State Supreme Court to hear case over wording of Allstate insurance policy regarding PIP fees

By Chandra Lye | Aug 23, 2016

TALLAHASSEE – Florida’s Supreme Court will soon weigh in on the dispute between Allstate Fire & Casualty Insurance Co and Florida Wellness & Rehabilitation.

TALLAHASSEE – Florida’s Supreme Court will soon weigh in on the dispute between Allstate Fire & Casualty Insurance Co and Florida Wellness & Rehabilitation.


At the center of the case is the language used in insurance coverage policies, particularly when it comes to covering medical costs for injured accident victims, or personal-injury protection (PIP) fees.


The 3rd District Court of Appeal sided with Allstate in mid-July, stating: “Allstate argues that the language 'subject to any and all limitations, authorized by section 627.736 . . . including but not limited to, all fee schedules' sufficiently places the insureds on notice that Allstate has elected to use the fee schedule limitations. Given that the policy plainly states that reimbursements 'shall' be subject to the limitations in section 627.736, including 'all fee schedules,' we agree with Allstate that this is sufficient notice of Allstate’s election to constrain its reimbursements in accordance with the limitations set forth in section 627.736 (5)(a)(2)(f),” the decision states.


“The language used by Allstate is sufficient to place the insureds on notice of Allstate’s election of the limitations allowed in the statutes.


“The use of the phrase 'subject to' in the policy places the insured on notice of the limitations elected by Allstate; indeed, we cannot discern any other alternative meaning to this language,” the judges wrote.


Personal injury attorney Dante Weston said the court had made its decision clear regarding the language in Allstate’s policy, but he believes the plaintiffs may be after something more.


"It is not so much about they really believe in their heart that the policy didn't put us on notice. They are looking for any wiggle room they can, any open door to get the policy thrown out because then they can say 'Well Allstate, Progressive, etc., you underpaid us for the last however many years; you owe us millions of dollars.' That is what they are looking for,” he told the Florida Record.

However, he added that he would like to see the statute changed.


“It is a law that basically, I want to say, it came into effect in the '70s. If you just consider, for example, the cost of a car in the '70s, the cost of clothing in the '70s, a cost of a house in the '70s versus now. There is no doubt that prices have inflated, yet these victims of car accidents are expected to use the same budget of medical treatment that was in place in the '70s.


“It is a sad thing when I have to meet with clients and let them know, you are on the same budget - you have the same car budget, you have the same clothing budget, you have the same budget for your medical treatment today as you would in the '70s. They haven't changed it at all and in fact, they keep taking things away from you. People aren't thrilled with that."


The case is scheduled to be in Supreme Court on Sept. 1.

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Florida Supreme Court The Allstate Corporation

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