RIGHT CHOICE MEDICAL & REHAB CORP., A/A/O LUCILA PRICE,
v.
ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY,
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This case involves medical providers appealing summary judgments granted to insurers for unpaid medical services. The court affirmed that the insurance policies provided sufficient notice of the insurer's intent to use permissive fee schedules but reversed because the insurers failed to prove they actually paid according to those schedules.
The court held that the policies at issue did provide legally sufficient notice of the insurer's election to use the permissive fee schedules. However, the court also held that the insurers failed to present evidence that they actually paid benefits pursuant to those fee schedules.
[1] An insurer may elect to use permissive fee schedules identified in section 627.736(5)(a)2., Florida Statutes, provided the applicable policies provide legally sufficient…
[2] Summary judgment for an insurer on a claim for unpaid medical benefits is improper if the record lacks evidence demonstrating payment was made pursuant to applicable fee…
Previewing 2 of 3 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“We discern no error and affirm the entry of summary judgment to the extent the trial court found that the policies at issue provide legally sufficient notice of the insurer’s election to use the permissive fee schedules identified in section 627.736(5)(a)2., Florida Statutes (2009).”
This quote establishes the court's finding that the policies contained adequate notice of the insurer's intent to use specific fee schedules.
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceMedical providers sued insurers for breach of personal injury protection policies, alleging non-payment for medical services. The trial court entered …
The full statement of facts, procedural history, and disposition for this case are member content.
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LOBREE, J. In this consolidated appeal,1 the medical providers appeal final summary judgments entered in favor of the insurers (collectively referred to as “Allstate”), on respective claims that Allstate breached the applicable personal injury protection policies by failing to pay benefits due for medical services provided to the insureds. We discern no error and affirm the entry of summary judgment to the extent the trial court found that the policies at issue provide legally sufficient notice of the insurer’s election to use the permissive fee schedules identified in section 627.736(5)(a)2., Florida Statutes (2009).2 Co. v. Orthopedic Specialists, 212 So. 3d
973, 979 (Fla. 2017). We are constrained to otherwise reverse, however, because the record is devoid of an affidavit, or any summary judgment evidence, showing that Allstate paid pursuant to the fee schedules. See Gonzalez v. Citizens Prop. Ins. Corp., 273 So. 3d 1031, 1036 (Fla. 3d DCA 2019) (explaining that summary judgment movant “must offer sufficient admissible evidence to support his claim of the non-existence of a genuine issue. If he fails to do this his motion is lost.” (quoting Harvey Bldg., Inc. v. Haley, 175 So. 2d 780, 782–83 (Fla. 1965))). As such, we affirm in part, reverse in part, and remand for further proceedings consistent with this opinion. Affirmed, in part, reversed, in part, and remanded.
Tampa v. State Farm Mut. Auto. Ins. Co., 334 So. 3d 577, 582 (Fla. 2021). This renumbering has no impact on our analysis.
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