Florida DCAs Weigh in on Allstate Case; PIP Litigation Now Headed to Supreme Court

The Florida Supreme Court soon will hear arguments in the case of Florida Wellness & Rehabilitation vs. Allstate Fire & Casualty Insurance Co., which pits medical providers against the automobile insurer on the issue of fees paid to injured accident victims.

The high court will take up the matter Sept. 1, 2016, less than two months after the 3rd District Court of Appeal in Miami sided with the insurer, which is facing claims that its policy language does not clearly indicate fees are to be paid out through Medicare. That decision clashed with one last year by the 4th District Court of Appeal in West Palm Beach, where judges ruled in favor of the providers.

It appears Allstate has an advantage, according to our Florida personal injury attorney, as three of Florida’s four appellate courts have sided with the company. Both the 1st DCA in Tallahassee and 2nd DCA in Lakeland backed the insurer in earlier rulings. The dispute involves five consolidated cases.

All About Profits

According to Car Insurance News, the language in question dates back to 2008, when the state Legislature voted to give the personal-injury protection, or PIP, system two options to pay claims.

“The language in Allstate’s policies said the insurer would pay 80 percent of reasonable expenses, but also said any amounts payable under the coverage would be subject to a Medicare fee schedule limitation…,” states an article titled “Allstate Wins Policy Language Row In Fla. Appeals Court.”

The statutory change spawned thousands of lawsuits about ambiguous and vague wording in policies. In response, lawmakers made another statutory change in 2013, mandating all insurers pay accident expenses based on the Medicare schedule.

Marlene Reiss, counsel for the providers, said it appears the plaintiffs have the advantage.

“If the courts can’t agree on the meaning of the policy language, how can the average consumer know the meaning?” Reiss said in the Car Insurance News article. “Any document, whether it’s an insurance policy or any other kind of contract, that contains the words ‘including, but not limited to’ is intentionally and inherently vague.”

Allstate’s policy reads thusly: “…any amounts payable under this coverage shall be subject to any and all limitations [authorized by law]…including, but not limited to, all fee schedules,” Daily Business Review reports in an article titled “Insurance Question Heads to Supreme Court After Appellate Courts Differ.”