Progressive Select Insurance Co. v. Florida Hospital Medical Center
The Florida Supreme Court resolved a certified conflict over the order of operations for applying a PIP deductible to hospital emergency-services bills. Holding that section 627.739(2)'s command that the deductible 'be applied to 100 percent of the expenses and losses described in s. 627.736' means the deductible comes off the provider's total charges first, the Court approved the Fifth District's Progressive decision and disapproved the Fourth District's Care Wellness.
Key facts
- Progressive Select Insurance Co. sought clarification on the order of applying PIP deductibles to hospital emergency-services bills under Florida's No-Fault insurance statute.
- A certified conflict existed between the Fifth District Court of Appeal (Progressive decision) and Fourth District Court of Appeal (Care Wellness decision) regarding whether the PIP deductible applies to the provider's total charges before or after the 75% usual-and-customary hospital fee limitation.
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Why it matters
This decision resolves an express district conflict on a recurring, high-volume PIP calculation issue, and the answer favors insureds and medical providers by increasing the benefits payable in every deductible case… — full analysis with a trial
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