Court Opinion

ID: 9916741
Source: CourtListenerOpinion
Date Created: 2024-01-10 16:03:04.170301+00
Date Added: 2024-06-11T13:25:52.675031
License: Public Domain

DISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA
                             FOURTH DISTRICT

            UNITED AUTOMOBILE INSURANCE COMPANY,
                          Appellant,

                                     v.

                   ISO-DIAGNOSTICS TESTING, INC.,
                  a/a/o SURYMA PINEIRO MORALES,
                             Appellee.

                            No. 4D2022-1735

                            [January 10, 2024]

   Appeal from the County Court for the Seventeenth Judicial Circuit,
Broward County; Kathleen McHugh, Judge; L.T. Case No.
COCE21029623.

   Francesca M. Stein and Lissette Gonzalez of Cole, Scott & Kissane, P.A.,
Miami, and Michael J. Neimand, House Counsel of United Automobile
Insurance Company, Miami, for appellant.

   Mac S. Phillips of Phillips Tadros, P.A., Fort Lauderdale, for appellee.

KLINGENSMITH, C.J.

    In a dispute over PIP benefits, United Automobile Insurance Company
(“United”) appeals the trial court’s order granting final summary judgment
in favor of ISO-Diagnostics Testing, Inc. (“ISO”). For the reasons discussed
herein, we reverse and remand.

    This dispute began when the insured sought treatment from ISO
following a car accident and assigned his PIP benefits to ISO for payment.
United’s automobile insurance policy with the insured required United to
pay based on the applicable fee schedule “in effect on March 1 of the year
in which the services” were rendered. The policy required United to “pay
in accordance with the No-Fault Act, as amended, to or for the benefit of
the named insured . . . .” (emphasis added). The policy defined the No-
Fault Act as “the Florida Motor Vehicle No-Fault Law, as the same may be
amended from time to time, and the provisions of said Act are hereby
incorporated by reference and included herein.” (emphasis added).
Further, under “Charges for Treatment of Injured Persons,” the policy
noted: “Pursuant to section 627.736(5)(a)1., Florida Statutes, as amended,
we will limit reimbursement under the personal injury protection (PIP)
section of ‘your’ insurance policy to 80 percent of the following schedule of
maximum charges . . . .” (emphasis added).

   After ISO submitted its bill, United issued a payout of $784.19 based
on the 2016 fee schedule. Believing United should have paid according to
the 2017 fee schedule, ISO filed suit to recover the difference. The parties
agreed the facts were not in dispute, and only questions of law remained.

   ISO moved for summary judgment, arguing the term “year” in the policy
applied to a calendar year, not a service year. ISO relied on when the
policy was written, arguing that United’s failure to modify its policy
language after the PIP statute was altered in 2015 meant the unambiguous
definition of the word “year” controlled. Thus, ISO maintained that United
should have paid according to the 2017 fee schedule. United separately
moved for summary judgment and argued the policy “unambiguously
provides that the claimant’s medical bills will be paid at the permissive
reimbursement methodology contained in F.S. § 627.736 in accordance
with the No-Fault Statute.”

    The trial court entered final summary judgment in favor of ISO. The
trial court found the plain meaning of the word “year” controlled and that
United should have paid according to the 2017 schedule because the
accident and payment request were made within the 2017 calendar year.
This appeal followed. The standard of review for an entry of summary
judgment is de novo. Volusia County v. Aberdeen at Ormond Beach, L.P.,
760 So. 2d 126, 130 (Fla. 2000).

   Here, the controversy centers on whether the term “year” as referenced
in the policy referred to a service year or a calendar year. When
interpreting an insurance policy where the language is “plain and
unambiguous, a court must interpret the policy in accordance with the
plain meaning so as to give effect to the policy as written.” Ducksbury v.
Progressive Express Ins. Co., 211 So. 3d 73, 75 (Fla. 4th DCA 2017)
(quoting Wash. Nat’l Ins. Corp. v. Ruderman, 117 So. 3d 943, 948 (Fla.
2013)). Here, the trial court erred in finding the term “year” referred to a
calendar year and not a service year, because section 627.736 and the
policy at issue are clear in their meaning. Before 2015, section 627.736
did not define “year” and simply stated, “the applicable fee schedule or
payment limitation under Medicare is the fee schedule or payment
limitation in effect on March 1 of the year in which the services, supplies,
or care is rendered . . . .” § 627.736(5)(a)2., Fla. Stat. (2013) (emphasis
added). However, in 2015, the statute was amended to change “year” to

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“service year,” and defined “service year” as “the period from March 1
through the end of February of the following year.” § 627.736(5)(a)2., Fla.
Stat. (2015).

   At the time of the accident in February 2017, section 627.736 dictated
the use of a service year, not a calendar year, and controlled which fee
schedule United was required to utilize. Because the accident occurred
before March 1, 2017, United correctly paid ISO based on the 2016 fee
schedule as provided under the then-current statute. The policy at issue
notes several times that the statute applies as amended and is thus
incorporated into the policy “as amended,” clearly indicating an
expectation by the insurer that the statute could change and obviating any
need to continually update the policy language to reflect any periodic
statutory changes after the policy was executed. Thus, the statute would
apply to insurer payouts at the time when the payout was made. In the
instant case, the expectation was clear that the post-amendment statute
in effect at the time of the payouts would apply to the instant claim.

   To illustrate this point, we note that the pre-amendment statute’s
reference to the fee schedule effective date (March 1) shows the
legislature’s intent to use a service year as the controlling timeframe. If
the legislature had intended to define a “year” as a calendar year, it would
have made January 1 the reference date. The inclusion of “March 1”
signifies using a service year as the anchor for the required payouts
because a service year would run from the beginning of March to the end
of February the following year. Considering the fee schedules for the
applicable year are published every November, 1 the “March 1” date shows
no other connotation than to help denote that a service year controls which
fee schedule an insurer should use under the policy. In doing so, the
policy’s incorporation of the statute was sufficient because it informed ISO
that United would pay out claims based on the fee schedule as dictated by
the No-Fault Law at the time of the payout. Applying a calendar year to
the payouts under the policy would lead to a “strained, forced or
unrealistic construction” of the policy. See Ducksbury, 211 So. 3d at 75
(quoting Gen. Accident Fire & Life Assurance Corp. v. Liberty Mut. Ins. Co.,
260 So. 2d 249, 253 (Fla. 4th DCA 1972)).

1 See 42 U.S.C. § 1395W-4(b)(1) (“Before November 1 of the preceding year, for

each year beginning with 1998, subject to subsection (p), the Secretary shall
establish, by regulation, fee schedules that establish payment amounts for all
physicians’ services furnished in all fee schedule areas (as defined in subsection
(j)(2)) for the year.”).

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   Therefore, under the plain meaning of the policy and the statute,
whether pre- or post-amendment, the definition of a “year” meant a service
year governing the payout at issue. As such, we reverse the trial court’s
final summary judgment in favor of ISO, and remand for entry of final
summary judgment in favor of United in accordance with this opinion.

   Reversed and remanded.

KUNTZ and ARTAU, JJ., concur.

                           *        *        *

   Not final until disposition of timely filed motion for rehearing.

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