty percent (80%) of medical benefits which are medically necessary, pursuant to the following schedule of maximum charges contained in the Florida Statutes § 627.736(5)(a)1., (a)2. and (a)3.:
. . . . [Schedule of fees]
A charge submitted by a provider, for an amount less than the amount allowed above, shall be paid in the amount of the ...

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