A divided state appellate court refused to accept jurisdiction on an insurance question, after siding with the insurer in a similar case in July.
The Florida Third District Court of Appeal Wednesday rejected an interpretive question on insurance policy language outlining payments for medical companies that treat injured accident victims. It refused a request for a writ of certiorari from Allstate Fire and Casualty Insurance Co. to quash lower tribunal rulings in favor of medical providers seeking higher payments under personal injury protection, or PIP, policies.
|Allegations of vague policy language
Providers in cases across the state allege Allstate and other insurers use vague language that falls short of specifying fees paid for services to insured patients after car accidents. Their litigation raised a similar question before the courts: Does the language of PIP policies provide adequate notice of limited reimbursement under Medicare Part B fee schedules?
At trial and on appeal before Miami-Dade Circuit Court's appellate division, Allstate lost to medical provider Hallandale Open MRI LLC. But it raised a challenge amid widespread splits within state and local courts. Its 2-1 rejection by the Third DCA this week followed a favorable ruling in that court in a similar case in July.
In the earlier case, the Third DCA found the policy language sufficient, but that decision conflicted with a finding from its sister appellate court in the Fourth District.
Those conflicting findings led the Florida Supreme Court to accept review of decisions from the Third, Second and First DCAs, which found the PIP policies clearly articulated limited reimbursement based on Medicare Part B fee schedules, and an opposing ruling from the Fourth DCA.
|Defer to Florida Supreme Court
This week, the Third DCA deferred to the high court. It ruled it lacked jurisdiction under the standard for second-tier certiorari review, which requires a violation of a "clearly established principle of law resulting in a miscarriage of justice" in prior proceedings.
"Granting the petition in this case would be tantamount to faulting the circuit court appellate division for lacking a crystal ball or Ouija board that would have revealed this court's decision issued seven months later," Third DCA Judge Vance Salter wrote in the majority decision with Judge Edwin Scales III.
But District Judge Thomas Logue issued a seven-page dissent, noting the "welter of conflicting decisions" by judges and judicial panels.
"It is clearly a miscarriage of justice to prevent further review in a manner that causes the identical cases of similarly situated persons in the same court to be decided differently based on conflicting legal interpretations," Logue wrote. "And this clear miscarriage of justice resulting from the failure to allow review reflects a departure from the most essential legal requirement—equality before the law. No other legal remedy exists to stop this miscarriage of justice here except a writ of certiorari."
|Multitude of courts unable to agree
Miami attorney Douglas Brehm and Suzanne Youmans Labrit of Shutts & Bowen in Tampa teamed with Peter J. Valeta of Cozen O'Connor in Chicago to represent Allstate. Miami lawyer Marlene S. Reiss represented Hallandale.
"We are happy to see the majority's thoughtful opinion regarding its limited second-tier jurisdiction," Reiss said. "As for the issue implicated in this case, which is currently in the Florida Supreme Court, we are anxious to see the Supreme Court's final word interpreting an ambiguous insurance policy provision on which a multitude of county, circuit and district courts could not agree for the past nine years."
Samantha Joseph is a writer for the Daily Business Review. She can be reached at [email protected].
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Samantha Joseph
Samantha Joseph is co-head of the Litigation Desk in ALM's global newsroom. Grad school: Newhouse Syracuse. Contact: [email protected]. On Twitter: @SjosephWriter
