INFINITY AUTO INSURANCE CO
v.
SUNSHINE REHAB MEDICAL INC
AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.
Infinity Insurance challenges a summary judgment favoring Sunshine Rehab Medical regarding payment obligations under a personal injury protection (PIP) insurance policy. The court held that the policy's endorsement was ambiguous by separating the 80% payment modifier from the 200% Medicare Part B modifier across different pages, and under Florida law, ambiguities in insurance policies must be resolved in favor of the insured/provider to provide greater coverage.
The court held that the policy constitutes an ambiguous contract because the insurer separated the 80% modifier from the 200% of Medicare Part B modifier on different pages, creating two reasonably inferable interpretations: either (1) 80% of all medical expenses or (2) 200% of the Medicare Part B fee schedule. Under Florida law, ambiguities in insurance policies must be resolved in the insured's favor by adopting the interpretation providing greater coverage, which is 200% of Medicare Part B.
[1] A court reviews a final summary judgment resolving a pure legal question de novo.
[2] An endorsement to an insurance policy limits or amends the policy's general provisions.
Previewing 2 of 6 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“Because the insurer separated the 80% modifier from the 200% of Medicare Part B modifier on different pages, we reasonably infer that this insurer intends to cover (1) 80% of all medical expenses or (2) 200% of the Medicare Part B fee schedule”
Establishes the court's finding of ambiguity based on the physical separation of policy terms across pages
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceInfinity Insurance issued a policy covering personal injury protection through an endorsement that modified the standard PIP provision. The endorsemen…
The full statement of facts, procedural history, and disposition for this case are member content.
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YOU ARE HEREBY COMMANDED that such further proceedings be had in said cause in accordance with the opinion of this COURT attached hereto and incorporated as part of this order, and with the rules of procedure and laws of the STATE OF FLORIDA. Lower Tribunal Case Number(s): 11—000200-SP 21 WITNESS the Honorable Abby Cynamon, Administrative Judge oftheAppellate Division ofthe Circuit Court ofthe Eleventh Judicial Circuit ofFlorida and the seal ofthe said Circuit Court at Miami, this 22"“ dayof April, 2015. l A True CODY Attest ,\ - fit,‘ HarveyRuvi "~11-_l_f':'._,§ CW<<>f1t» to i - I ~ ,.. -' 1 =~*.I..,f-1*-,i_ ;*_ ,, By: -.- /’" - .1 1' T D. Be :=_v_. __ ‘H1 eputyCler ~-Qumv. _
DEBORAH P. IZQUIERDO, ESQ.
SUZANNE Y. LABRIT, ESQ.
PJCHARD PATINO, ESQ.
ANTHONYJ. RUSSO, ESQ.
Mandate rev. [0/22/2008 [*2] NOT FINAL UNTIL TIME EXPIRES
T0 FILE REHEARING MOTION, .
_. AND, IF FILED, DISPOSED or IN THE CIRCUIT count ELEVENTH JUDICIAL CIRCEEE" . .3.
IN AND FOR MIAMI-DADE
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FLORIDA
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APPELLATE DIVISION
INFINITY AUTOMOBILE
L INSUEANCE COMPAN‘1’, CASE NUMBER: 12- 179 AP Appellant-Defendant CASE BELOW: 11-200 SP 21 v. . :3 SUNSHINE REHAB & MEDICAL, lNC., Q , 9% a/a]o Osvaldo Borras, y 9 Appellee-Plaintiff. {[9[ —-" £7/5' “Ell; Opinion filed: G , 201/i. Oral argument: June 5, 2 13. - k On appeal from a final judgment rendered by the County Court for Miami-Dade County, Florida, Hon. TQf\(‘I1'IFlI‘I1"IFl q|"I'l\lfQ‘l"‘I"7 .....,..-,.... L,-.........,. Suzanne Labrit (oral argument) of Shutts & Bowen, LLP (Tampa, Fl.); Lewis F. Collins, Jr., Anthony
J. R
' l ' usso, and Ezequiel Lugo of Butler Pappas Weihmuller Katz Craig, LLP for the Appellant- Defendant. Ryan Peterson (oral argument) and Richard Patino, the Patino Law Firm, for the Appellee-Plaintiff. Before KORVICK, JOSE RODRIGUEZ, and LOBREE, JJ.
PER CURIAM.
