MRI providers’ lawsuit fails
An ongoing series of lawsuits by South Florida medical providers against automobile insurance companies regarding Personal Injury Protection (PIP) claims is over, with an appellate court affirming Florida’s No-Fault law calls for 80% – not full – reimbursement for medical expenses from car accidents.
In Plantation Open MRI et al v. Infinity Indemnity Insurance Company, et al three MRI clinics brought multiple lawsuits that were later consolidated in Broward Circuit Court. They argued that PIP policies required the insurance companies to pay more than the 80% of the statutory $10,000 fee limit because they had a provision for “total limits of benefits” based on the difference between the deductible and the total bill.
The Circuit Court found in favor of the insurance companies but certified the case to Florida’s Fourth District Court of Appeal based on a question of great public importance. The 4th DCA last week upheld the circuit court’s ruling, noting that interpretation of insurance contracts must be “according to the entirety of its terms and conditions” per Florida Statutes and that “true ambiguity does not exist merely because a contract can possibly be interpreted in more than one manner,” per case law.
The medical providers, Plantation Open MRI LLC, M R Services I Inc., and Upright Open MRI LLC wanted their patients fully reimbursed for their medical treatments. Instead, insurance companies Infinity Indemnity Insurance Co., Infinity Auto Insurance Co., and Infinity Assurance Insurance Co. were deemed to have satisfied their policies’ requirement to reimburse the patients at the 80% rate of total treatment costs.
LMA Newsletter of 9-28-20