Opinion
Case No. 5D21-184
03-25-2022
GEICO INDEMNITY COMPANY, Appellant, v. AFFINITY HEALTHCARE CENTER AT WATERFORD LAKES, PL a/a/o Ernst Pereira, Appellee.
Rebecca Delaney and Scott W. Dutton, of Dutton Law Group, PA, Tampa, for Appellant. Chad A. Barr, of Chad Barr Law, Altamonte Springs, for Appellee.
Rebecca Delaney and Scott W. Dutton, of Dutton Law Group, PA, Tampa, for Appellant.
Chad A. Barr, of Chad Barr Law, Altamonte Springs, for Appellee.
PER CURIAM.
Appellee, Affinity Healthcare Center at Waterford Lakes, PL, a/a/o Ernst Pereira, ("Affinity"), filed suit against Appellant, Geico Indemnity Company, ("Geico"), seeking reimbursement of additional personal injury protection (PIP) benefits pursuant to Geico's contract with its insured, Ernst Pereira. The county court entered summary final judgment in favor of Affinity in March 2018. Upon motion, the circuit court stayed the appeal of the county court's order pending resolution of other appeals in cases dealing with similar issues. This court lifted that stay on February 9, 2022. The resolution of other appeals during the pendency of the stay has largely resolved the issues before us.
This appeal was transferred from the circuit court to this court due to a jurisdictional change which took effect January 1, 2021. See Ch. 20-61, § 3, Laws of Fla. (amending § 26.012(1), Florida Statutes ).
First, we conclude that the trial court properly determined that Geico was required to subtract the deductible from Affinity's total medical charges before applying reimbursement limitations. See Progressive Select Ins. Co. v. Fla. Hosp. Med. Ctr. , 260 So. 3d 219, 223 (Fla. 2018) ("A plain reading of the statutory provisions makes clear that the deductible must be subtracted from the provider's charges before the reimbursement limitation is applied."). Second, we conclude that the trial court erred in requiring Geico to pay 100% of Affinity's billed amount where the billed amount was more than 80% of 200% of the applicable fee schedule. Although the trial court properly rejected Geico's argument that it was only required to pay 80% of the billed amount, it should have ordered Geico to pay 80% of 200% of the applicable fee schedule. See Hands On Chiropractic PL v. GEICO Gen. lns. Co. , 327 So. 3d 439, 443 (Fla. 5th DCA 2021) ("There is nothing in the applicable statute or Geico's policy that allows it to pay 80 percent of the billed amount. It must either pay the amount allowed based on the applicable fee schedule (80 percent of 200 percent) or, if the billed amount is less than the amount allowed, it is to be paid in full."). Finally, we conclude that Geico's argument that Affinity failed to comply with conditions precedent to filing suit was not preserved below. See Saavedra v. Universal Prop. & Cas. Ins. Co. , 314 So. 3d 729, 730 (Fla. 5th DCA 2021) ("Pursuant to rule 1.120(c), in denying that conditions precedent were met, a defendant is required to ‘identify both the nature of the conditions precedent and the nature of the alleged noncompliance or nonoccurrence.’ ").
AFFIRMED, in part; REVERSED in part; REMANDED for further proceedings consistent with this opinion.
LAMBERT, C.J., EVANDER and COHEN, JJ., concur.