Third District Court of Appeal Upholds Decision Awarding Larger PIP Benefit Payment to Florida Health Care Provider

In all civil litigation, the right to appeal an order of the trial court is essential to the judicial process. Incorporating tiers of review injects a system of checks and balances. If one suffers an injury in an accident, files suit, is dealt an unfavorable ruling, and feels the court ruled incorrectly, one can appeal the decision by the trial court judge. Since there are statutory timelines for filing suit, there are timelines for an issue or verdict to be appealed. Statutory time limitations help establish finality and closure for litigants or potential parties. Even with these measures in place, it is not always clear when all appellate options are truly exhausted.  The Third District recently assessed whether an issue involving Personal Injury Protection benefits (PIP) could be re-examined in light of a state Supreme Court decision issued early in 2017.

The underlying legal issue in this Florida car accident case asked whether or not the PIP automobile insurance policy contained the required specific language to limit provider reimbursements. Section 627.736(5)(a)2.f. Florida Statutes (2013) allows a reduction of 80% of the maximum charges, but the insurer must provide notice it is choosing to elect this reduction to the insured. The medical provider, dissatisfied with the PIP payments issued to them by the auto insurer, filed suit in 2013 for what they considered to be the full amount of PIP payments obligated under the law. The trial court issued a directed verdict for the medical provider, based on its conclusion the auto policy language wasn’t specific, as required by the Florida statutes.

The insurer appealed to the appellate division of the circuit court but did not seek a stay pending review. The medical care provider also did not seek execution or other enforcement of the trial court’s judgment. In 2015, the circuit court appellate panel affirmed the final judgment against the insurer, based on the case law at the time of its decision. The circuit court panel noted in its decision that appeals in other district appellate courts addressed this issue but were in conflict with one another on what constituted sufficient notice. The Third District Court of Appeal did not have a decision at that time to follow.

The insurer then filed a petition seeking second-tier certiorari from the circuit panel’s decision. The medical care provider opposed the petition, alleging there were no jurisdictional nor substantive grounds. In the meantime, the Florida Supreme Court accepted jurisdiction to review the conflicting District Court of Appeal cases from the First and Fourth Districts. During this same time period, the Third District Court of Appeal issued a decision in a different case with the same auto insurer, holding the policy language was clear and unambiguous.

Two months after the Third District issued their opinion, but before the Florida Supreme Court issued theirs, the insurer’s appeal in the present case was dismissed for lack of jurisdiction. The appellate court followed the Supreme Court’s limitations outlined in Custer Medical Center v. United Automobile Ins. Co., which constrains second-tier certiorari decisions to the question of whether there was a violation of a clearly established principle of law resulting in a miscarriage of justice.

The insurer moved for a rehearing after the appellate opinion in their favor, and the Third District initially found in their favor. The medical provider appealed, arguing the matter had been settled. Upon rehearing, the appellate court dismissed the insurer’s petition for certiorari but certified the question to the state’s Supreme Court as a question of great public importance.

The Florida personal injury attorneys at Donaldson & Weston can aggressively litigate your car accident case. If you’ve been injured and want to explore which damages are available to you, contact us at 772-266-5555 or 561-299-3999.

More Blog Posts:

Florida District Appellate Court Reviews Future Medical Expenses in Multi-Car Accident Case, Florida Injury Lawyer Blog, November 28, 2016

Federal Circuit Court of Appeal Declines to Find Equitable Tolling in Slip and Fall Case, Florida Injury Lawyer Blog, October 21, 2016

Florida Court of Appeal Allows Injured Motorist to Pursue Additional PIP Payments to Medical Providers, Florida Injury Lawyer Blog, May 18, 2017