Allstate Ins. Co. v. Holy Cross Hosp., Inc.

961 So. 2d 328, 32 Fla. L. Weekly Supp. 453, 2007 Fla. LEXIS 1228, 2007 WL 2002542
CourtSupreme Court of Florida
DecidedJuly 12, 2007
DocketSC05-435, SC05-545
StatusPublished
Cited by21 cases

This text of 961 So. 2d 328 (Allstate Ins. Co. v. Holy Cross Hosp., Inc.) is published on Counsel Stack Legal Research, covering Supreme Court of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allstate Ins. Co. v. Holy Cross Hosp., Inc., 961 So. 2d 328, 32 Fla. L. Weekly Supp. 453, 2007 Fla. LEXIS 1228, 2007 WL 2002542 (Fla. 2007).

Opinion

961 So.2d 328 (2007)

ALLSTATE INSURANCE COMPANY, Petitioner,
v.
HOLY CROSS HOSPITAL, INC., etc., Respondent.
Holy Cross Hospital, Inc., et al., Petitioners,
v.
Allstate Insurance Company, Respondent.

Nos. SC05-435, SC05-545.

Supreme Court of Florida.

July 12, 2007.

*330 Richard C. Godfrey, Andrew A. Kassof, and R. Christopher Heck of Kirkland and Ellis, LLP, Chicago, IL, and Jack R. Reiter of Adorno and Yoss, LLP, Miami, FL, for Petitioner/Cross-Respondent.

George A. Vaka of Vaka, Larson, and Johnson, PL, Tampa, FL, and Laura M. Watson of Watson and Lentner, Fort Lauderdale, FL, for Respondent/Cross-Petitioner.

Peter J. Valeta of Meckler, Bulger and Tilson, LLP, Chicago, IL, on behalf of the Florida Insurance Council, Inc.; Eric Lee of Lee and Amtzis, PL, Boca Raton, FL, and Lawrence M. Kopelman of Kopelman and Blankman, Fort Lauderdale, FL, on behalf of Florida Consumer Action Network; and Laura M. Watson, Fort Lauderdale, FL, on behalf of Florida Hospital Association and Florida Orthopaedic Society, as Amicus Curiae.

PARIENTE, J.

This case arises from a dispute concerning the amount an automobile insurance company was required to pay a hospital at which its insureds received medical treatment. In Allstate Insurance Co. v. Holy Cross Hospital, Inc., 895 So.2d 1241 (Fla. 4th DCA 2005), the Fourth District Court of Appeal certified conflict with the Fifth District Court of Appeal's decision in Nationwide Mutual Fire Insurance Co. v. Central Florida Physiatrists, P.A., 851 So.2d 762 (Fla. 5th DCA 2003) (CFP).[1] The conflict issue is whether a personal injury protection (PIP) insurer must comply with the requirements of section 627.736(10), Florida Statutes (2006), in order to pay PIP benefits based on a reduced rate that a medical provider contractually agreed to accept. The Fourth District aligned itself with the Second District Court of Appeal's decision in Nationwide Mutual Insurance Co. v. Jewell, 862 So.2d 79 (Fla. 2d DCA 2003), which concluded that compliance with section 627.736(10) is not a prerequisite to the payment of PIP benefits at reduced rates that the medical provider contractually agreed to accept. Because we agree with both the Second District and the Fourth District on this issue, we approve the Fourth District's decision in Holy Cross and the Second District's decision in Jewell and disapprove of the Fifth District's decision in CFP.

FACTS AND PROCEDURAL HISTORY

Lawrence Weisner and Matthew Winik were injured in separate automobile accidents on April 12, 2001, and May 10, 2001, respectively. Weisner and Winik each had automobile insurance policies through Allstate that contained PIP benefits. Both received medical treatment on the day of their accidents at Holy Cross Hospital, Inc. (Holy Cross), which submitted the medical bills to Allstate. Although the record is silent as to how Weisner and Winik chose to receive treatment at Holy Cross, there is no evidence to suggest that they were directed to this hospital by Allstate.

Rather than remitting eighty percent of the entire bill as charged, Allstate paid eighty percent of a reduced rate. Allstate's payment at this reduced rate was predicated on separate contracts that Holy Cross and Allstate each allegedly entered into with a provider network known as Beech Street Corporation (Beech Street). *331 Allstate asserted that, based on Holy Cross's contract with Beech Street and Beech Street's contract with Allstate, the hospital agreed to provide medical services to covered insureds at reduced rates. Holy Cross insisted that because neither Weisner nor Winik had preferred provider (PPO) policies with Allstate and because Allstate had not contracted directly with any health care provider, Allstate could not take advantage of any reduced rates and was required to pay eighty percent of all reasonable medical expenses, i.e., eighty percent of the full bill as charged, as set forth in section 627.736(1)(a), Florida Statutes (2006).[2] Based on assignments from Weisner and Winik of their benefits under Allstate's policies, Holy Cross filed suit seeking declaratory judgment and damages.

