In Progressive, the Court considered the proper method of applying a personal injury protection (“PIP”) insurance policy deductible to a medical provider’s bill for hospital emergency services and care. A Progressive insured received treatment at the plaintiff hospital following an automobile accident. The hospital submitted a payment to Progressive which applied the deduction to the patient’s bill prior to the statutorily mandated reduction of fees. Progressive adjusted these charges by subtracting the deductible after applying the statutory reimbursement limitation of 75 percent of a hospitals usual and customary charges. The Hospital brought suit to recover the $200 difference between the calculation methods. While ongoing, the Fourth DCA issued an opinion, Care Wellness, which supported Progressive’s methodology. The county court granted summary judgment to the Hospital, and the circuit court affirmed. The Fifth DCA declined to exercise second-tier review, believing that using Progressive’s methodology would render the requirement that the deductible be applied to all expenses and losses meaningless.
The Florida Justice Reform Institute filed an amicus curiae brief in support of Progressive, arguing that the Fifth DCA’s decision negated the statutory protection from excessive medical charges for PIP insureds with deductibles. Furthermore, the Institute argued that the district court’s interpretation frustrated the purpose of the legislature’s stated goal of regulating the amounts providers can charge for services covered by PIP, and instead incentivizes providers to charge more than a reasonable amount for their services so as to maximize recovery.
The Florida Supreme Court, however, found for the hospital’s methodology. The Court reasoned that a plain reading of the statutory provision made clear that the deductible is to be subtracted from the medical provider’s charges prior to the reimbursement limitation being applied. As such, the Court disapproved the Fourth Circuit’s decision in Care Wellness and approved Progressive.
FJRI represented by Peter Valeta of Cozen O’Connor and William W. Large.