Florida Appeals Court Holds Injury Victim’s PIP Benefits Applicable to Insured’s Deductible

In Mercury Insurance Co. v. Emergency Physicians of Central Florida, the plaintiff suffered injuries in a car crash. The plaintiff held a $10,000 personal injury protection (“PIP”) benefits policy at the time of the accident that she had bought from her car insurance carrier. Pursuant to the policy’s provisions, the injured woman selected to receive a $500 deductible. After the accident, the injured woman received medical care at a local emergency care facility. The facility later submitted a bill for $191 to the injured woman’s PIP carrier but did not submit any additional bills.

Over two months later, the medical facility sent a statutory demand letter to the injured woman’s insurance company, requesting payment for the medical treatment that it provided to their insured. The carrier did not respond to the demand letter, and the medical facility initiated a lawsuit against the carrier in Florida. The insurer claimed that it was not liable for the medical expenses because the amount of care was below the deductible that the injured woman chose pursuant to the PIP policy.

The medical facility moved for summary judgment, alleging that it was entitled to payment for the medical expenses regardless of the insured’s deductible level, based on Florida Statutes Section 627.736(4)(c). In response, the insurer filed its own motion for summary judgment, claiming that the statute cited by the medical facility did not prohibit the carrier from insisting that payment of the medical bills come through the insured’s deductible. Ultimately, the court granted the medical facility’s motion for summary judgment, stating that to deny it would contravene the intent of the Florida Legislature.

The insurance company appealed to the Florida circuit court, claiming that the lower court essentially provided the injured woman with more PIP benefits than her policy provided. The circuit court panel of judges hearing the appeal upheld the lower court’s decision, and the insurance company appealed to Florida’s District Court of Appeal. According to this court, the section cited by the parties did not address the effect of a PIP deductible. Instead, the statute stated explicitly that the PIP deductible must be applied fully to the losses described in the statute. The court determined that such an interpretation was consistent with the purpose of a deductible provision in an insurance contract and that the plain language of the statute required any existing deductible to be applied to the losses described therein. When discussing the purpose of a deductible, the court stated that the provision is intended to reduce the insured’s payments in return for a specific amount of self-insurance should a loss occur.

If you or someone you love has suffered injuries as the result of another person’s negligence, you may be entitled to compensation. A car accident is a terrible, stressful, and painful event for any victim. The last thing you should have to struggle with during this time is negotiating with an insurance company and ensuring that you are getting the fair and equitable deal that you deserve. At Lusk, Drasites & Tolisano, our skilled and experienced team of car accident lawyers has provided diligent legal guidance to victims throughout Southwest Florida, including in Naples, Fort Myers, and Cape Coral. Call us now at 1-800-283-7442 or contact us online to set up your free consultation today.

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