ALLSTATE PROPERTY & CASUALTY INS CO
v.
ROYAL DIAGNOSTIC CENTER INC

11th Cir. Ct. App. Div. | 2014-04-03
No. 2013-000073-AP-01
1 FLCA 3408 Eleventh Judicial Circuit Court, Appellate Division (2014)

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.

Synopsis

Allstate appealed a trial court ruling that denied it the right to use fee schedule reimbursement limitations under Florida's no-fault insurance statute. The Eleventh Circuit reversed, finding that Allstate's policy language clearly and unambiguously notified insureds of the insurer's election to apply fee schedules, relying on the Florida Supreme Court's Virtual Imaging decision as persuasive authority.


Holding

Allstate's policy language clearly and unambiguously notified insureds of the insurer's election to apply fee schedule reimbursement limitations. The language stating that payments "shall be subject to" fee schedules leaves no room for ambiguity and is substantially similar to the amended GEICO policy language that the Florida Supreme Court found sufficient in Virtual Imaging. Therefore, Allstate was legally authorized to utilize the fee schedule reimbursement limitations under section 627.736(5)(a)(2)(f).


Headnotes

[1] An insurer must provide clear and unambiguous notice in its policy of its election to use statutory fee schedules for medical expense reimbursements.

[2] Policy language stating that amounts payable shall be subject to limitations authorized by all fee schedules provides clear and unambiguous notice of the insurer's electi…

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

Key Quotes

“the insurer must provide notice in the policy of its election to use the fee schedules”

Establishes the legal requirement from Virtual Imaging that insurers must clearly notify policyholders of their election to use 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 intelligence

Facts & Procedural History

The trial court ruled against Allstate in five consolidated cases with identical stipulated facts and judgments, determining that Allstate could not u…

The full statement of facts, procedural history, and disposition for this case are member content.

Join FLexlaw to unlock all legal intelligence

© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.

Opinion of the Court

SMITH, J .

..._n B80338 80:1 The trial court, in each consolidated case, ruled against Allstate and determined that it could not utilize the fee schedule reimbursement [*2] l i l I l r __._.-__;_.____.___.. _ I limitations authorized by Florida Statute section 627.736(5)(a)(2)(f) in calculating the amount that it would pay to the Appellee as a reasonable expense for medical care. Subsequent to the trial court‘s ruling in the instant case, the Florida Supreme Court decided GEICO General Ins. C0. v. Virtual Imaging Services, Inc., 2013 WL 3332385 _(Fla. 2013) (“Virtual Imaging”). In Virtual Imaging, the Florida Supreme Court found that in order to exercise its option to utilize the fee schedules set forth in section 627.736(5)(a)2, “the insurer must provide notice in the policy of its election to use the fee schedules.” Id. at * l0. The notice must be clear and unambiguous. Id. at *9. In the instant case, the policy contains the following relevant language: Any amounts payable under this coverage shall be subject to any and all limitations authorized by section 627.736, or any other provisions of the Florida Motor Vehicle No-Fault Law, as enacted, amended, or otherwise continued in the law, including but not iimited to, all fee schedules. Thus, the issue is whether this language clearly and unambiguously notifies the insured of Allstate’s intent to take advantage of the fee schedule reimbursement limitations authorized by 627.736(5)(a)(2)(t). Of particular usefulness in analyzing this issue is that in Virtual Imaging, the Florida Supreme Court noted in dicta that “the GEICO policy has . . . been amended to include an election of the Medicare fee schedules as the method of calculating reimbursements,” thereby apparently indicating that the amended GIECO policy language provides sufficient notice to its insureds that GEICO elected to limit reimbursements under the fee schedules. The amended GEICO policy provided that GIECO would “pay in accordance with the Florida Motor Vehicle No Fault Law . . . and where applicable in accordance with all fee schedules contained in the Florida Motor Vehicle No Fault Law . . . .” The amended GEICO policy language is very similar to Allstate’s policy language in the instant case. Both policies reference the Florida Motor Vehicle No Fault Law in general and specifically reference “all fee schedules.” The amended GEICO language states that payments will be made in accordance with all fee schedules, and the Allstate language from the instant case states that amounts payable under the policy shall be subject to limitations authorized by all fee schedules. Since the Florida Supreme Court indicated that the amended GIECO policy language provides sufficient notice to its [*3] i a. l {l l l

I.

i. ! T é. insureds that GEICO elected to limit reimbursements under the fee schedules, it would seem that the Allstate policy language would also provide sufficient notice. Because the Florida Supreme Court had not decided Virtual Imaging at the time that the trial court entered its ruling, the trial court did not have the advantage of being able to make this comparison. We are in a better position, and having read the Florida Supreme Court’s approval of the amended GEICO policy, we find such approval very persuasive as it relates to Allstate’s policy language.‘ Indeed, it is our view that Allstate’s policy language clearly and unambiguously subjects payments to all fee schedules authorized by the PIP statute. In fact, it states that payments “shall be subject to” the fee schedules. (Emphasis added.) This leaves no room for ambiguity. As such, we find that the language in A]lstate’s insurance policy adequately notifies the insured of Allstate’s intent to take advantage of the fee schedule reimbursement limitations authorized by 627.736(5)(a)(2)(l), and therefore, Allstate was legally allowed utilize the fee schedule reimbursement limitations authorized by Florida Statute section 627.736(5)(a)(2)(i) in calculating the amount that it would pay to the Appellee as a reasonable expense for medical care. Accordingly, we REVERSE and REMAND, with instructions that the trial court enter an order consistent with this opinion. r LOBREE, and VERDE, JJ., concur. ‘ We also have the advantage of having seen the opinion of the Sixth Judicial Circuit, in Allstate Fire and Casually Ins. C0. v. Orthopedic Specialists, N0. 13-000003AP—38B (Fla. 6"‘ Cir. Ct. December I0, 2013), which persuasively found that the same policy language ofAllstate clearly and unambiguously elected the permissive fee schedule payment methodology, and numerous county court cases which have addressed the language, including1" Open MRI v. Allstate, No. I2-1678i SP 05 (Fla. ll“‘ Cir. Cty. Ct. December 30, 2013), which we find particularly persuasive.

Footnotes
1 C3‘ This appeal concerns a dei novo application of the law to stipulated facts. Four other cases have been consolidated with this one, based upon identical stipulated facts and identical judgments below.

Cases With Similar Vibessemantic neighbors from the corpus

Full citator, related cases, and AI research tools

Open in FLexlaw