Progressive Select Insurance Company, commonly known as just Progressive, recently lost the latest round in its battle over the proper method of applying deductibles in personal injury protection (PIP) cases.
These deductibles are set out in Florida statute's §627.739(2). But the matter is not over yet; There may be one round left in the fight, and the stage will be set in the Florida Supreme Court.
PIP Deductible Dispute
The case arose after an insured Florida driver was involved in a vehicle accident and received treatment at Florida Hospital Medical Center.
The medical bills to treat the injured victim exceeded the deductible amount, and the insured paid her PIP benefit , as is customary in cases of this type and permitted under Florida law.
The underlying controversy came to light after the Florida Hospital Medical Center sent Progressive a bill for the patient's treatment.
Controversy arose over the contrasting methods of how to apply Florida's law regarding PIP reimbursement limits. In other words, the two sides had different opinions on how the law should be applied before reducing the deductible, Deductible first and then insurance companies can apply reimbursement limits.
As you might expect, Progressive's method resulted in $200.00 less reimbursement than the method used by Florida Hospital Medical Center.
What have the courts said so far?
Florida Hospital Medical Center filed suit in county court seeking $200.00 plus interest. They also hope to set a legal precedent that could potentially amount to millions.
Both parties filed petitions for summary judgment, and the county court entered final summary judgment in favor of Florida Hospital Medical Center.
The Progressives, unhappy with the decision against them, appealed the decision to the Higher Circuit Court.
The circuit court affirmed the county court's decision; Again, in favor of Florida Hospital Medical Center. Progressive then petitioned a higher court, the 5th District Court of Appeals, to review the lower court's decision "to determine whether the county court overruled section §627.736(5)(a)1.b". whether or not the correct law was used in interpreting.
and §627.739(2)" regarding the applicability of the deductible. The petition was dismissed. [Click here to read the full petition.]
What's next for the case ?
According to the Court of Appeals case docket, a review request for this case was sent to the Supreme Court.
Unfortunately, there were no further details. It appears, at least at this time, that the5th District Courtcertified the underlying issue in this case to be a 'question of great public importance'.
to be subtracted from the gross amount of deductible medical fees. prior to applying the reimbursement limits under section 627.736(5)(a)1 .b.; or, should the reimbursement limit be reduced from the first and the remaining amounts?" In a case in the4th District Court, if that court expressly5th DCA, the Supreme The Court may have a strong incentive to hear the case and integrate the law.
It should be noted that the Florida Supreme Court has discretionary jurisdiction, meaning that the court can choose whether or not to review a case. It is not mandatory.
If the Florida Supreme Court accepts the petition for review, the case will be considered and decided on the merits.
For a free legal consultation, 866-458-3982
What does this mean for Florida drivers?
As this case is relatively new, it is likely that Progressive and possibly other insurers incorrectly applied the deductible to multiple patient files. Thus, these patients may be entitled to additional reimbursement.
At Dolman Law Group Accident Injury Lawyer, PA, we'll be taking a closer look at this case and see if the Supreme Court decides to review it. If you are a medical provider or medical manager and have questions regarding PIP, please do not hesitate to contact us.
PIP suit clients of Dolman Law Group Accident Injury Lawyers, PA do not pay out of pocket expenses.
All attorney fees earned are separate and distinct from the benefits we seek on your behalf.
We do not charge a percentage of outstanding bills for services provided by your medical practice.
The fee we charge is created by law and paid by insurance companies when they force you to hire us in order to get the reimbursement that you are entitled to. We regularly conduct audits for multiple medical providers and have the staff and resources to handle your PIP claims.
Feel free to contact us….. ask us to remit your nonpayment, denial, and improper deductions so that we can begin working to obtain the reimbursements that are rightfully yours.
To schedule a free consultation with Dolman Law Group accident injury attorneys, PA attorneys, please contact us at (727) 472-3909, our online form, or visit one of our three office locations in the Tampa area.
We look forward to hearing from you and advocating vigorously on your behalf.