5th Circuit Reaffirms Holding That Payment to Emergency Medical Providers Still Subject to Deductible
Feb 23, 2016 in Case Law Updates by bronsteincarmona
In Progressive v. Florida Emergency Physicians, the 5th DCA reaffirmed its October 16, 2015 holding in Mercury Insurance Company v. Emergency Physicians of Central Florida. In Mercury, the issue was whether a PIP insurer could apply the deductible to all bills received, including a bill submitted by an emergency service provider within the 30 day reserve period required by § 627.735(4)(c).
Section 627.735(4)(c) requires an insurer, upon being notified of an accident, to reserve $5,000.00 of PIP benefits for thirty days, for payment to certain emergency service providers. The Court found that while § 627.735(4)(c) requires claims by emergency service providers submitted within the 30 day reserve period be prioritized for payment, any such payment will be subject to any deductibles in the insurance contract. The court describes the deductible as an agreement by the insured to be subject to the deductible amount in exchange for a reduced monthly premium. Effectively, the insured agrees to self-insure for the deductible amount.