Law360, New York (January 21, 2016, 2:00 PM ET) — The Florida Supreme Court on Wednesday agreed to take up Allstate Insurance Co.’s appeal of a ruling that it wrongfully limited its reimbursements under Medicare fee schedules for motorists’ personal injury protection claims, an opinion which conflicts with another appellate court decision.
Pursuant to its order, the state’s high court will review the Fourth District Court of Appeals’ ruling from August that a bare reference to the state’s personal injury protection statute didn’t constitute sufficient notice that the insurer was electing to employ Medicare fee schedules for PIP claims.
With its decision, the Fourth District revived health care providers’ 32 consolidated cases against Allstate and also certified a conflict with another Florida appellate court district’s opinion in a similar case, Allstate Fire and Casualty Insurance v. Stand-Up MRI of Tallahassee PA, which found Allstate’s policy was clear.
Attorneys for both sides did not immediately respond to requests for comment Thursday.
In reaching its decision, the appellate court found that the Florida Supreme Court’s 2013 decision in Geico General Insurance Co. v. Virtual Imaging Services Inc. and the Florida appellate court’s 2011 opinion in Kingsway Amigo Insurance Co. v. Ocean Health Inc. held that a bare reference to the state’s personal injury protection statute didn’t constitute sufficient notice that an insurer was electing to employ the Medicare fee schedules.
Allstate petitioned the high court to exercise its jurisdiction over the matter in December, saying the issue is an important one with statewide impact. The insurer also noted that in addition to the split between the First District and the Fourth District, the Second and Third Districts are currently reviewing essentially the same question.
Attorneys for the providers agreed with Allstate that the issue should be resolved by the Supreme Court, as the Fourth District plainly stated that it disagreed with the First District’s ruling in Stand-Up MRI, which involved an identical issue of law.
In the instant case, the providers had argued that the coverage called for payment of 80 percent of the medical service charges, while Allstate contended that under a Florida amendatory endorsement, it is only required lesser amounts under Medicare Part B Fee schedules. The providers contended that Allstate can’t get out of paying the higher fees because it failed to state plainly that it will not pay the 80 percent of reasonable charges, according to court documents.
A lower court, however, sided with Allstate, finding that its policy was not unclear or ambiguous and thus granting summary judgment in favor of the insurer. The providers appealed, filing an opening brief in June 2014.
In their order, the justices instructed Allstate to file an initial brief on the merits by Feb. 9.
The providers are represented by Gary M. Farmer, Sr. of Farmer Jaffe Weissing Edwards Fistos & Lehrman PL, David M. Caldevilla of De La Parte & Gilbert PA, and Stephen Deitsch, William Foman and Lindsay Porak of Deitsch & Wright PA.
The case is Allstate Insurance Co. v. Orthopedic Specialists, case number SC15-2298, in the Supreme Court of Florida.