The county court granted Holy Cross's motion for partial summary judgment based on the Fifth District's decision in CFP, which at that time was the only appellate court to have addressed the issue.[3] The county court also certified the following question as one of great public importance to the Fourth District: "Is an insurer required to comply with the provisions of section 627.736(10), Fla. Stat. in order to take preferred provider reductions in the payment of PIP benefits for medical services rendered to its insureds?" Holy Cross, 895 So.2d at 1242.

On appeal, the Fourth District answered the certified question in the negative, adopting the view of the Second District in Jewell. Accordingly, the Fourth District reversed the trial court's grant of summary judgment in favor of Holy Cross, remanded to the trial court for a determination of any outstanding issues concerning the contracts between Beech Street and both Holy Cross and Allstate, and certified conflict with CFP. See Holy Cross, 895 So.2d at 1244-45. We accepted jurisdiction to resolve the conflict.

ANALYSIS

The issue we decide is whether an automobile PIP insurer must comply with the requirements of section 627.736(10) in order to pay PIP benefits based on a reduced rate that a medical provider contractually agreed to accept. Because the conflict issue requires this Court to interpret provisions of the Florida Motor Vehicle No-Fault Law (No-Fault Law),[4] the standard of review is de novo. See Foundation Health v. Westside EKG Assocs., 944 So.2d 188, 193-94 (Fla.2006) (applying the de novo standard of review to questions of statutory interpretation); Aramark Unif. & Career Apparel, Inc. v. Easton, 894 So.2d 20, 23 (Fla.2004) (same).

In 1971, the Florida Legislature enacted the No-Fault Law. See ch. 71-252, § 1, Laws of Fla. The No-Fault Law is a comprehensive *332 statutory scheme, the purpose of which is to "provide for medical, surgical, funeral, and disability insurance benefits without regard to fault, and to require motor vehicle insurance securing such benefits." § 627.731, Fla. Stat. (2006); accord United Auto. Ins. Co. v. Rodriguez, 808 So.2d 82, 85 (Fla.2001) (stating that the intent of the No-Fault Law is "to provide a minimum level of insurance benefits without regard to fault"). The No-Fault Law mandates security that can be established by alternative means, one of which is PIP insurance. See § 627.733, Fla. Stat. (2006).

The "Required Personal Injury Protection" provision, or the PIP statute, is codified at section 627.736 and is "an integral part of the no-fault statutory scheme." Flores v. Allstate Ins. Co., 819 So.2d 740, 744 (Fla.2002). The statute requires motor vehicle insurance policies issued in Florida to provide PIP benefits for bodily injury "arising out of the ownership, maintenance, or use of a motor vehicle." § 627.736(1), Fla. Stat. (2006); accord Blish v. Atlanta Cas. Co., 736 So.2d 1151, 1153 (Fla.1999). The PIP statute is unique, in that it abolished "a traditional common-law right by limiting the recovery available to car accident victims" and in exchange, required PIP insurance that was recoverable without regard to fault. State Farm Mut. Auto. Ins. Co. v. Nichols, 932 So.2d 1067, 1077 (Fla.2006).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Allstate Indemnity Company v. Gady Abramson, D.C., P.A., Etc.
District Court of Appeal of Florida, 2024
Lenworth Bailey v. Rocky Mountain Holdings, LLC
889 F.3d 1259 (Eleventh Circuit, 2018)
Merly Nunez v. Geico General Insurance Company
726 F.3d 1231 (Eleventh Circuit, 2013)
Geico General Insurance Co. v. Virtual Imaging Services, Inc.
141 So. 3d 147 (Supreme Court of Florida, 2013)
Nunez v. Geico General Insurance
117 So. 3d 388 (Supreme Court of Florida, 2013)
Allstate Fire & Casualty Insurance Co. v. Perez
111 So. 3d 960 (District Court of Appeal of Florida, 2013)
SOCC, P.L. v. State Farm Mutual Automobile Insurance Co.
95 So. 3d 903 (District Court of Appeal of Florida, 2012)
Hampton v. State
103 So. 3d 98 (Supreme Court of Florida, 2012)
Geico Indemnity Co. v. Virtual Imaging Services, Inc.
79 So. 3d 55 (District Court of Appeal of Florida, 2011)
Menendez v. Progressive Express Insurance Co.
35 So. 3d 873 (Supreme Court of Florida, 2010)
Progressive American Ins. Co. v. Stand-Up MRI of Orlando
990 So. 2d 3 (District Court of Appeal of Florida, 2008)

Cite This Page — Counsel Stack

Bluebook (online)
961 So. 2d 328, 32 Fla. L. Weekly Supp. 453, 2007 Fla. LEXIS 1228, 2007 WL 2002542, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allstate-ins-co-v-holy-cross-hosp-inc-fla-2007.