TALLAHASSEE – Florida's Supreme Court on Aug. 30 is scheduled to hear oral arguments regarding the clarity of statements insurance companies include in no-fault auto insurance policies regarding the amount and method they use to reimburse medical services providers for treating patients injured in auto accidents. Differing opinions in recent lower court decisions paved the way to the Supreme Court hearing.
On Aug. 30, the Supreme Court is scheduled to hear arguments from attorneys representing defendant Allstate Insurance Co. in a case that consolidates 32 individual lawsuits involving Florida's personal injury protection (PIP) statute. More specifically, the issue in question revolves around insurers' disclosure of limits of liability provisions as authorized in the Florida Motor Vehicle No-Fault Law.
In Allstate Fire & Casualty Insurance v. Stand-Up MRI of Tallahassee, P.A. the 3rd District Court of Appeal on July 13 ruled in Allstate's favor, confirming the opinion of a county court. The district court's opinion conflicts with that of an earlier opinion issued by the 4th District Court in Orthopedic Specialists v. Allstate Insurance Co., however.
No-fault auto insurance claims have been rising in both volume and average cost in Florida this year since a downward trend from an average peak of just under $9,700 began in 2012. Beginning that year, a change in legislation required those allegedly injured in auto accidents to show proof of having received emergency medical treatment within 14 days of an accident in order to qualify for a $10,000 benefit, the Insurance of Institute of America's Lynne McChristian told the Florida Record. Benefits for those that do not are capped at $2,000.
Improving economic conditions, which leads to more cars on the roads and more accidents, and lower gasoline prices, which encourage more driving, have contributed to the recent rise, McChristian said.
A 2013 Florida Supreme Court decision in GEICO v. Medical Imaging opened the door for attorneys and medical services providers to file a large and still growing number of lawsuits asserting that the language auto insurers used to explain the amounts and methods used to calculate reimbursements for medical treatment as per the state's no-fault auto insurance legislation were unclear and ambiguous.
Many fall in the general category of unscrupulous attempts by attorneys to generate legal fees and medical service providers to obtain more money from insurers by alleging ambiguous language exists in the notification of reimbursement rates and methods insurers provide as per Florida's No-Fault Law statute, Bret Dubbert, managing partner for the Orlando office of Smith Rolfes & Skavdahl explained.
Dubbert and his team at Smith Rolfes in Orlando have represented insurance companies in many such cases.
"Fortunately, the 3rd District Court got it right and affirmed the county court's orders in deciding that the plaintiffs would not receive additional payment above and beyond what they were owed," he told the Florida Record.
The 3rd District Court of Appeal case arose out of the consolidation of five separate lawsuits in which Allstate serves as the defendant. In consolidating them, the county court certified a single question of great importance, Dubbert continued: whether or not Allstate's PIP notification to medical services providers regarding the Medicare permissive fee schedule it elected to use in calculating reimbursements to medical services providers for treating patients injured in auto accidents was clear and unambiguous.
The PIP lawsuits that have cropped up in Florida in the wake of the Supreme Court's 2013 decision in GEICO v. Virtual Imaging are fee-driven, he explained.
"These lawsuits can be filed for under $100, while attorneys are getting paid between $400 and $500 an hour to litigate them. Most of these cases don't have any merit, pollute the court dockets and cost taxpayer dollars," Dubbert said.
"It's kind of a crapshoot when it comes to Florida PIP law and medical services providers at this point."
Florida is a mandatory PIP state, which means insurers are required to include details of how they will calculate medical reimbursements clearly and unambiguously in their no-fault auto insurance policies. Other states have enacted similar PIP legislation, including Kentucky, where Smith Rolfes & Skavdahl also has an office. The law firm is beginning to see similar lawsuits there, Dubbert said.
"Frankly, I believe our [Florida's] PIP statute is a well-crafted and excellent system for covering medical expenses while limiting liability claims at the same time. It benefits taxpayers, insureds, medical services providers and promotes timely treatment of patients," he said. "Unfortunately, unscrupulous attorneys and medical service providers are costing taxpayers and threatening it by flooding the courts with lawsuits that lack any merit."