Infinity Automobile Insurance Company (“insurance company” or “insurer”) challenges a final summary judgment rendered in Sunshine Rehab Medical, lnc.’s (“provider”) favor. Section 26.0l2(1), Florida Statutes, authorizes us to review this appeal. We review a final summary judgment resolving a pure legal question de nova. Kingsway Amigo Ins. C0. v. Ocean Health Ina, 63 So. 3d 63, 66 (Fla. 4th DCA 2011). _ According to the provider, the policy informs that the insurer will limit payment to the “schedule of maximum charges, rather than 80% of the schedule of maximum charges.” The provider advances that nothing in the policy permits me 20% reduction; thus, the insurer “must pay 100% of the schedule ofmaximum charges, rather than 80%.” [*3] ——-——.—-.i:-—__V_' The statutory provision at issue states: With respect to a determination of whether a charge for a particular service, treatment, or otherwise is reasonable, consideration may be given to . . . various federal and state medical fee schedules applicable to automobile and other insurance coverages . . . 2. The insurer may limit reimbursement to 80 percent of the following schedule of maximum charges: . . . f. For all other medical services, supplies, and care, 200 percent of the allowable amount under the participating physicians schedule ofMedicare Part B. § 627.736(5)(a)2.f., Fla. Stat. (2010) (emphasis added).1 We read section 627.736(5)(a)2.f. as authorizing an insurer to limit reimbtusement to eighty percent (80%) of two-hundred (200%) percent of the amount allowed pursuant to the Medicare Part B schedule. Regarding incorporating subsection (5)(a)2.f. into the policy, the insurer must specifically elect the payment method in the policy. Geico Indem. Co. v. Virtual Imaging Servs., 79 So. 3d 55, 56 (Fla. 3d DCA 2011); Kingsway, 63 So. 3d at 64. _ The Insurance Policy This insurer amended its policy by replacing the personal injury protection provision with an endorsement (R. 321). An endorsement to a policy limits or amends the policy’s general provisions. 43 Am. Jur. 2d Insurance § 304. Florida courts apply an endoi-sement’s plain meaning. Harris v. Cotton States Mut. Ins. Co., 821 So. 2d 1211, 1213 (Fla. lst DCA 2002). We read each policy as a whole, endeavoring to give every provision its full meaning and operative effect. Riveroll v. Winterthur Intern. Ltd, 787 So. 2d 891, 892 (Fla. 3d DCA 2001). However, where “a contract is susceptible to two di'f'erent interpretations, each one of which is reasonably inferred from” the contract terms, “the agreement is ambiguous.” Commercial Capital Res., LLC v. Giovannetti, 955 So. 2d ll5l, ll53 (Fla. 3d DCA 2007) (emphasis added). . - Here, the insurance company separated the terms * iedical expenses” and ‘ 05$2Q\ C»-as pi l\3c: c> percent” of the Medicare Part B schedule by a page in the endorsement. Because the insurer separated the 80% modifier from the 200% of Medicare Part B modifier on different pages, we reasonably infer that this insurer intends to cover (1) 80% of all medical expenses or (2) 200% of the Medicare Part B fee schedule (R. 324-325). We conclude that this policy constitutes an ambiguous contract. When language in an insurance policy is ambiguous, a court will resolve the ambiguity in the insured’sfavor by adopting the reasonable interpretation that provides coverage as opposed to the interpretation limiting coverage. State Farm Mut. Auto. Ins. Co. v. Menendez, 70 So. 3d 566, 570 (Fla. 2011). See 1 The insurance declaration indicates coverage effective February 11, 2010 through August 11, 2010 (R. 321). We apply the version of section 627.736(5)(a)2.f. in effect on February 1 1, 2010, the policy’s effective date. UnitedAuto. Ins. Co. v. Tejada, 18 Fla. L. Weekly Supp. 353a (Fla. llth Cir. Ct. Feb. 8, 2011). C [*4] Am. Indep. Ins. Co. v. Gables Ins. Recovery, Inc., a/a/0 Lima, 19 Fla. L. Weekly Supp. l4b (Fla. llth Cir. Ct. Oct. 12, 2011). Because this endorsement discusses two (2) different payment methods, we rely upon 1W€fi€i'ICléZ as requiring this insurer to pay me higher coverageamount. Here, the county court did not clarify whether the $1,321.07 constitutes payment pursuant to 80% of medical expenses or 80% of 200% of the Medicare Part B schedule (R. 387). Accordingly, we affirm the final summary judgment but remand for the trial court to amend the final summary judgment to include re-calculated damages reflecting the endorsement provision providing greater coverage. See Menendez, 70 sp. 3d at 510; Lima, 19 Fla. L. Weekly Supp. l4b. Our decision to render appellate judgment against the insurer satisfies section 627.428(1)’s criteria. Accordingly, we grant the provider’s motion for section 627.428(1) appellate attorney’s fees. AFFIRMED, REMANDED WITH DIRECTIONS, and ATTORNEY’S FEES GRANTED. p
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Citator
Authorities Cited
- State Farm Mut. Auto. Ins. Co. v. Gilda Menendez, 70 So. 3d 566 (Fla. 2011)
- Kingsway Amigo Ins. Co. v. Ocean Health, Inc., 63 So. 3d 63 (Fla. 4th DCA 2011)
- GEICO Indem. Co. v. Virtual Imaging Servs., Inc., 79 So. 3d 55 (Fla. 3d DCA 2011)
- Riveroll v. Winterthur Int'l Ltd., 787 So. 2d 891 (Fla. 3d DCA 2001)
- Harris v. Cotton States Mut. Ins. Co., 821 So. 2d 1211 (Fla. 1st DCA 2002)