Titania Haynes (North Palm Beach, FL) (Personal Injury Protection) obtained Summary Judgment on behalf of our client, Direct General Insurance Company, in the Martin County Court case of B. Greenwald Medical Center a/a/o Nancy Morrow v. Direct General. Plaintiff, a chiropractic services provider, filed suit for breach of contract for our client’s alleged failure to pay benefits for the services rendered by Plaintiff on the insured, Nancy Morrow who was injured in an automobile accident. The insured took out an automobile insurance policy with Direct and elected to have a $1,000.00 deductible apply to her PIP benefits. The insured sought treatment with the provider, and the provider thereafter filed a claim with Direct for the treatment and submitted bills that only totaled $705.00. As the total amount of the bills was less than the deductible, Direct issued no payment for the PIP benefits to the provider. In accordance with the then-controlling law of the 4th DCA (State Farm v. Care Wellness Center, 240 So. 3d 22 (2018)), Direct reduced the bills to fee schedule before applying the $1,000.00 deductible, which resulted in zero payment to the provider for any PIP benefits.
During the course of litigation, the Florida Supreme Court addressed the hotly-contested issue of the deductible methodology and ruled that the deductible must first be applied to 100% of the bills before same is reduced per the fee schedule. As a result, Plaintiff filed a Motion for Partial Summary Judgment as to Liability for the Deductible Issue and alleged that Direct’s “unilateral choice to apply the fee schedule limitations was wrong as a matter of law.” In our Response in Opposition and Cross-Motion for Final Summary Judgment, we included our client’s Affidavit which attested to the fact that Plaintiff’s bills were the first bills received by Direct. Furthermore, we supplemented our discovery responses on the issue of the deductible wherein we supplied two (2) reconsidered Explanations of Benefits provided by Direct wherein it re-evaluated the application of the deductible and applied it to 100% of the Plaintiff’s bills, in accordance with the Supreme Court’s ruling. In fact, Direct fully re-evaluated how it applied the deductible to all providers affected and made the proper adjustments to reflect the deductible being applied to 100% of the providers’ bills (EOR’s of same were also produced in supplemental discovery. We also supplemented our Affidavit to rebut Plaintiff’s position by producing the Explanations of Benefits of all providers of whom the deductible was re-evaluated against, showing that even with the corrected application of the deductible Plaintiff still gets nothing.
The trial judge denied Plaintiff’s Motion for Partial Summary Judgment and granted our Motion for Final Summary Judgment. Our Motion to Tax Costs is pending.