Allstate Fire and Casualty Ins. Co. v. Hallandale Open Mri, LLC

253 So. 3d 36
District Court of Appeal of Florida·Decided November 29, 2017·No. 16-0038·Published

Opinion

Third District Court of Appeal State of Florida

Opinion filed November 29, 2017. This Opinion is not final until disposition of any further motion for rehearing and/or motion for rehearing en banc. Any previously-filed motion for rehearing en banc is deemed moot. ________________

No. 3D16-38 Lower Tribunal No. 13-461 ________________

Allstate Fire and Casualty Insurance Company, Petitioner,

vs.

Hallandale Open MRI, LLC, a/a/o Alexia Blake, Respondent.

On Petition for Writ of Certiorari from the Circuit Court for Miami-Dade County, Appellate Division, Jacqueline Hogan Scola, Jorge Cueto, and Ariana Fajardo Orshan, Judges.

Shutts & Bowen, and Suzanne Youmans Labrit and Douglas G. Brehm (Tampa); Cozen O’Connor, and Peter J. Valeta (Chicago, IL), for petitioner.

Marlene S. Reiss, for respondent.

Before SALTER, LOGUE and SCALES, JJ. SALTER, J.

On Motions for Rehearing and for Certification

On consideration of the respondent’s motion for rehearing and motion to

certify questions of great public importance, and the response, we withdraw our

opinion in this case issued April 19, 2017, 1 and replace it with the opinion which

follows.

I. The Underlying Legal Issue and Final County Court Judgment

This case involves a dispute between Allstate Fire and Casualty Insurance

Company (“Allstate”) and a medical provider (Hallandale Open MRI, or

“Hallandale”) regarding a single legal issue: whether a personal injury protection

(“PIP”) automobile insurance policy issued by Allstate contains language

sufficiently specific to limit provider reimbursements to 80% of the maximum

charges described in section 627.736(5)(a)2.f., Florida Statutes (2013). The issue

arose in the Miami-Dade County Court, based on stipulated facts pertaining to the

policy and the medical services provided by Hallandale. In October 2013—a time

when this Court had not ruled on the specific legal issue presented to the County

Court—the County Court issued a directed verdict for Hallandale (determining that

1 Allstate Fire & Cas. Ins. Co. v. Hallandale Open MRI, LLC, 42 Fla. L. Weekly D893 (Fla. 3d DCA Apr. 19, 2017).

2 the Allstate policy language was insufficiently specific to invoke the statutory

limitations on payment) and entered final judgment for Hallandale in the amount of

$407.26, plus prejudgment interest.

II. Allstate’s Appeal to the Circuit Court Appellate Division

Allstate appealed to the appellate division of the Miami-Dade Circuit Court.

Allstate did not seek a stay pending review, and Hallandale did not seek execution

or other enforcement of the County Court judgment. In December 2015, the three-

judge Circuit Court appellate division panel affirmed the final judgment against

Allstate. The five-page opinion affirming the County Court judgment surveyed

pertinent case law from the Florida Supreme Court and several of Florida’s District

Courts of Appeal.

In Geico General Insurance Co. v. Virtual Imaging Services, Inc., 141 So. 3d

147, 159 (Fla. 2013), the Florida Supreme Court held that PIP insurers were required

to notify insureds by specifically electing the limitations in the Medicare fee

schedules in order to apply them to medical reimbursement claims. The appellate

division then observed that the First and Fourth District Courts of Appeal had issued

conflicting decisions regarding the sufficiency of such notice, in Allstate Fire &

Casualty Insurance v. Stand-Up MRI of Tallahassee, P.A., 188 So. 3d 1 (Fla. 1st

DCA 2015) (policy provided legally sufficient notice), and Orthopedic Specialists

3 v. Allstate Insurance Co., 177 So. 3d 19 (Fla. 4th DCA 2015) (identical policy

language not legally sufficient). The appellate division also noted that this Court

had not issued a controlling decision on the issue.

After surveying the reported decisions, the Circuit Court appellate division

found the policy language insufficient to support the statutory limitation computed

using the Medicare fee schedules and, as already noted, affirmed the County Court

final judgment in favor of Hallandale. In early 2016, Allstate filed a petition seeking

second-tier certiorari from the appellate division decision. Allstate’s petition cited

four Miami-Dade Circuit Court appellate division opinions that directly conflicted

with the appellate division decision (and on the specific, controlling legal issue

within the decision) involved in the present case. 2

Hallandale opposed the second-tier petition on jurisdictional and substantive

grounds. Allstate did not seek a stay of enforcement of the County Court’s

2 Allstate Prop. & Cas. Ins. Co. v. Royal Diagnostic Ctr., Inc. a/a/o Mondy, 21 Fla. L. Weekly Supp. 627a (Fla. 11th Cir. Ct. April 3, 2014); Allstate Fire & Cas. Ins. Co. v. Hallandale Open MRI LLC a/a/o Politesse, 21 Fla. L. Weekly Supp. 989a (Fla. 11th Cir. Ct. June 23, 2014); Allstate Prop. & Cas. Co. v. Royal Diagnostic Ctr., Inc. a/a/o Leon, 22 Fla. L. Weekly Supp. 787a (Fla. 11th Cir. Ct. January 29, 2015); and Allstate Indem. Co. v. Gables Ins. Recov., Inc. a/a/o Jimenez, 22 Fla. L. Weekly Supp. 1146a (Fla. 11th Cir. Ct. June 8, 2015).

4 judgment, nor did Hallandale seek to enforce the judgment, while the petition was

pending.

III. Florida Supreme Court Accepts Review of the Conflict Cases from the

First and Fourth Districts

On January 20, 2016, the Florida Supreme Court accepted jurisdiction to

review the two 2015 District Court of Appeal conflict cases from the First and Fourth

Districts, Stand-Up MRI and Orthopedic Specialists, cited above. Allstate Ins. Co.

v. Orthopedic Specialists, No. SC15-2298 (Fla. Jan. 20, 2016) (accepting

jurisdiction). A decision resolving the conflict issue was issued in January 2017

(discussed further below). Allstate Ins. Co. v. Orthopedic Specialists, 212 So. 3d

973 (Fla. 2017).

IV. An Intervening Decision by This Court on the Conflict Issue

While the petition for second-tier certiorari was pending in this Court and the

conflict case was pending in the Florida Supreme Court, a panel of this Court issued

a decision on the same issue, as certified by the Miami-Dade County Court for direct

review under Florida Rule of Appellate Procedure 9.030(b)(4)(A) (discretionary

review of an order certified by the county court to be of great public importance).

Fla. Wellness & Rehab. v. Allstate Fire & Cas. Ins. Co., 201 So. 3d 169 (Fla. 3d

DCA 2016) (holding that the Allstate policy language was clear and unambiguous,

5 as determined by the First District in Stand-Up MRI). That decision, issued in July

2016, also certified conflict with the Fourth District opinion in Orthopedic

Specialists.

IV. This Court’s Dismissal of Allstate’s Petition

Two months after this Court’s opinion deciding the conflict issue, but while

the conflict was still pending before the Florida Supreme Court, we dismissed

Allstate’s petition for lack of jurisdiction. Judge Logue dissented in an opinion

which stressed the importance of exercising jurisdiction when the County Court and

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